Typhoid Fever Typhoid Fever

Global and Public Health ImpactGlobal and Public Health Impact Sade Adeneye MPH StudentSade Adeneye MPH Student

Walden UniversityWalden UniversityPUBH 6165-2 Environmental HealthPUBH 6165-2 Environmental Health

Instructor: Rebecca HeickInstructor: Rebecca HeickWinter, 2010Winter, 2010

IntroductionIntroduction

Typhoid fever is a life threatening illness that is Typhoid fever is a life threatening illness that is caused by the bacterium caused by the bacterium Salmonella typhiSalmonella typhi. .

Typhoid fever is more common in developing Typhoid fever is more common in developing countries, and greatly impacts morbidity and countries, and greatly impacts morbidity and mortality mortality

Need for improved diagnostic and treatment Need for improved diagnostic and treatment measures globally.measures globally.

No adequate surveillance, monitoring and No adequate surveillance, monitoring and reporting system of disease occurrencereporting system of disease occurrence

`̀ WHO(2003). Background document: The diagnosis treatment and prevention of typhoid WHO(2003). Background document: The diagnosis treatment and prevention of typhoid

fever. Communicable Disease Surveillance and Response Vaccines and Biologicals. fever. Communicable Disease Surveillance and Response Vaccines and Biologicals. Retrieved from:Retrieved from:

Varying information on annual worldwide Varying information on annual worldwide morbidity and mortality occurrencesmorbidity and mortality occurrences

Some researchers estimate global Some researchers estimate global morbidity and mortality annual rates are morbidity and mortality annual rates are between 200,000 and 600,000, while between 200,000 and 600,000, while others say it could be in the millions.others say it could be in the millions.

Merican, I. (1997). Typhoid fever: present and future. Merican, I. (1997). Typhoid fever: present and future. Medical Journal of MalaysiaMedical Journal of Malaysia. 52(3): . 52(3): 299-308299-308

Bhutta, Z.A., & Threlfall, J. (2009). Addressing the global disease burden of Typhoid Fever. Bhutta, Z.A., & Threlfall, J. (2009). Addressing the global disease burden of Typhoid Fever. JAMA 302(8); 898-899 JAMA 302(8); 898-899

Passey, M. (1995). The new problem of typhoid fever in Papua New Guinea: how do we Passey, M. (1995). The new problem of typhoid fever in Papua New Guinea: how do we deal with it. deal with it. Papua New Guinea Medical JournalPapua New Guinea Medical Journal, Dec; 38(4): 300-304, Dec; 38(4): 300-304

Irepepolu, O.H., Entonu, P.E., & Agwale, S.M. (2008). A review of the disease burden, 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, impact and prevention of typhoid fever in Nigeria. West African Journal of Medicine, July 27(3):127-133.July 27(3):127-133.

Salmonella Typhi bacteriaSalmonella Typhi bacteria

Geographical distribution of Typhoid FeverGeographical distribution of Typhoid Fever

http://www.spmsd.co.uk/upload/public/docImages/1/typhoid_feverI.gifhttp://www.spmsd.co.uk/upload/public/docImages/1/typhoid_feverI.gif

EtiologyEtiology Salmonella typhi Salmonella typhi bacteria is carried in bacteria is carried in

bloodstream and intestines.bloodstream and intestines. Exposure is through contact with sewage, water Exposure is through contact with sewage, water

or food, or persons carrying or food, or persons carrying S.typhiS.typhi bacteria. bacteria. Contaminated food or beverages are major Contaminated food or beverages are major

sources of infection (i.e. milk, ice-cream).sources of infection (i.e. milk, ice-cream). Bacterial cells multiply and migrate systemically Bacterial cells multiply and migrate systemically

to other organs of the body throughout the to other organs of the body throughout the infection process.infection process.

Fecal-oral mode of transmissionFecal-oral mode of transmission

CDC - Centers for Disease Control and Prevention, (2008). National Typhoid and CDC - Centers for Disease Control and Prevention, (2008). National Typhoid and Paratyphoid Fever SurveillanceParatyphoid Fever Surveillance

CDC - Centers for Disease Control and Prevention (2009), Typhoid FeverCDC - Centers for Disease Control and Prevention (2009), Typhoid Fever

Symptoms of typhoid feverSymptoms of typhoid fever

Varying levels of intensity of infectionVarying levels of intensity of infection Fever (up to 104 degrees Fahrenheit)Fever (up to 104 degrees Fahrenheit) StomachacheStomachache HeadacheHeadache Vomiting Vomiting General body weaknessGeneral body weakness

Selvaraj, I. (2009). Typhoid Fever & Control MeasuresSelvaraj, I. (2009). Typhoid Fever & Control Measures

Incubation period is 1-2 weeksIncubation period is 1-2 weeks

Infected individuals could remain Infected individuals could remain contagious for awhile contagious for awhile Become carriersBecome carriers ““Typhoid” Mary MallonTyphoid” Mary Mallon

National Institute of Health, (2001). Typhoid fever in the United States. NIH Backgrounder

DiagnosisDiagnosis

Isolation of bacterial cultures from Isolation of bacterial cultures from blood blood stoolstool urineurine

Widal serology test Widal serology test Measures titers of antigens seen Measures titers of antigens seen

as early as week 1as early as week 1

Chang, H.J., Lynm, C., & Glass, R.M. (2009). Typhoid Fever. Chang, H.J., Lynm, C., & Glass, R.M. (2009). Typhoid Fever. Journal of Journal of American Medical AssociationAmerican Medical Association. 302(8), pg: 914. 302(8), pg: 914

Diagnosis contdDiagnosis contd..

