Angela Success
Typhoid fever, which has been linked to 222,000 deaths in the world annually, is actually preventable. Identifying chronic carriers and treating them are part of the strategy that can eliminate the spread of this illness in our communities. So far up to 21 million cases of this disease have been recorded in the world, according to a report published in 2014.
Paratyphoid organisms, like the salmonella and bacillus, can be transmitted to humans through consumption of contaminated water, food, and shellfish taken from sewage polluted water or directly through faecal-oral transmission. Another mode of transmission of typhoid is through eating of raw fruits and vegetables cultivated with contaminated excreta. Flies also carry some of these organisms from infected items to exposed food.
This fever in acute cases presents with headache, prolonged fever, nausea, diarrhea or are times constipation and joint pains. The symptoms of this illness appear like that of malaria or other febrile fevers. Severe cases of this illness, if untreated, can lead to serious complications or death, but World Health Organisation (WHO) has recommended a programme, which, if implemented in the context of other efforts, will eliminate or prevent the spread of this disease. This includes typhoid vaccination programme for children, health education, water quality and sanitation improvements, as well as training of health professionals in diagnosis and treatment of typhoid.
Health education
To prevent typhoid fever infection, it is recommended that one washes the hands before preparing and eating food as well as after using the toilet. Everyone, including children, should be encouraged to wash their hands frequently with soap. The use of alcohol-based sanitisers is also advised when clean water is not available. People should also avoid drinking untreated water or any water that they are not sure of the source. Raw fruits and vegetables should be washed thoroughly with vegetable washes like vinegar and salt water solutions before consumption.
Typhoid immunization and vaccination
Prevention is said to be the best way to protect children from being infected by this dangerous disease. It has been reported that WHO, in December 2017, prequalified the first conjugate vaccine for typhoid. This new vaccine has longer-lasting immunity than older vaccines and requires fewer doses. It can be administered to children from the age of six months.
According to the report, the vaccine will be prioritised for countries with the highest burden of typhoid disease, so as to help reduce the frequent use of antibiotics for typhoid treatment and its resistance in the treatment of Salmonella Typhoid. Some of the older vaccines can be given to children from the age of two and some can immunise adults for a while in typhoid endemic areas, but they are not readily available in our environment.
Dr. Mrs. Olubunmi Onyagbodor of the Health Services Department, the University of Port Harcourt, said typhoid fever was an illness caused by a group of organisms, Salmonella typhoid and paratyphoid organisms.
According to her, Paratyphoid has different types and people get this organism by what they eat or drink, adding that transmission was faecal-oral, meaning that someone passes it out and what is passed out by the person that defecated now contaminates the food or drink. It commonly happens in places with poor water supply. When the supply is not good it can be easily contaminated.
This, she said, can also happen when foods are eaten fresh from the farms. For example the fruits and vegetables that we buy, when washed with contaminated water can get the organisms into our system. Fruits and vegetables get contaminated also during farming if contaminated fertilizers are used to grow them. Usually when the person takes it in through the mouth, the
first place that the organism gets into and starts producing symptoms is the small intestine. From there, it could spread and now cause generalised illness and can cause abdominal pain, fever, constipation, sometimes there could be vomiting. The fever, she said, is the type that persists. It keeps getting higher and higher unlike malaria fever that comes and goes.
The fever from typhoid starts low, but keeps on getting higher. That is how it presents.
Speaking on its diagnosis, Doctor Onyagbodor said that Typhoid is usually diagnosed in the hospital by both the symptoms and laboratory tests. When the two are in agreement the diagnosis will be made and the person will be treated. The person can be treated with antibiotics when it is uncomplicated but in complicated cases in which the organism has caused some damages in the small intestine, the person will eventually require surgery for it to be cured.
She however believes that one can live typhoid free by preventing the transmission of the organisms into the body. She reiterated the importance of such personal hygiene practices like washing of hands after using the toilet, washing fruits and vegetables that will be taken raw properly using vinegar if available. Good personal hygiene she said is very important. People should ensure that the water they drink is pure. You can do that by getting your own water and boiling it or getting water from a trusted source that has been properly treated to make sure that there is no contamination.
According to her, treating anyone that comes down with this illness is another way of preventing the spread of this disease and living a typhoid fever-free life. The infected person should be taken to the hospital and treated properly as some people not so treated could become chronic carriers without manifesting any symptoms. This group of people tends to perpetrate or spread the organisms any where they are found. They have the organism harboured in their gall bladder and regularly excrete them.
The carrier might not be obviously sick and this makes it difficult for the source of the transmission to be identified easily in some cases.
She pointed out that carriers who are particularly dangerous are food vendors and those who work in restaurants. As they handle food they contaminate it, she said.
The medical doctor advised that if typhoid fever becomes a common illness around a particular community or environment, its source can be traced and monitored. It may be transmitted through the water supply or through the food vendors.
She said organizations should screen the staff of their restaurant and food handlers regularly for typhoid, while noting that this disease can be commonly over-diagnosed because the old standard for diagnoses is doing a culture but the nature of the organism makes it difficult to culture. This, she said, is why the Widal test is used. She advised that to make a diagnosis with Widal test, it should be done repeatedly in a good laboratory by a qualified medical laboratory scientist.