Typhoid Fever Global and Public Health Impact

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Typhoid Fever Global and Public Health Impact

• Sade Adeneye MPH Student
• Walden University
• PUBH 6165-2 Environmental Health
• Instructor Rebecca Heick
• Winter, 2010

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Introduction

• Typhoid fever is a life threatening illness that
  is caused by the bacterium Salmonella typhi.
• Typhoid fever is more common in developing
  countries, and greatly impacts morbidity and
  mortality
• Need for improved diagnostic and treatment
  measures globally.
• No adequate surveillance, monitoring and
  reporting system of disease occurrence
• WHO(2003). Background document The diagnosis
  treatment and prevention of typhoid fever.
  Communicable Disease Surveillance and Response
  Vaccines and Biologicals. Retrieved from

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• Varying information on annual worldwide morbidity
  and mortality occurrences
• Some researchers estimate global morbidity and
  mortality annual rates are between 200,000 and
  600,000, while others say it could be in the
  millions.
• Merican, I. (1997). Typhoid fever present and
  future. Medical Journal of Malaysia. 52(3)
  299-308
• Bhutta, Z.A., Threlfall, J. (2009). Addressing
  the global disease burden of Typhoid Fever. JAMA
  302(8) 898-899
• Passey, M. (1995). The new problem of typhoid
  fever in Papua New Guinea how do we deal with
  it. Papua New Guinea Medical Journal, Dec 38(4)
  300-304
• Irepepolu, O.H., Entonu, P.E., Agwale, S.M.
  (2008). A review of the disease burden, impact
  and prevention of typhoid fever in Nigeria. West
  African Journal of Medicine, July 27(3)127-133.

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Salmonella Typhi bacteria
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Geographical distribution of Typhoid Fever
http//www.spmsd.co.uk/upload/public/docImages/1/t
yphoid_feverI.gif
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Etiology

• Salmonella typhi bacteria is carried in
  bloodstream and intestines.
• Exposure is through contact with sewage, water or
  food, or persons carrying S.typhi bacteria.
• Contaminated food or beverages are major sources
  of infection (i.e. milk, ice-cream).
• Bacterial cells multiply and migrate systemically
  to other organs of the body throughout the
  infection process.
• Fecal-oral mode of transmission
• CDC - Centers for Disease Control and Prevention,
  (2008). National Typhoid and Paratyphoid Fever
  Surveillance
• CDC - Centers for Disease Control and Prevention
  (2009), Typhoid Fever

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Symptoms of typhoid fever

• Varying levels of intensity of infection
• Fever (up to 104 degrees Fahrenheit)
• Stomachache
• Headache
• Vomiting
• General body weakness
• Selvaraj, I. (2009). Typhoid Fever Control
  Measures

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• Incubation period is 1-2 weeks
• Infected individuals could remain contagious for
  awhile
• Become carriers
• Typhoid Mary Mallon
• National Institute of Health, (2001). Typhoid
  fever in the United States. NIH Backgrounder

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Diagnosis

• Isolation of bacterial cultures from
• blood
• stool
• urine
• Widal serology test
• Measures titers of antigens seen as early as week
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• Chang, H.J., Lynm, C., Glass, R.M. (2009).
  Typhoid Fever. Journal of American Medical
  Association. 302(8), pg 914

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Diagnosis contd.

• Bone Marrow aspirate cultures
• Locating carriers through sewer swab technique
• Selvaraj, I. (2009). Typhoid Fever Control
  Measures

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• Age group
• Affects all ages
• Significant cause of death in children between
  ages 1-5years
• Sex More common in males than females.
• Population Disease of low socioeconomic class
  and status.
• Selvaraj, I. (2009). Typhoid Fever Control
  Measures
• Sinha, et.al, (1999). Typhoid fever in children
  aged less than 5 years. Lancet 354(9180)
  734-737
• Irepepolu, O.H., Entonu, P.E., Agwale, S.M.
  (2008). A review of the disease burden, impact
  and prevention of typhoid fever in Nigeria. West
  African Journal of Medicine, July 27(3)127-133.

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Contamination and transmission
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Prevention and Treatment

• Constant washing of hands
• Avoid eating risky foods or drinks (especially
  for travelers)
• Drink water from sanitary sources, i.e. bottled
  or filtered
• Handle food safely
• Boil or cook food thoroughly
• Prophylactic attenuated Salmonella typhi vaccine
  (available for travelers)
• CDC - Centers for Disease Control and Prevention,
  (2008). National Typhoid and Paratyphoid Fever
  Surveillance
• World Health Organization (2003). Background
  document The diagnosis treatment and prevention
  typhoid fever. Communicable Disease Surveillance
  and Response Vaccines and Biologicals.
• Duszczyk, E., Talarek, E. (2008). Routine and
  recommended vaccinations for travelers.
  International Maritime Health, 59(1-4) 116 123
• Bhunia, R., and co. ((2009). Recent advances in
  typhoid fever. Malaria Weekly publication.
  Atlanta August 3, pg 22.

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Prevention and Treatment Contd.

• Education of food handlers
• Medications
• Chloramphenicol
• Quinolones
• Ceftiaxone
• Ampicillin
• Ciprofloxacin
• Bhunia, R., and co. ((2009). Recent advances in
  typhoid fever. Malaria Weekly publication.
  Atlanta August 3, pg 22.

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Treatment Challenges

• Resistance to treatment with new strains of
  bacteria
• Overuse of antimicrobials has caused treatment
  failures
• Lack of appropriate diagnostic facilities,
  technology and manpower
• Reduced or lack of access to appropriate
  medications
• World Health Organization (2005). Drug-resistant
  Salmonella.
• Threlfall, E.J., Ward, L.R., Rowe, B., et al.
  (1992). Widespread occurrence of multiple
  drug-resistant Salmonella Typhi in India.

