Prevention of Typhoid Fever

Recently, there has been a lot of public outcry over repeated cases of misdiagnosis of typhoid fever. Nigerians deserve to know what this disease is all about; how it can be detected, treated and prevented.

Typhoid fever is an acute illness associated with fever caused by the Salmonella typhi bacteria. It can also be caused by Salmonella paratyphi, a related bacterium that usually causes a less severe illness. The bacteria are deposited in water or food by a human carrier and are then spread to other people in the area.

Transmission

Typhoid fever is contracted by drinking or eating the bacteria in contaminated food or water. People with acute illness can contaminate the surrounding water supply through stool, which contains a high concentration of the bacteria. Contamination of the water supply can, in turn, taint the food supply. The bacteria can survive for weeks in water or dried sewage.

Diagnosis

After the ingestion of contaminated food or water, the Salmonella bacteria invade the small intestine and enter the bloodstream temporarily. The bacteria are carried by white blood cells in the liver, spleen, and bone marrow, where they multiply and re-enter the bloodstream. If a test result isn’t clear, blood samples will be taken to make a diagnosis.

The Widal test may suggest infection with Salmonella typhi. But they are not diagnostic because of the number of false-positive and false-negative. Isolation of Salmonella  bacteria that causes typhoid) from cultures of stool, blood, urine, or bone marrow are necessary to confirm the diagnosis of typhoid fever.

Symptoms

The incubation period is usually one to two weeks, and the duration of the illness is about three to four weeks. Symptoms include: Poor appetite, headaches , generalised aches and pains, fever, lethargy, diarrhea and chest congestion may develop some, and abdominal pain and discomfort are common. The fever becomes constant. Improvement occurs in the third and fourth week in those without complications. About 10 per cent of people have recurrent symptoms after feeling better for one to two weeks. Relapses are actually more common in individuals treated with inappropriate dosing of antibiotics.

Treatment

Typhoid fever is treated with antibiotics which kill the Salmonella bacteria. Prior to the use of antibiotics, the fatality rate was 20 per cent. Death occurred from overwhelming infection, pneumonia, intestinal bleeding, or intestinal perforation. With antibiotics and supportive care, mortality has been reduced. With appropriate antibiotic therapy, there is usually improvement within one to two days and recovery within seven to 10 days.

Several antibiotics are effective for the treatment of typhoid fever. Chloramphenicol was the original drug of choice for many years. Because of side effects, chloramphenicol has been replaced by other effective antibiotics. Those who become chronically ill (about three to five per cent of those infected), can be treated with prolonged antibiotics. Often, removal of the gallbladder, the site of chronic infection, will provide a cure.

Prevention

Prevention is the best way to protect the child against typhoid fever. Some simple steps to reduce chances of catching this infection are listed below:

Drink pure or bottle water

Contaminated drinking water is a common source of the infection. Boil your water and allow it to cool before drinking or stick to purified water .

Hand washing

Teach children to wash hands frequently. Wash with warm, soapy water before eating food. Also wash after using the toilet. Public education campaigns encouraging people to wash their hands after defecating and before handling food are an important component in controlling spread of the disease. Alcohol-based hand sanitiser can kill germs when water is not available.

Wash fruits and vegetables thoroughly

Raw fruit or vegetables may have been washed in contaminated water. There is the need to rewash the fruits and vegetables thoroughly.

Typhoid immunisation / vaccination

Typhoid vaccine is readily available and can be used in children from two years of age. Adults can also be given the typhoid vaccination to prevent them from typhoid fever. For those travelling to high-risk areas, vaccines are now available.