Typhoid fever:

epidemiology, prevention
and control
BM Hamooya
Background
• Typhoid fever in humans is caused by salmonella typhi

• It is an acute infectious disease

• It usually enters the body through ingestion of contaminated food or

water

• It penetrates intestinal wall, and multiplies in lymphoid tissue it then

enters the bloodstream and causes bacteremia
 Historical landmarks in typhoid
• In 1880s, typhoid bacillus were observed by Eberth in spleen and
mesenteric lymph nodes from a patient who died from typhoid

• In 1881, Robert Koch confirmed the related findings and succeeded in

cultivating the bacterium

• But due to lack of differential characters, separation of typhoid from

other enteric bacteria was difficulty.

• Sero-diagnosis of typhoid was possible by 1896

 Typhoid Mary (real Mary Mallon)
• Food handler who was responsible for infecting about 78 people and
killing 5.
• Worked as a cook in New York City early 1900s
• She was tracked down by a public Health pioneer- Sara Josephine Baker
• Many cases were linked to her
• She was also linked to a second outbreak of typhoid , so she was put
behind bars again where she lived until she died

• Carriers are highly infectious and pose a great risk to public health
• Typhoid is highly endemic in Africa

• Enteric fevers: associated with with a few Salmonella such as

Salmonella typhi (most important) and Paratyphi A,B,C
• Previous epidemics of typhoid has been due to public pollution of water supplies

• Food or water/milk may also be contaminated by a human carrier of the disease

who is handling or processing them

• Symptoms of typhoid appear after an average of 10-14 dyas

• Symptoms include:
• Headache
• Malaise
• Generalized aching
• Fever
• Loss of appetite
• Diarrhea
• restlessness
Diagnosis

• Diagnosis Is made by:

• blood culture

• Stool culture

• Serological test
Prevention and control
• Mainly depend on:
• proper sewage treatment

• Chlorination of water

• Avoiding employing carriers in food industries and restaurants

Treatment- as prevention
• Antibiotics primarily fluoroquinolones (e.g., ciprofloxacin), ceftriaxone, or
azithromycin (or some combination thereof).

• Treatment should be based on antibiotic sensitivity test

• Treatment of typhoid has been complicated by antibiotic resistant strains of

salmonella typhi

• Vaccines- injectable for people over 2 years and attenuated oral vaccine in
capsule formulation for people over 5 years of age