TYPHOID FEVER & CONTROL MEASURES. Dr . I. Selvaraj.
Dr . I. Selvaraj
In 1906, Irish immigrant Mary Mallon worked as a cook in the Oyster Bay summer home of New York banker Charles Henry Warren and his family. By the end of the summer, six members of the household had contracted typhoid fever. The Warrens hired sanitary engineer, George Soper, to determine the source of the disease. Soper concluded that Mallon, while immune herself to the disease, was its carrier. For three years, she was isolated on North Brother Island, near Rikers Island, earning the nickname "Typhoid Mary." Instructed not to cook for others upon her release, she nevertheless changed her name and became a cook at a maternity hospital in Manhattan. At least 25 staff members contracted typhoid. "Typhoid Mary" returned to North Brother Island, where she lived alone for 23 years, until her death in 1938. She is shown here on the island in an undated photo. She died of a stroke after 23 years in quarantine.
b) Food poisoning group
The bacilli are killed at 55ºc in one hour or at 60ºc in 15 minutes.
They are killed within 5 minutes by mercuric cholride or 5% phenol
Boiling or chlorination of water and pasteurization of milk destroy the bacilli
The proportion of typhoid to paratyphoid A is 10:1, Paratyphoid B is rare and paratyphoid C is very rare in India
Occupation : Certain categories of persons handling the infective material and live cultures of S. typhi are at increased risk of acquiring infection.
Socio-economic factors : It is a disease of poverty as it is often associated with inadequate sanitation facilities and unsafe water supplies.
Incubation period : Usually10-14days but it may be as short as 3 days or as long as 21 days depending upon the dose of the inoculums.
Reservoir of infection : Man is the only known reservoir of infection - cases or carriers.
Period of communicability: A case is infectious as long as the bacilli appear in stool or urine.
Mode of transmission : The disease is transmitted by faeco - oral route or urine – oral routes – either directly through hands soiled with faeces or urine of cases or carriers or indirectly by ingestion of contaminated water, milk, food, or through flies. Contaminated ice, ice-creams, and milk products are a rich source of infection.
Temporary (convalescent or incubatory) carriers usually excrete bacilli up to 6-8 weeks. By the end of one year, 3-4 per cent of cases continue to excrete typhoid bacilli.
Persons who excrete the bacilli for more than a year after a clinical attack are called chronic carriers.
Salmonella typhiinfecting the body via the Peyer's patches of the small intestine. The bacteria migrates to mesenteric lymph nodes and arrive via the blood in the liver and spleen during the first exposure. After multiple replication in the above locations, the bacteria Migrates back into the Peyer's patches of the small intestine for the secondary exposure and consequently the clinical symptoms are seen. Inflammation in the small intestine leads to ulcers and necrosis.
Typhoid hepatitis,Emphyema, Osteomyelitis, and Psychosis.
2-5% patients may become Gall-bladder carriers
Wilson and Blair bismuth sulphite medium jet black colony with a metallic sheen
Other disease or conditions that need to be eliminated
Other infectious diseases
MEASURES DIRECTED TO RESERVOIR
a) Case detection and treatment
c)Disinfection of stools and urine
d)Detection & treatment of carriers
MEASURES AT ROUTES OF TRANSMISSION
a) Water sanitation
b) Food sanitation
c) Excreta disposal
d) Fly control
MEASURES FOR SUSCEPTIBLES
THREE TYPES OF VACCINES
2. The live oral vaccine (TYPHORAL)
3. TAB vaccine
Injectable Typhim -Vi
The most common adverse reactions are injection site pain, erythema, and induration, which almost always resolve within 48 hours of vaccination. Occasional fever, flu-like episodes, headache, tremor, abdominal pains, vomiting, diarrhea, and cervical pains have been reported.
Nausea, abdominal pain and cramps, vomiting, fever, headache, and rash or urticaria may occur in some instances but are rare.
Typhoid & paratyphoid fevers
International Classification of Disease Codes for Typhoid fever