TYPHOID

 As of 2019, an estimated 9 million people get sick from typhoid and 1,10,000 people die
from it every year.

 Symptoms include prolonged fever, fatigue, headache, nausea, abdominal pain, and
constipation or diarrhoea. Some patients may have a rash. Severe cases may lead to serious
complications or even death.

 Typhoid fever can be treated with antibiotics although increasing resistance to different
types of antibiotics is making treatment more complicated.

 The typhoid conjugate vaccine is recommended for use in children from 6 months of age and
in adults up to 45 years or 65 years (depending on the vaccine).

 Two typhoid conjugate vaccines have been prequalified by WHO since December 2017 and
are being introduced into childhood immunization programmes in typhoid endemic
countries.

Overview :-
 Typhoid fever is a life-threatening infection caused by the bacterium Salmonella Typhi. It is
usually spread through contaminated food or water. Once Salmonella Typhi bacteria are
ingested, they multiply and spread into the bloodstream.

 Urbanization and climate change have the potential to increase the global burden of typhoid.
In addition, increasing resistance to antibiotic treatment is making it easier for typhoid to
spread in communities that lack access to safe drinking water or adequate sanitation.

Pathogen :-
Typhoid fever is a disease caused by Salmonella enterica

serotype. Typhi bacteria, also called Salmonella typhi.

Mode of infection :-
Spreads through food, drinks, and drinking water
that are contaminated with infected faecal
matter. Washing fruit and vegetables can spread
it as well if the water is contaminated.

Some people have typhoid without experiencing

People who test positive for typhoid may not be allowed to work with children or older adults
until medical tests are negative.
These pathogens generally enter the small intestine through food and water contaminated with
them and migrate to other organs through blood.

Signs and Symptoms :-

The two main symptoms of typhoid are fever and rash. Sustained high fever 104ºF. (39° to 40°C)

The rash, which does not affect every person, consists of rose-coloured spots, particularly on the
neck and abdomen.)

Other symptoms include :-

High fever Weakness Stomach pain Headache Constipation

Intestinal perforation and death may occur in severe cases.

Treatment :-
Typhoid fever can be treated with antibiotics. Antimicrobial resistance is common with
likelihood of more complicated and expensive treatment options required in the most affected
regions.

Even when the symptoms go away, people may still be carrying typhoid bacteria, meaning they
can spread it to others, through shedding of bacteria in their faeces.

It is important for people being treated for typhoid fever to do the following:

Take prescribed antibiotics for as long as the doctor has prescribed.

Wash their hands with soap and water after using the bathroom and avoid preparing or serving
food for other people. This will lower the chance of passing the infection on to someone else.

Have their doctor test to ensure that no Salmonella Typhi bacteria remain in their body.

Widal Test :-
 The Widal test is a serological test that helps diagnose typhoid fever by measuring the body's
immune response (antibodies) to the Salmonella bacteria. It specifically tests for antibodies to
the O and H antigens of Salmonella typhi and other related bacteria like Salmonella paratyphi.
The presence of these antibodies indicates an infection, helping doctors diagnose and manage
the condition effectively.

This test is widely used in areas where typhoid fever is endemic, as early diagnosis can prevent
complications and aid in the timely treatment of the disease.

About Typhoid Mary:

Mary Mallon as “Typhoid Mary” in the local newspaper of the era

Mary Mallon was born in 1869 in Ireland and emigrated to the US in 1884. She had worked in a
variety of domestic positions for wealthy families prior to settling into her career as a cook. As a
healthy carrier of Salmonella typhi her nickname of “Typhoid Mary” had become synonymous
with the spread of disease, as many were infected due to her denial of being ill. She was forced
into quarantine on two separate occasions on North Brother Island for a total of 26 years and
died alone without friends, having evidently found consolation in her religion to which she gave
her faith and loyalty.

Mary Mallon in the “Riverside Hospital”

Prevention :-
Typhoid fever is common in places with poor sanitation and a lack of safe drinking water. Access to
safe water and adequate sanitation, hygiene among food handlers and typhoid vaccination are all
effective in preventing typhoid fever.

Two additional vaccines have been used for many years in older children and adults at risk of
typhoid, including travellers. These vaccines do not provide long-lasting immunity (requiring repeat
or booster doses) and are not approved for children younger than 2 years old:

 an injectable vaccine based on the purified antigen for people aged 2 years and above; and

 a live attenuated oral vaccine in capsule formulation for people aged over 6 years.

Two typhoid conjugate vaccines have been prequalified by WHO since December 2017 and are being
introduced into childhood immunization programmes in typhoid endemic countries.

All travellers to endemic areas are at potential risk of typhoid fever, although the risk is generally low
in tourist and business centres where standards of accommodation, sanitation and food hygiene are
high. Typhoid fever vaccination should be offered to travellers to destinations where the risk of
typhoid fever is high.

The following recommendations will help ensure safety while travelling:

 Ensure food is properly cooked and still hot when served.

 Avoid raw milk and products made from raw milk. Drink only pasteurized or boiled milk.

 Avoid ice unless it is made from safe water.

 When the safety of drinking water is questionable, boil it, or if this is not possible, disinfect it
with a reliable, slow-release disinfectant agent (usually available at pharmacies).

 Wash hands thoroughly and frequently using soap, in particular after contact with pets or
farm animals, or after having been to the toilet.

 Wash fruits and vegetables carefully, particularly if they are eaten raw. If possible, vegetables
and fruits should be peeled.