Typhoid fever in Ujung Pandang, Indonesia – high‐risk groups and high‐risk behaviours

Abstract

We performed a hospital-based case-control study to identify high risk groups and routes of transmission of typhoid fever in the city of Ujung Pandang on the island of Sulawesi, Indonesia. The annual incidence of this disease in southern Sulawesi is estimated at 3.1/1000 and the case fatality at 5.1% Cases were 50 patients over 13 years of age admitted to Stella Maris Hospital with a diagnosis of typhoid fever between June and September 1991. Diagnosis was made on clinical grounds and in 90% of cases confirmed by a Widal test. Controls were 42 patients admitted for non-infectious disorders during the same period and individually matched by age and sex. Controls did not have a history of typhoid fever. Interviews took place in hospital. Analysis was by unconditional logistic regression. High-risk groups consisted of those who were single, unemployed and those who had a university education. Median age of cases was 22 years. Consumption of food from warungs (food stalls in the street) was strongly associated with risk (OR = 45). Both cases and controls washed hands after use of the toilet and before meals, but cases used soap significantly less often (OR = 30). The results of this study can be used to take preventive measures against this severe disease of educated and single young adults by targetting them for IEC-activities emphasizing the importance of thorough hand-washing and the need to take care in the selection of street-foods.

The epidemiology of typhoid fever in the Dong Thap Province, Mekong Delta region of Vietnam.

“…Following acute infections, patients may continue to excrete S. typhi for several weeks or for years as a chronic carrier. 2 Nearly half of the culture-positive typhoid fever in this study oc- Galloway and others 14 Scragg and others 15 Mulligan 16 Johnson and others 17 Thisyakorn and others 18 Chow and others 19 Ellis and others 20 Lepage and others 22 Verma and others 21 Velema and others 24 Mirsa and others 23 This study curred in March and April, the two months at the end of the dry season. The water level progressively gets lower during the dry season, especially in smaller waterways.…”

“…Similar observations were also made in Indonesia where increased rainfall in December and January was followed by a peak of typhoid fever cases five months later when the rainfall was the lowest. 24 Considering that typhoid fever is endemic and one-third of fish latrines in the study area connect directly to the river in the study areas, one would expect the contamination of river water by S. typhi. Since almost all households use river water as the main source of water for drinking and for washing vegetables which are often served raw, and about 30% of households occasionally or never boil water for drinking, the likelihood of ingesting S. typhi from contaminated water is high.…”

A Deterministic Mathematical Model for Direct and Indirect Transmission Dynamics of Typhoid Fever

“…The worst case scenario in case of epidemic outbreak may be experienced when the level of hygiene is poor; maximizing person-toperson contact rate and when there is no accesses to clean water; which maximizes disease transmission through contact with the contaminated reservoir. If immunization of the susceptible population alone does not bring about typhoid elimination, then measures to reduce per case or per carrier infectivity, such as improved sanitation or hand washing with soap, might be considered instead of or in conjunction with vaccination [24] [25]. The multi-compartment models suggest such a reduction in effective contact rates could lead to important reduction in prevalence [3] [26] [27].…”

Epidemiology of <i>Salmonella</i> and <i>Salmonellosis</i>

“…Moreover, geographic clusters of cases in which no verifiable food source have been determined, such as those recently caused by S. javiana in the southeastern US which do not follow the same geographic patterns as cases which have been linked to a known food source but rather mimic amphibian distribution patterns (Srikantiah, 2004). S. typhi, which is only transmitted from human to human, is most common in developing nations where access to safe drinking water may be limited and waste disposal and treatment may be inadequate (Velema et al, 1997).…”