Management, Epidemiology and Pathogenicity of Typhoid Fever

Background

Typhoid fever is among the four most important infectious diseases in the eastern Indonesian archipelago. The disease often manifests with severe complications and has a high mortality rate. Typhoid fever is caused by infection with Salmonella enterica serovar Typhi and is common in poor and crowded communities and in rural areas.

The pathogen is spread by the oral-fecal route and the consumption of contaminated food and water along with poor hygiene, sanitation and living conditions are among the major factors that add to the high prevalence and spread of the infection. Even though humans are the exclusive hosts of S. Typhi, the epidemiology is complex and the control and prevention of typhoid are complicated by the presence of asymptomatic carriers who periodically shed large amounts of bacteria in their stool.

Recently the Indonesian government has recognized the importance of typhoid fever and started the supply of antibiotics to health care centers and hospitals. However, most medical facilities lack the appropriate diagnostic tools to make a proper diagnosis. In order to develop an effective strategy for disease control it is essential to have detailed knowledge about the prevalence, drug-susceptibility, risk groups and risk factors.
Objectives

The main objectives of this project are to promote early typhoid fever diagnosis and treatment, improve treatment outcome and reduce morbidity. Furthermore, sources of infection and risk factors for disease will be identified, determinants and the dynamics of transmission will be investigated and protocols for disease control and preventive measures will be developed.
Activities

• implementation of blood culture and the use of a simple and rapid device in health facilities in South-Sulawesi, East Papua and East Kalimantan to improve the early diagnosis and treatment of typhoid fever

• characterization of S. Typhi isolates to look for a correlation of specific genetic characteristics with phenotypic traits and disease presentation

• isolation of S. Typhi from gallbladder samples to search for carriers

• identification of major risk factors and risk groups and the development of a set of recommendations for the prevention of typhoid

Our results indicate that in urban and suburban communities the risk of attracting typhoid fever is associated with general low hygiene and associated poor food habits. Disease education of school-age children could be a highly effective tool to improve hygiene at the household level and in time could be essential to persuade policy makers to improve sanitation and drinking water supply and to implement a vaccination program.

Funders

UBS Optimus Foundation