Typhoid Fever

Typhoid fever is a bacterial infection caused by a bacterium called Salmonella enterica Typhi. Typhoid is mostly passed on through contaminated drinking water and food. It is prevalent in areas where people hardly practice handwashing. The disease is transmitted from one person to another through fecal-oral means where an asymptomatic or infected person (with no observable symptoms) who do not practice handwashing passes the infection to another individual when handling water or food.

World Health Organization reports that typhoid affects 11 to 20 million people in the world with 128, 000 – 161, 000 losing their lives every year. The condition is prevalent in developing countries with poor water and sewage sanitation.

In Kenya, urban slums are the most affected. A Study conducted by the US CDC Kenya Office revealed that many children get sick from typhoid fever in populated urban slums such as Kibera.

The study showed that 2, 243 children per 100, 000 aged 2-4 years in Kibera were at 15 times higher risk of getting typhoid than rates reported in Lwak for the similar age group. Sanitation is very poor in Kibera where one-pit latrine serves up to 200 people which forces some residents to use plastic bags for relief and dispose of them anywhere – a practice known as ‘flying toilets.

Note that the Salmonella Typhi bacteria live in human beings only. Diagnosed persons carry it in their intestinal tract and bloodstream. Therefore, typhoid fever can only be confirmed through blood testing. A doctor orders a typhoid blood test when he/she learns about the following symptoms. 

Symptoms

  • Prolonged high fever
  • Fatigue or weakness
  • Headache
  • Abdominal pain
  • Nausea
  • Constipation/diarrhea
  • Few patients develop a rash on their trunk
  • Lack of appetite
  • Constipation
  • Malaise

If typhoid remains untreated even after the above symptoms, the patient’s bowel can become perforated and lead to peritonitis. At this point, typhoid fever is likely to be lethal and lead to death.

Treatment

Typhoid treatment is only done using antibiotics. In Kenya, the most common antibiotics used are ceftriaxone and Ciprofloxacin (for non-pregnant adults). As of May 2019, a full dose of Arixon (Ceftriaxone) retails for KSH. 1,440 while Axone (Ceftriaxone) retails for KSH. 262.50.

Typhoid Resistance Concern

Typhoid fever is mostly treated using antibiotics. However, there is current concern about the increasing resistance of antibiotics to S. Typhi.

For example, the study conducted by CDC Kenya Office found that 75% of Serovar Typhi strains from surveyed children with typhoid fever were resistant to common antibiotics used to treat the condition. More research is on course to resolve this problem.

Prevention

Preventive measures include:

  • Access to and use of safe water
  • Adequate sanitation
  • Hygiene among food handlers
  • Use of typhoid vaccination

Two common vaccines are;

  • Oral Medication: a live, attenuated vaccine (Comprises of 4 tables taken in 2-days intervals)
  • One-off injection: It is an inactivated vaccine administered 2 weeks a person travels to high-risk areas.

Note that vaccines are not 100% effective which means that you should take caution when eating and drinking. Live oral dose is not recommended for any person with HIV.

Avoiding Infection

To be on the safe side, adhere to the following general rules:

  • Drink carbonated, bottled water
  • If bottled water is not available, use boiled water
  • Avoid eating at street food vendors and consume food that is still hot
  • Avoid uncooked or undercooked food
  • Avoid raw vegetables and fruits, peel fruits before eating them and do not eat the peel
  • Do not use ice in drinks

Sources

https://www.who.int/news-room/fact-sheets/detail/typhoid

https://www.cdc.gov/globalhealth/countries/kenya/blog/typhoid.htm

https://www.medicalnewstoday.com/articles/156859.php

https://www.kibs.co.ke/dawa/branddetails.php?brnd=Ceftriaxone