Typhoid Fever Global and Public Health Impact Sade Adeneye MPH Student Walden University PUBH Environmental Health Instructor: Rebecca Heick Winter, 2010

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: WHO(2003). Background document: The diagnosis treatment and prevention of typhoid fever. Communicable Disease Surveillance and Response Vaccines and Biologicals. Retrieved from:

 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): Bhutta, Z.A., & Threlfall, J. (2009). Addressing the global disease burden of Typhoid Fever. JAMA 302(8); 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): 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):

Salmonella Typhi bacteria

Geographical distribution of Typhoid Fever

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

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

 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

Diagnosis  Isolation of bacterial cultures from  blood  stool  urine  Widal serology test  Measures titers of antigens seen as early as week 1 Chang, H.J., Lynm, C., & Glass, R.M. (2009). Typhoid Fever. Journal of American Medical Association. 302(8), pg: 914

Diagnosis contd.  Bone Marrow aspirate cultures  Locating carriers through “sewer swab technique” Selvaraj, I. (2009). Typhoid Fever & Control Measures

 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); 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):

Faeces and Urine from infected persons Water Soil Foods Raw or cooked Consumed by Humans Hands Foods Raw or cooked Consumed by Humans Flies Foods Raw or cooked Consumed by Humans Contamination and transmission

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.

 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. Prevention and Treatment Contd.

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.

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

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

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

Additional resources for your reference Additional resources for your reference : Pfizer drug trial misconduct information, can be found at humanrights.org/Categories/Lawlawsuits/Lawsuitsregulatoryaction/LawsuitsSelectedc ases/PfizerlawsuitreNigeriahttp:// humanrights.org/Categories/Lawlawsuits/Lawsuitsregulatoryaction/LawsuitsSelectedc ases/PfizerlawsuitreNigeria Additional information on governance and public service delivery, can be found at nigeria nigeria Article on the Healthcare system in Nigeria, can be found at Additional information on healthcare and welfare in developing nations can be found at

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); Retrieved from:  CDC - Centers for Disease Control and Prevention (2009), Typhoid Fever.  CDC - Centers for Disease Control and Prevention, (2008). National Typhoid and Paratyphoid Fever Surveillance. Retrieved from:  Chang, H.J., Lynm, C., & Glass, R.M. (2009). Typhoid Fever. Journal of American Medical Association. 302(8), pg: 914

References Contd.  Duszczyk, E., and Talarek, E. (2008). Routine and recommended vaccinations for travelers. International Maritime Health, 59(1-4): 116 – 123. Retrieved from:  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) , retrieved on October 3, 2009, from:  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):  Merican, I. (1997). Typhoid fever: present and future. Medical Journal of Malaysia. 52(3): Retrieved from:   National Institute of Health, (2001). Typhoid fever in the United States. NIH Backgrounder. Retrieved from:  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): Retrieved from:

References Contd.  Selvaraj, I. (2009). Typhoid Fever & Control Measures Retrieved from:  Sinha, et.al, (1999). Typhoid fever in children aged less than 5 years. Lancet 354(9180);  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):  World Health Organization (2009). Initiative for vaccine research: Typhoid Fever. Retrieved from:  World Health Organization (2003). Background document: The diagnosis treatment and prevention of typhoid fever. Communicable Disease Surveillance and Response Vaccines and Biologicals. Retrieved from: