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INTRODUCTION

INTRODUCTION
TYPHOID FEVER (TF) is an intestinal
disease which is still widely in developing
countries, include in Indonesia.
High incidence depends on many factors,
(In Indonesia 350-810 cases/100.000/years).
Many types of potential sources of
transmission infection.
Mortality is still high, may be caused by
complication.

INTRODUCTION
INTRODUCTION
Hygiene sanitation, personal hygiene
and ignorancy are important role on
transmission.
Any problems on Era PostChloramphenicol treatment :
(1) Relaps
(2) Drug resistency
(3) Clinical picture insidious
(4) Complications >>
In Indonesia : endemic, young adult, sex
ratio no difference.

DEFINITION
DEFINITION OF
OF TF.
TF.

Systemic infectious disease in


human, characteristic clinical
signed by continual fever,
roseole, toxemia, enlargment of
spleen, intestinal lymfadenopathy
and intestinal complication
and/or non-intestinal.

TF. CAUSATIVE AGENT


EBERT (1880) discovered of TF causes
- Erbethella typhosa --> Salmonella
typhi. (WILLIAM BUDD, identified
1886), ACARD dan BESANDI (1896)
--> discovered of paratyphoid bacteria.
S.typhi and S.paratyphi --> Salmonella
group --> Enteric Fever.
Paratyphoid fever is the same symptom
and sign with TF, mild sign and duration
of fever is short time, diarrhae is
dominant symptom.

SHEATH (Vi antigen)


FLAGELLUM
(H antigen)
SEXUAL PILUS
NUCLEUS

PLAMID (DNA)

CELL WALL
(O ANTIGEN)
CYTOPLASM

MORPHOLOGY OF AGENT
Gram negative bacteriae
Aerobic, Nonsporing, motile coliform
Active motility by spiral
Easily destroyed by sunlight and
desinfectan
Thermal death point in water is 60 o C in
boiling water in 15 minutes
In faecal masses are protected
In septic tank can survived for 14 days.
Bacteria could be identified by antigenetic

EPIDEMIOLOGY OF TF
Word-wide distribution,
Frequency of Paratyphoid fever
A, B and C is 10-30% of TF.
Climate & season are important
role.
No ethnic immune for TF/PTF.
Young Adult is frequent (< 30

EPIDEMIOLOGY OF TF
Global Annual Inc. 33 million
cases; case fatality is 500.000.
In developing countries 4-5
times greater than in developed
countries
Potential sources of infections :
active patients and carriers.
Chronic carriers are dangerous

EPIDEMIOLOGY OF TF
Transmission to a new host
occurs directly or indirectly
Contamination may occurred by
(a) carriers patients,
(b) water supply, milk, ice,
(c) food, flies, fingers and
fomites.

INGESTION OF BACILLI (>105)


INTESTINAL

ABSORPTION

MULTIPLICATION IN MESENTRIC
LYMPHATIC GANGLIA
Bacterical lysis
libeation of endotoxin
into the blood

Bacterical reach the


blood by the l
ymphatic system

ENDOTOXINS
AUTONOMIC HEART
NERVOUS
SYSTEM

SEPTICEMIA
DIGESTIVE
TRACT

HEMORRHAGE
INTESTINAL PERFORATION
CARDIOVASCULAR INSUFFICIENCY
AUTONOMIC DIISTURBANCES
TYPHOID STATE

DISEMINATION
SPLENIC
BILIARY GLAND
HEPATIC
MENINGEAL
BONE
PULMONARY

CONTROL OF TYPHOID FEVER

Applying the principle of hygiene


Depend of the improvement of income
Cultural changes of personal hygiene
Many effort for control of TF, are :
(1) Treatment and control of sources
infection : Adequate antibiotic treatment for
active patients and carriers, special isolation
in the hospital ?, desinfections of the
excreta, sterilization of the patients linen
etc.

