Typhoid fever all but disappeared from Western countries in the 20th century through massive improvements in water and sanitation, but after causing misery and death in its newly industrialising but unsanitary cities.
Tragically, much of the rest of the world is still grappling with typhoid. The World Health Organisation estimates that there are as many as 21 million cases of typhoid annually.
The disease is responsible for 220,000 avoidable deaths every year. And without urgent action, the fear is that the number of cases could rapidly escalate, particularly in Africa.
Until recently, it was thought that Asia, and particularly India, were the areas worst hit by the disease. However, new research reveals a worrying reality about typhoid in sub-Saharan Africa.
The International Vaccine Institute’s study shows that typhoid is far from being a minor problem in Africa. In fact, in some areas, incidences are as high as in Asia.
Major outbreaks have been recently reported in Malawi, Uganda, and Zimbabwe. Further, current demographic trends in Africa fuel a potential danger for a rapid rise in the disease’s prevalence.
DENSELY POPULATED AREAS
Those most at risk from typhoid are children living in densely populated urban areas with inadequate water and sanitation.
And Africa is in the midst of a population boom that suggests that by 2050, more than half of its population will live in cities. That is the equivalent of the current population of China.
Without major changes, rapid and unregulated urbanisation may result in millions residing in crowded slums with poor access to safe water or developed sanitation. This could be a hotbed for a massive spread of typhoid, as well as other water-borne diseases such as cholera.
The public health challenge could be made even worse by the emergence of multidrug-resistant typhoid in Zambia and Malawi.
Infections caused by these strains already lead to more severe illnesses and higher death rates because they cannot effectively be treated by antibiotics.
More than ever before, vaccines are central to the reduction of the threat of typhoid while the world follows through on its water and sanitation improvement programmes as a part of the Sustainable Development Goals agenda.
Typhoid poses a major health challenge to the African continent, but we also know how successful new vaccines have been in tackling a wide range of diseases, including rotavirus infections and meningococcal meningitis in Africa.
We are much further along in the fight against typhoid than we were 100 years ago. Concerted and coordinated control efforts can prevent a 19th century health risk becoming a 21st century crisis in sub-Saharan Africa.
Ms Zaidi is the director of the Enteric Diarrheal Diseases Programme at the Bill & Melinda Gates Foundation. [email protected]