Bone Marrow aspirate culturesBone Marrow aspirate cultures Locating carriers through “sewer Locating carriers through “sewer

swab technique”swab technique”

Selvaraj, I. (2009). Typhoid Fever & Control MeasuresSelvaraj, I. (2009). Typhoid Fever & Control Measures

Age groupAge group: : Affects all agesAffects all ages Significant cause of death in children between Significant cause of death in children between

ages 1-5yearsages 1-5years SexSex: More common in males than females.: More common in males than females.

PopulationPopulation: Disease of low socioeconomic : Disease of low socioeconomic class and status.class and status.

Selvaraj, I. (2009). Typhoid Fever & Control MeasuresSelvaraj, I. (2009). Typhoid Fever & Control MeasuresSinha, et.al, (1999). Typhoid fever in children aged less than 5 years. Sinha, et.al, (1999). Typhoid fever in children aged less than 5 years. LancetLancet 354(9180); 734- 354(9180); 734-

737737

Irepepolu, O.H., Entonu, P.E., & Agwale, S.M. (2008). A review of the disease burden, impact 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 and prevention of typhoid fever in Nigeria. West African Journal of Medicine, July 27(3):127-133.27(3):127-133.

Faeces and Urine from infected

persons

WaterSoil

Hands

Flies

FoodsRaw or cooked

Consumed by Humans

FoodsRaw or cooked

Consumed by Humans

FoodsRaw or cooked

Consumed by Humans

Contamination and transmissionContamination and transmission

Prevention and TreatmentPrevention and Treatment Constant washing of handsConstant washing of hands Avoid eating risky foods or drinks (especially for Avoid eating risky foods or drinks (especially for

travelers)travelers) Drink water from sanitary sources, i.e. bottled or Drink water from sanitary sources, i.e. bottled or

filtered filtered Handle food safely Handle food safely Boil or cook food thoroughlyBoil or cook food thoroughly Prophylactic attenuated Prophylactic attenuated Salmonella typhiSalmonella typhi vaccine vaccine

(available for travelers)(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 handlersEducation of food handlers MedicationsMedications

Chloramphenicol Chloramphenicol Quinolones Quinolones Ceftiaxone Ceftiaxone Ampicillin Ampicillin CiprofloxacinCiprofloxacin

Bhunia, R., and co. ((2009). Recent advances in typhoid fever. Malaria Weekly publication. Atlanta: August 3, pg: 22.

Prevention and Treatment Prevention and Treatment Contd.Contd.

Treatment Challenges

Resistance to treatment with new strains of bacteriaResistance to treatment with new strains of bacteria Overuse of antimicrobials has caused treatment failuresOveruse of antimicrobials has caused treatment failures Lack of appropriate diagnostic facilities, technology and Lack of appropriate diagnostic facilities, technology and

manpowermanpower Reduced or lack of access to appropriate medicationsReduced 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 ProvidersGuidelines for Vaccine Providers Inform the people on the importance of vaccineInform the people on the importance of vaccine Use community health centers as meeting pointsUse community health centers as meeting points Visit homes with fliers for awareness campaignVisit homes with fliers for awareness campaign Use students to reach their parentsUse students to reach their parents Make posters with pictures of victims of Typhoid Make posters with pictures of victims of Typhoid

feverfever Visit local leaders and seek their cooperation and Visit local leaders and seek their cooperation and

supportsupport Ensure that professionalism is the watch wordEnsure that professionalism is the watch word

ConclusionConclusion

400 cases annually in the United States400 cases annually in the United States 12.5 millions persons globally12.5 millions persons globally Typhoid fever is a global and public health Typhoid fever is a global and public health

issueissue Implications of lack of effective reporting Implications of lack of effective reporting

systemsystem Benefits of global policiesBenefits 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 NigeriaChallenges in Nigeria

Program and policy development Program and policy development Integrity and specific goals of the Integrity and specific goals of the

programprogram Implementation, enforcement, and Implementation, enforcement, and

participation by communityparticipation by community Integrity of program coordinatorsIntegrity of program coordinators Lack of desire for maintenance or Lack of desire for maintenance or

sustenancesustenance

Additional resources for your Additional resources for your referencereference:

Pfizer drug trial misconduct information, can be found at http://www.business-humanrights.org/Categories/Lawlawsuits/Lawsuitsregulatoryaction/LawsuitsSelectedcases/PfizerlawsuitreNigeria

Additional information on governance and public service delivery, can be found at http://www.ifpri.cgiar.org/publication/decentralization-and-public-service-delivery-nigeria

Article on the Healthcare system in Nigeria, can be found at http://www.kwenu.com/publications/orabuchi/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/

ReferencesReferences

Bhunia, R., and co. ((2009). Recent advances in typhoid fever. Malaria Bhunia, R., and co. ((2009). Recent advances in typhoid fever. Malaria Weekly Weekly publication. Atlanta: August 3, pg: 22. Retrieved from: publication. Atlanta: August 3, pg: 22. Retrieved from: ProQuest Health and ProQuest Health and Medical database accessed through Walden Medical database accessed through Walden Library.Library.

