How do I prevent the spread of typhoid at home?

Dear Askadoc,

My mother has been feeling unwell for a few months and when she went to hospital was diagnosed with typhoid. She has been put on medication but she is still in and out of hospital because the disease is not completely cured.

Is there a cure for typhoid? Why is it difficult to treat? My children visit her on the holidays. Should I be worried that they will be infected?

Jane.

Dear Jane,

Typhoid fever, also known as enteric fever, is a deadly, prevalent and highly contagious but preventable water borne disease. Typhoid is caused by bacterium Salmonella Typhi and is transmitted through the ingestion water or food contaminated with infected human waste.

Typhoid is common in the developing world and affects people from all walks of life in urban and peri-urban areas. In Kenya, typhoid fever is endemic and more than 4,000 cases are reported every year. Other high risk areas of typhoid include; Central America, the Indian sub-continent, the Middle East, South America and South and East Asia.

According to the World Health Organisation (WHO), typhoid kills almost five million babies annually and infects a sixth of the population, making it one of the most common epidemics. In 2011, a series of typhoid outbreaks in DRC, Zambia and Zimbabwe were attributed to problems in sanitation and water. Frequent water shortages in urban areas also contribute to its spread.

Some of the risk factors include, poor sanitation in the home, leaking drainage systems, polluted water and contaminated food. Some high risk groups include commercial food handlers, urban slum dwellers with poor water supply and sanitation, school-going children, nomadic communities and also health workers who are exposed to typhoid in their line of duty.

If hands are not washed properly after going to the toilet, any food that is handled can be contaminated. If this contaminated food is ingested by someone else the disease spreads.

In addition, typhoid can also be spread by drinking or eating food that is contaminated, not washing ones hands after using the toilet and consuming shellfish or other seafood from a water source that has been contaminated with infected feaces or urine.

Typhoid fever presents with flu-like symptoms that include high fever, a dull headache coupled with abdominal pain, constipation and diarrhoea.

A positive laboratory test showing the presence of bacterium Salmonella Typhi in the blood, stool, bone marrow and even bowel fluid, will confirm that the patient has typhoid.

Laboratory testing should be carried out in areas where contamination of food or waterborne transmission is suspected. Thi should be done before administration of antibiotics begin.

Should testing confirm that the patient has typhoid fever, it is important that other members of the household get tested to prevent further infection. If typhoid is diagnosed early, patients can be treated from home with the right antibiotics.

The antibiotic treatment should be based on sensitivity of the bacteria to the drugs. Symptoms should normally begin to improve within two or three days of taking antibiotics. Completing the course of antibiotics will help prevent a recurrence. Antipyretics (fever-reducing drugs) like acetaminophen are also used.

Hydration should be increased through use of oral and intravenous fluids. An antibiotic sensitivity test is recommended because some strains of Salmonella Typhi have developed resistance to one or more types of antibiotics and thus new and more expensive drugs will be arequired for treatment.

The patient should also take time to rest, ensure that they eat regular meals and drink plenty of fluids. One can also take smaller but frequent meals in case of nausea.

More serious cases require hospital admission. Hospital treatment is usually recommended if one has;

Persistent vomiting

Severe vomiting

Swollen abdomen.

For treatment, intravenous fluids and antibiotics are given. If the person is not treated, the bacteria can spread to the intestines, liver, bloodstream and bone marrow. The spreading of the bacteria out of the bowels worsens the infection during the second and third weeks.

Should the organs or tissues become damaged, internal bleeding can occur. Perforation can also occur and bacteria in the digestive system can move to the stomach and affect the peritoneum — the lining of the abdomen. Infection of the peritoneum is referred to as peritonitis and if it not treated can lead to multiple organ failure and eventual death.

When typhoid fever is left untreated, those who survive the infection become carriers of the disease. Some of those who survive can be left with permanent physical or mental disabilities. Carriers however do not have any symptoms of typhoid. The bacteria continues to dwell in the bladder and remains capable of spreading the typhoid fever in stool or urine.

Relapse of typhoid symptoms normally occurs in around one in 20 people. Symptoms may occur around a week after the antibiotic treatment is completed. Symptoms are normally milder and last for a shorter period of time. Further treatment with antibiotics is usually advised.

To prevent typhoid, the basic measures of hygiene, water supply and sanitation must be strengthened. Drink clean water at all times, wash hands before meals and after using toilets.

There is a typhoid vaccine as well as tablets that help prevent infection. The vaccine should be given at least one month before travelling to areas suspected of compromised sanitation. For those in the hospitality and food industry, vaccinations should be given periodically and booster vaccines given subsequently every three years.

However, the vaccines are not suitable for those with a weakened immune systems or childrenunder two years of age. The Ministry if Health recommends vaccination to those at the highest risk of contracting or transmitting the disease including food handlers — especially those employed in institutions of learning and prisons — laboratory staff handling specimens as well as employees of sewage treatment companies.

— By Dr Torooti Mwirigi. Having health problems? Send your questions to [email protected]