NICD raises red alert about typhoid fever in SA

The National Institute for Communicable Diseases (NICD) says investigations of typhoid outbreaks are ongoing in at least two provinces — the Western Cape and North West — after a spike of cases in these two regions this year.

Head of the centre for enteric diseases Juno Thomas said the institute is currently working with health authorities to bring under control three separate outbreaks in the Western Cape and another one in the North West.

She said since the outbreak of cases dating back to 2020, the NICD is using a genome sequencing — similar to the one used in 2017 to trace listeriosis — to investigate all typhoid fever cases in the country to check the genetic makeup of the outbreaks. This will help investigators trace where the clusters of cases are and where the common source of infection is. The same technology has helped investigators to understand the genetic makeup of different clusters of infection from various parts of the country.

While the country generally saw less than 150 cases of typhoid fever a year in the last few years, there was a steady increase of typhoid cases, particularly in the two provinces.

Typhoid fever, also called enteric fever, is a systemic illness caused by a bacterial infection with Salmonella enteric. In the pre-antibiotic era, typhoid carried a mortality of 5-20%, but there are currently very effective antibiotics for treatment. In SA, typhoid is a notifiable condition, as it has outbreak potential.

The Western Cape currently has 64 cases of typhoid in three separate outbreaks. Gauteng has recorded 45 cases and there are 18 cases in the North West. Thomas said even though Gauteng has a high number of cases, the disease is so extensively distributed in that province that there is no distinct outbreak.

The latest outbreak in the Western Cape and North West follows the country’s last outbreak in 2005 in Delmas, Mpumalanga, where almost 3,000 cases of typhoid were recorded due to contaminated water.

In the Western Cape the outbreaks are currently in the Cape Town Metro health district, the Cape Winelands and the Garden Route.

In the North West, the outbreak is in the Dr Kenneth Kaunda district.

Thomas said finding possible sources of typhoid transmission in the midst of an outbreak can be quite challenging as there are sometimes multiple sources of transmission, which include contaminated food and water supplies.

“This can be at the household level, but it can also be at a much larger population level. For example, if you've got someone who works in the food industry and handles a lot of food that gets distributed quite widely and eaten by many people, then there’s a potential for many people to become infected. But then if you have contamination of a water system that serves thousands of people and it’s heavily contaminated, then you’ll get obviously many hundreds or thousands of cases quite rapidly.”

She said the outbreaks in the two provinces had cases stretching back from 2020, making them “established outbreaks”.

Thomas said one of the challenges in diagnosing typhoid fever in SA is lack of awareness among clinicians and healthcare workers. Even though SA has fewer cases of typhoid fever, the NICD noted that this bacterial infection is significantly underreported with healthcare workers generally not investigating its symptoms such as headaches, diarrhoea, nausea, and weakness.

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