Bhutta, Z.A., & Threlfall, J. (2009). Addressing the global disease burden Bhutta, Z.A., & Threlfall, J. (2009). Addressing the global disease burden of Typhoid of Typhoid Fever. JAMA 302(8); 898-899. Retrieved from: 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. 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 CDC - Centers for Disease Control and Prevention, (2008). National Typhoid and Typhoid and Paratyphoid Fever Surveillance. Retrieved from: Paratyphoid Fever Surveillance. Retrieved from: http://www.cdc.gov/nationalsurveillance/typhoid_surveillance.htmlhttp://www.cdc.gov/nationalsurveillance/typhoid_surveillance.html

Chang, H.J., Lynm, C., & Glass, R.M. (2009). Typhoid Fever. Chang, H.J., Lynm, C., & Glass, R.M. (2009). Typhoid Fever. Journal of Journal of American American Medical AssociationMedical Association. 302(8), pg: 914. 302(8), pg: 914

References Contd.References Contd.

Duszczyk, E., and Talarek, E. (2008). Routine and recommended vaccinations for Duszczyk, E., and Talarek, E. (2008). Routine and recommended vaccinations for travelers. travelers. International Maritime Health, 59(1-4): 116 – 123. Retrieved from: 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 House, D., Wain, J., Ho, A.V., Diep, T.S., Chinh, N.T., Bay, P.V. et al. (2001). Serology of Typhoid Typhoid Fever In An Area of Endemicity And Its Relevance To Diagnosis. Journal of Fever In An Area of Endemicity And Its Relevance To Diagnosis. Journal of Clinical Clinical Microbiology, 39(3) 1002-1007, retrieved on October 3, 2009, from: Microbiology, 39(3) 1002-1007, retrieved on October 3, 2009, from: http://jcm.asm.org/cgi/reprint/39/3/1002

Irepepolu, O.H., Entonu, P.E., & Agwale, S.M. (2008). A review of the disease burden, Irepepolu, O.H., Entonu, P.E., & Agwale, S.M. (2008). A review of the disease burden, impact and impact and prevention of typhoid fever in Nigeria. West African Journal of prevention of typhoid fever in Nigeria. West African Journal of Medicine, July 27(3):127-133.Medicine, July 27(3):127-133.

Merican, I. (1997). Typhoid fever: present and future. Merican, I. (1997). Typhoid fever: present and future. Medical Journal of Medical Journal of MalaysiaMalaysia. . 52(3): 299-308 Retrieved from: 52(3): 299-308 Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/10968104http://www.ncbi.nlm.nih.gov/pubmed/10968104

National Institute of Health, (2001). Typhoid fever in the United States. NIH Backgrounder. Retrieved from: http://www.nichd.nih.gov/news/releases/typhoid_background.cfm

Passey, M. (1995). The new problem of typhoid fever in Papua New Guinea: Passey, M. (1995). The new problem of typhoid fever in Papua New Guinea: how do we how do we deal with it? deal with it? Papua New Guinea Medical JournalPapua New Guinea Medical Journal, Dec; 38(4): , Dec; 38(4): 300-304. Retrieved 300-304. Retrieved from: from: www.ncbi.nlm.nih.gov/pubmed/9522872

References Contd.References Contd.

Selvaraj, I. (2009). Typhoid Fever & Control MeasuresSelvaraj, I. (2009). Typhoid Fever & Control MeasuresRetrieved from: www.pitt.edu/~super7/23011-24001/23121.pptRetrieved from: www.pitt.edu/~super7/23011-24001/23121.ppt

Sinha, et.al, (1999). Typhoid fever in children aged less than 5 years. Sinha, et.al, (1999). Typhoid fever in children aged less than 5 years. LancetLancet 354(9180); 354(9180);

734-737734-737

Threlfall, E.J., Ward, L.R., Rowe, B., et al. (1992). Widespread occurrence of multiple 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 drug-resistant Salmonella Typhi in India. Eur J. clinical Microbiology of Infectious Disease, Nov; 11(11): 990-993Disease, Nov; 11(11): 990-993

World Health Organization (2009). Initiative for vaccine research: Typhoid Fever. World Health Organization (2009). Initiative for vaccine research: Typhoid Fever. Retrieved from: Retrieved from:

http://www.who.int/vaccine_research/diseases/diarrhoeal/en/index7.html

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

http://www.who.int/vaccines-documents/DocsPDF03/www740.pdf