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