Prevention of Enteric Fever is a challenge for everybody. Social awareness is the key to preventing enteric fever.

Name of Diseases

Typhoid Fever and Paratyphoid fever

Typhoid and paratyphoid fever is a major cause of illness in most developing countries, including Bangladesh. It remains the most common bloodstream infection in many resource-poor settings. It requires the ingestion of at least 105 Salmonella bacteria at a time to produce typhoid. Recently estimated 22 million new typhoid cases occur each year in the world, with some 0.2 million of these resulting in death. Paratyphoid fever is similar in its symptoms to typhoid fever, but typhoid fever has a higher fatality rate. Bangladesh is located in a region where typhoid is highly endemic.  Prevention of enteric fever is a gradual process and only social awareness can mitigate the disease.

Source of Infection

Food & Drinks (Raw vegetables, meat, seafood, milk & water)

Responsible Microorganisms

• Salmonella enterica serovar Typhi (Salmonella Typhi): Typhoid Fever
• Salmonella enterica serovar Paratyphi (Salmonella Paratyphi): Paratyphoid Fever

Size & Shape: Rod Shaped 0.7 – 1.5 µm by 2.0 – 5.0 µm

Source of contamination: Stool and urine of infected persons

Note: Salmonella absorbs oxygen as a parasite from human body to live and reproduction. Human may be infected due to take Salmonella contaminated water and food, sometimes may die also. Case-fatality rates of 10% can be reduced to less than 1% with appropriate antibiotic therapy. Children and Adolescents (up to 19 years) are more vulnerable to this infection.

The Root of transmission: Digestive system (Mouth & Nose)

Clinical Symptoms

• Fever (Temperature ≤1030 F and persist 7 days or more)
• Headache
• Nausea, Vomiting
• Diarrhea (Sometimes bloody)
• Urinary Tract Infection (UTI), Nephritis
• Splenomegaly
• Abdominal pain or cramp
• Constipation
• Gastroenteritis
• Cough
• Bradycardia

Incubation Period: 8 – 14 days

Symptoms existence: 2 – 6 weeks with possibilities of recurrent contamination

Complications

• Loss of appetite
• Cholecystitis
• Intestinal perforation or hemorrhage
• Myocarditis

Management of Typhoid Patients

• Oral Saline for dehydration management
• Consultation with medical doctor as soon as possible
• Proper antibiotic (Directed by physician) after confirm diagnosis

Vaccines for Typhoid

• There are three types of typhoid vaccines licensed for use:*
• Typhoid conjugate vaccine (TCV)
• The unconjugated Vi polysaccharide (ViPS) vaccine
• The live attenuated Ty21a vaccine.

In 2018, WHO Recommended

• The first prequalified TCV for intramuscular administration of a single dose (0.5 mL) in children ≥ 6 months of age and in adults up to 45 years of age.
• The VIPs vaccine is recommended for intramuscular or subcutaneous administration in individuals 2 years of age and older.
• Ty21a vaccine is available in enteric-coated capsules recommended for oral administration on alternate days in a three-dose regimen in persons above 6 years of age.

Repeat vaccination is recommended for VIPs every three years, and for Ty21a every three to seven years, depending on national policies. There are currently no licensed vaccines against paratyphoid fever and iNTS disease. Prevention of enteric fever is not impossible but necessary steps need to be taken.

Cause of Salmonella Contamination

• Defective sewage system (Housing or farming)
• The defective or unclean water supply system

Prevention from Salmonella Pollution

• Drink safe water
• Maintain hygiene and use safe water including cooking food
• Develop sewage and water supply system, sanitary disposal of excreta
• Preserve separately raw and cooked food
• Use RO purifier to ensure safe drinking and kitchen water

MICRO Filtration: Pore size: 0.1 micron

ULTRA Filtration: Pore size: 0.01 micron

NANO Filtration: Pore size: 0.001 micron

Reverse Osmosis (RO) Filtration: Pore size: 0.0001 micron

Note: The pore size of the membrane of RO Purifier is too small than the size of Salmonella. For this reason only RO purifier with accurate size (0.0001 microns) of membrane capable to prevent Salmonella and ensure 100% safe drinking & kitchen water Solution.

To ensure pure drinking water and health safety ULTIMA CARE brought RO Purifier for you. The process of 6-10 steps water purifier prevents harmful germs and provides you with 100% safe water for drinking. Prevention of enteric fever will no longer serious issues if safe water treatment is insured.

Ultima RO Water Purifier

Edited By:

Dr. Hefjur Rahman Ojaer

BUMS (DU), MPH (NIPSOM – BSMMU)

Source

• https://www.dhakatribune.com/uncategorized/2013/06/21/treating-typhoid
• https://www.who.int/immunization/monitoring_surveillance/burden/vpd/WHO_SurveillanceVaccinePreventable_21_Typhoid_R1.pdf?ua=1
• https://apps.who.int/iris/bitstream/handle/10665/272272/WER9313.pdf?ua=1