Tshwane faces typhoid fever outbreak: What you need to know

The City of Tshwane is currently grappling with an outbreak of enteric fever, commonly known as typhoid fever, prompting investigations and calls for heightened public vigilance regarding hygiene and sanitation.

Typhoid fever is categorised as a waterborne disease, similar to cholera, and is typically linked to contaminated water, sanitation, and a lack of hygiene.

While authorities are on edge, they have noted that the surge has not yet been linked to the municipal water supply. Preliminary results of recent drinking water samples have not determined an epidemiological link or the source of contamination.

The city maintains stringent monitoring and testing protocols to ensure treated water complies with the South African National Standard (SANS 241).

How does typhoid fever spread?

The disease is usually spread through contaminated water or food. Once the bacteria is ingested, it multiplies and enters the bloodstream and intestinal tract.

The bacteria lives in the gut of infected people and can be shed in stool. Transmission occurs if wastewater, usually containing faeces or urine) gets into drinking water or onto food, or if an infected person doesn't wash their hands after using the bathroom and contaminates food or surfaces.

What are the symptoms of typhoid fever?

Symptoms of typhoid fever usually start slowly, often appearing one to three weeks after contact with the bacteria. Early symptoms may be flu-like, but the condition is characterised by a fever that gets progressively higher.

Common symptoms include:

• Prolonged or lasting high fever (which can reach 40°C).
• Fatigue or weakness.
• Headache.
• Nausea and vomiting.
• Abdominal pain or cramps.
• Constipation or diarrhoea.
• Some patients may develop a faint "rose spots" rash on the chest or stomach.

If left untreated, severe cases can lead to serious complications and fatality. Complications usually occur around the third week and can include internal bleeding, intestinal perforation (a hole in the intestines), kidney failure, and neurological symptoms like confusion and seizures.

Treatment and contagiousness

Typhoid fever is diagnosed through blood testing and is treated with antibiotics prescribed by health professionals. Patients are advised to finish all prescribed medicines. Early treatment generally leads to recovery within seven to ten days. Severe cases may require hospital admission.

Some strains of S. Typhi have developed resistance to previously used medications. Health officials are concerned about extremely drug resistant (XDR) typhoid and the possibility of losing effective treatment options if resistance increases further.

Unlike many illnesses, a person can still be contagious with typhoid even after symptoms clear up. About 5% of recovered patients remain contagious for a year or longer, known as a long-term carrier. Patients must have a health-care professional test whether the bacteria has remained in the body to ensure they do not spread it to others.

Individuals can also get vaccinated against typhoid fever. An injectable vaccine based on the purified antigen is available for people aged two years and older. A live attenuated oral vaccine in capsule formulation is available for people aged five and older.

How to prevent it?

Residents can reduce their risk of contracting or spreading typhoid by strictly adhering to hygiene and food safety protocols:

Wash hands thoroughly and frequently using soap and water. This is especially important after using the bathroom, preparing food, or changing a diaper. The World Health Organization (WHO) advises that if you are infected, you should not prepare or serve food to others, as this lowers the chance of transmission. If working in a lab or health/food sector, testing may be required before returning to work after recovery.

Only use piped municipal water that has been properly treated and tested for drinking and cooking.

Refrain from using untreated river or borehole water for domestic purposes as a precautionary measure. If the safety of the water is questionable, boil the water before drinking.

Avoid ice unless you are certain the water is safe. Store water in a clean container with a small opening or cover and use it within four hours. Make sure all food consumed is properly cooked.

Wash fruit and vegetables carefully before consumption. WHO advises that fruits and vegetables eaten raw should be peeled. Avoid consuming raw milk products; drink only pasteurised or boiled milk.

IOL