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Guidelines for Vaccine Providers

• Inform the people on the importance of vaccine
• Use community health centers as meeting points
• Visit homes with fliers for awareness campaign
• Use students to reach their parents
• Make posters with pictures of victims of Typhoid
  fever
• Visit local leaders and seek their cooperation
  and support
• Ensure that professionalism is the watch word

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Conclusion

• 400 cases annually in the United States
• 12.5 millions persons globally
• Typhoid fever is a global and public health issue
• Implications of lack of effective reporting
  system
• Benefits of global policies
• CDC - Centers for Disease Control and Prevention,
  (2008). National Typhoid and Paratyphoid Fever
  Surveillance
• World Health Organization (2005). Drug-resistant
  Salmonella

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Challenges in Nigeria

• Program and policy development
• Integrity and specific goals of the program
• Implementation, enforcement, and participation by
  community
• Integrity of program coordinators
• Lack of desire for maintenance or sustenance

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Additional resources for your reference

• Pfizer drug trial misconduct information, can be
  found at http//www.business-humanrights.org/Categ
  ories/Lawlawsuits/Lawsuitsregulatoryaction/Lawsuit
  sSelectedcases/PfizerlawsuitreNigeria
• Additional information on governance and public
  service delivery, can be found at
  http//www.ifpri.cgiar.org/publication/decentraliz
  ation-and-public-service-delivery-nigeria
• Article on the Healthcare system in Nigeria, can
  be found at http//www.kwenu.com/publications/orab
  uchi/poor_healthcare.htm
• Additional information on healthcare and welfare
  in developing nations can be found at
  http//www.who.int/bulletin/volumes/88/1/09-067868
  /en/

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References

• Bhunia, R., and co. ((2009). Recent advances in
  typhoid fever. Malaria Weekly publication.
  Atlanta August 3, pg 22. Retrieved from
  ProQuest Health and Medical database accessed
  through Walden Library.
• Bhutta, Z.A., Threlfall, J. (2009). Addressing
  the global disease burden of Typhoid Fever.
  JAMA 302(8) 898-899. Retrieved from
• http//jama.ama-assn.org/cgi/content/extract/302
  /8/898
• CDC - Centers for Disease Control and Prevention
  (2009), Typhoid Fever. http//www.cdc.gov/ncidod/
  dbmd/diseaseinfo/TyphoidFever_g.html
• CDC - Centers for Disease Control and Prevention,
  (2008). National Typhoid and Paratyphoid Fever
  Surveillance. Retrieved from http//www.cdc.gov/
  nationalsurveillance/typhoid_surveillance.html
• Chang, H.J., Lynm, C., Glass, R.M. (2009).
  Typhoid Fever. Journal of American Medical
  Association. 302(8), pg 914

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References Contd.

• Duszczyk, E., and Talarek, E. (2008). Routine
  and recommended vaccinations for travelers.
  International Maritime Health, 59(1-4) 116
  123. Retrieved from http//www.ncbi.nlm.nih.gov/
  pubmed/19227745
• House, D., Wain, J., Ho, A.V., Diep, T.S., Chinh,
  N.T., Bay, P.V. et al. (2001). Serology of
  Typhoid Fever In An Area of Endemicity And Its
  Relevance To Diagnosis. Journal of Clinical
  Microbiology, 39(3) 1002-1007, retrieved on
  October 3, 2009, from http//jcm.asm.org/cgi/rep
  rint/39/3/1002
• Irepepolu, O.H., Entonu, P.E., Agwale, S.M.
  (2008). A review of the disease burden, impact
  and prevention of typhoid fever in Nigeria.
  West African Journal of Medicine, July
  27(3)127-133.
• Merican, I. (1997). Typhoid fever present and
  future. Medical Journal of Malaysia. 52(3)
  299-308 Retrieved from http//www.ncbi.nlm.nih.go
  v/pubmed/10968104
• National Institute of Health, (2001). Typhoid
  fever in the United States. NIH Backgrounder.
  Retrieved from http//www.nichd.nih.gov/news/rel
  eases/typhoid_background.cfm
• Passey, M. (1995). The new problem of typhoid
  fever in Papua New Guinea how do we deal with
  it? Papua New Guinea Medical Journal, Dec 38(4)
  300-304. Retrieved from www.ncbi.nlm.nih.gov/pu
  bmed/9522872

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References Contd.

• Selvaraj, I. (2009). Typhoid Fever Control
  Measures
• Retrieved from www.pitt.edu/super7/23011-24001
  /23121.ppt
• Sinha, et.al, (1999). Typhoid fever in children
  aged less than 5 years. Lancet 354(9180)
• 734-737
• Threlfall, E.J., Ward, L.R., Rowe, B., et al.
  (1992). Widespread occurrence of multiple
  drug-resistant Salmonella Typhi in India. Eur J.
  clinical Microbiology of Infectious Disease, Nov
  11(11) 990-993
• World Health Organization (2009). Initiative for
  vaccine research Typhoid Fever. Retrieved
  from http//www.who.int/vaccine_research/disease
  s/diarrhoeal/en/index7.html
• World Health Organization (2003). Background
  document The diagnosis treatment and prevention
  of typhoid fever. Communicable Disease
  Surveillance and Response Vaccines and
  Biologicals. Retrieved from
• http//www.who.int/vaccines-documents/DocsPDF03
  /www740.pdf