CONTROL OF TYPHOID FEVER


(2) Improved on environment health :
. To trace the source infection
. To investigate of routes transmision
. Water purification/chlorination
. Control of all exposed foods for
sale in the market and store.
. Reduction the house-flies density
. To avoid of having open garbage
pail etc.

CONTROL OF TYPHOID FEVER


(3) Supervision on food industries and restaurant
. Supervision on sanitation of places work and
food processin, equipment etc.
. Prohibition to employ people who infected
. Routine examination of stool culture
. To trace of food, if as medium suspected
. All milk and milk products should be
pasteurized or boiled.

CONTROL OF TYPHOID FEVER


(4) Control of healthy population
. Supervision on hygiene of food and
drink
. Serving the food in hot condition
. Health education for community
. Providing the places for washing hand
. Conducting vaccination of TF in endemic
area, however, improvement of
sanitation and health system is very
important role.

CONTROL OF TYPHOID FEVER


Criteria of vaccination programme :
. Having a highly efficacious vaccine
. Having practical use
. Having minimal side-effects
. Relatively inexpensive

Recommended vacccination to :
. Community of TF highly endemic
. Individual travelling to endemic area
. Persons working in laboratories

CONTROL OF TYPHOID FEVER

Many type of TF vaccine :


. TAB Vaccine (Acetone killed vaccine) :
partial protection, more side effects.
. Wholle cell killed parenteral vacccine
(Acetone and heat phenol inactivated
vacccine, protective efficacy is 51-88%,
side effects >.
. Oral live attenuated vacccine (Ty21a) :
trial has been done in Egypt, Chile,
Indonesia.
. Vi parenteral vaccine : bacterial
subcomponent

CONTROL OF TYPHOID FEVER


Result of the Ty21a Trial
. Efficacy related to the TF incidence
. Related to the number of doses ingested
. A short interval, better protection
. The liquid form is better than capsule
. Protective effects at least 3 years
. Minimal side-effects
. Possibility of developing herd community
. Able to induce cellular and humoral
immune response.

CONTROL OF TYPHOID FEVER


Vi Parenteral Vaccine
. Adverse reactions is minimal
(systemic reaction may be observed)
. Other advantages of the Vi vaccine :
- Single dose administered
- Relatively inexpensive
- Can be used to infants and children
- Could be mixed with other vaccine
- Personal compliance is good
- Booster is done after 3 years

THE WHO GOLDEN RULES FOR


SAVE FOOD PREPARATION

Choose foods processing for safety.


Cook food thoroughly.
Eat cooked food immediately.
Store cooked food thoroughly.
Reheat cooked food thoroughly.
Avoid contact between raw and cooked foods.
Wash hands repeately.
Keep all kitchen surfaces meticolously clean.
Protect foods from insects, rodents & animals.
Use pure water.

Distribusi Faktor Risiko Lingkungan dan Perilaku Terhadap


Kejadian
Demam Tifoid Pada Kelompok Kasus dan Kontrol
di Kota Semarang

Lanjutan

Lanjutan

Analisis Multivariat Faktor Risiko Lingkungan dan


Perilaku
dengan Kejadian Demam Tifoid di Kota Semarang

Hasil perhitungan persamaan regresi logistik menggambarkan bahwa jika kondisi


kebiasaan jajan diluar, tidak mencuci tangan sebelum makan, makan sayur mentah
(tidak dimasak) dan pengetahuan tentang penularan demam tifoid kurang, maka
memiliki probabilitas terjadinya demam tifoid sebesar 83,9 %.

Flora residen

Flora transien
PERDALIN/2010

31

PERDALIN 2010

32

SUMMARY OF TF CONTROL

TF most prevalent in developing countries.


In Indonesia incidence still high.
Transmission most of indirectly route.
The strategies of TF Control are :
. Detection and control of source,
. Disease survaillance,
. Health education in community,
. Improvement of sanitation,
. Promotion of food hygiene,
. Prevention contamination in food production,
. Conducting TF vaccination.