A large and persistent outbreak of typhoid fever caused by consuming contaminated water and street-vended beverages: Kampala, Uganda, January – June 2015

Abstract

BackgroundOn 6 February 2015, Kampala city authorities alerted the Ugandan Ministry of Health of a “strange disease” that killed one person and sickened dozens. We conducted an epidemiologic investigation to identify the nature of the disease, mode of transmission, and risk factors to inform timely and effective control measures.MethodsWe defined a suspected case as onset of fever (≥37.5 °C) for more than 3 days with abdominal pain, headache, negative malaria test or failed anti-malaria treatment, and at least 2 of the following: diarrhea, nausea or vomiting, constipation, fatigue. A probable case was defined as a suspected case with a positive TUBEX® TF test. A confirmed case had blood culture yielding Salmonella Typhi. We conducted a case-control study to compare exposures of 33 suspected case-patients and 78 controls, and tested water and juice samples.ResultsFrom 17 February–12 June, we identified 10,230 suspected, 1038 probable, and 51 confirmed cases. Approximately 22.58% (7/31) of case-patients and 2.56% (2/78) of controls drank water sold in small plastic bags (ORM-H = 8.90; 95%CI = 1.60–49.00); 54.54% (18/33) of case-patients and 19.23% (15/78) of controls consumed locally-made drinks (ORM-H = 4.60; 95%CI: 1.90–11.00). All isolates were susceptible to ciprofloxacin and ceftriaxone. Water and juice samples exhibited evidence of fecal contamination.ConclusionContaminated water and street-vended beverages were likely vehicles of this outbreak. At our recommendation authorities closed unsafe water sources and supplied safe water to affected areas.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-4002-0) contains supplementary material, which is available to authorized users.

Neurological Complications of Typhoid Fever : Case of Guillain-Barre' Syndrome about an Observation in Dakar, Senegal

“…A few cases have been reports in Island, India and some areas(May & Senitiri, 2010;Mehndiratta et al, 2012). Besides the disease is rare before the age of 15 years and after 60 years(Kabwama et al, 2017). The patient in the current study is a 10-year-old boy.…”

“…Typhoid fever is a systemic disease caused by Salmonella enterica serovar Typhi, a Gram-negative bacterium. Humans are the only host, and transmission most commonly occurs through ingestion of water or food contaminated by feces from an acutely ill or convalescent patient or an asymptomatic carrier (Kabwama et al, 2017). Guillain-Barre' syndrome is a rare complication of typhoid fever (Kapoor et al, 2014).…”

Environmental Survey of Drinking Water Sources in Kampala, Uganda, during a Typhoid Fever Outbreak

“…By June, more than 10,000 suspected cases had been reported throughout the five districts in Kampala. The attack rate was higher in males (11.0/1,000 residents) than in females (8.4/1,000 resident) and higher in adults 15 to 59 (12.0/1,000 residents) than in children under 15 (2.0/1,000 residents) (5). The World Health Organization (WHO) reported that contaminated drinking water and juices were the main sources of the outbreak and that most water sources tested were heavily contaminated with Escherichia coli, with groundwater being of the worst quality (see http://www.who.int/csr/don/17-march-2015-uganda/en/).…”

“…The World Health Organization (WHO) reported that contaminated drinking water and juices were the main sources of the outbreak and that most water sources tested were heavily contaminated with Escherichia coli, with groundwater being of the worst quality (see http://www.who.int/csr/don/17-march-2015-uganda/en/). This was supported by a small-scale study conducted in early April 2015 that detected evidence of fecal contamination in street-vended beverages and in unprotected spring water sources (5).…”

Typhoid conjugate vaccines: making vaccine history in Africa

“…What is very clear is the significant spatial and temporal heterogeneity of typhoid burden in Africa. There has been a well-documented increase in cases throughout East and Central/Southern Africa following multiple introductions of the H58 MDR strain from the Indian subcontinent, and there have been well-described local epidemics and outbreaks with this clade [4,[9][10][11][12] while different non-H58 MDR clades have been shown to circulate in West Africa [13]. The distribution of cases between urban and rural sites is currently unclear and represents a major data gap.…”