Drought water rationing heavy rains and the outbreaks of typhoid in Zimbabwe

Typhoid outbreak in Harare and around Zimbabwe: what is typhoid.

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Zimbabwe is going through a very wet spell right now after such a severe drought  and now Typhoid is dominating the headlines. Of significance was the water rationing that was being implemented country wide for most of mid 2016. This pointed to the likelihood of development of outbreaks as people started drinking water from unprotected sources especially in large urban areas. The extract below from one of the local presses in Zimbabwe on the water rationing and drought highlights this point.

Extracted from Tropical infectious diseases by Guerrant, Walker and Willer

Zim runs dry

The devastating effects of the El Nino-induced drought are now being felt across the country with residents and officials warning of a potential national disaster if the critical water situation is not dealt with.

-With dams drying up and people now being forced to drink water from unprotected sources, residents groups in Harare, Gweru, Chitungwiza and Bulawayo fear an outbreak that could surpass the 2008/2009 era.

Parirenyatwa said as the rainy season approaches, possible outbreaks of waterborne diseases such as cholera, typhoid and diarrhoea are heightened.
“When water flows it scoops all the dirt and this dirt some of it goes into the shallow wells in the city here. Some people will take cholera infected water from those shallow wells,” he said.
Harare’s satellite town of Chitungwiza is also bearing the full brunt of water shortages with people now being forced to sleep in queues to access the basic commodity.

“Chitungwiza does not have its own source of water and depends entirely on the city of Harare. This means that households that used to access tap water once a week are now accessing it once per fortnight or a month,” Kumalo said.
He added that the situation has forced many residents to resort to shallow wells and boreholes which are also drying up fast.

“The quality of water is so appalling that people often find particulates floating in their tap....... You can see urine flowing along the sidewalks and that makes the spread of diseases very easy,”

(extracted from https://www.dailynews.co.zw/articles/2016/10/16/zim-runs-dry

dailynews.co.zw )

 

typhoid cycle extracted from Tropical infectious diseases by Guerrant and others

By end of year typhoid outbreaks were being recorded in Zimbabwe with the capital city having a number of cases. See extracts below on the outbreaks.

Typhoid outbreak strikes Harare

 "Harare’s oldest suburb of Mbare has been hit by an outbreak of the deadly typhoid fever which is suspected to have claimed the life of a 13-year-old girl amid fears that it could spread to other suburbs due to intensifying rains.
-they recorded at least 39 suspected cases of typhoid fever in Mbare where many have been sickened by contaminated water and food.
- On further investigations, about 30 people on 8th and 9th Street in Mbare were then treated for suspected typhoid. -At the moment, nine people from the area are admitted and several others receiving treatment as a precautionary measure. The city Health department has deployed heavily in Mbare to mobilise and educate residents against behaviour that may lead to typhoid and other communicable diseases,” added Chideme.


-“The city has provisionally singled out a borehole in the area as the source of the problem as its  not properly secured, a factor which might cause runoff water and sewer to seep through and cause illnesses,” Chideme said.
“The city encourages people exhibiting suspected typhoid symptoms to quickly seek medical attention, wash hands before and after eating food and after visiting the toilet.

extracted from  https://www.dailynews.co.zw/articles/2016/12/28/typhoid-outbreak-strikes-harare

Besides typhoid, other diarrhoeal diseases also were recorded, as can be seen from the extract below were an outbreak of shigella.

Typhoid outbreak hits city



-Harare City Health director Dr Prosper Chonzi said since last Friday they had confirmed three cases in Glen Norah, two in Hopley and one in Hatfield.
“We have sent our teams to assess the situation in those areas, particularly in Hopley, where there is strong suspicion that people could be sick from their homes. The teams will be interviewing and treating all suspected cases.”

Dr Chonzi said Hopley was a cause for concern because of its proximity to Mbudzi roundabout where people prepare food and sell fruits under unhygienic conditions.

“We are not yet sure of the magnitude of the problem because some people could still be in the incubation stage which takes up to 21 days. So we continue to urge residents to practice basic hygiene standards,” he said.
Dr Chonzi said more than 30 cases of typhoid in an area constituted an outbreak.

Meanwhile, 48 cases of Shigella have been recorded at Roosevelt Girls High School in Harare.
Shigella is a common diarrhoeal disease caused by bacteria. It spreads fast in areas with poor water and sanitation facilities.

http://www.herald.co.zw/typhoid-outbreak-hits-city/

Typhoid outbreaks was taken so seriously neighbouring countries such as South African offered an alert for fear of the disease crossing over to their countries. Below is another extract

Modes of transmission of disease from trpopical infectious diseases by Guerrant, Walker and Weller

  SA says on high alert

SOUTH Africa’s National Institute for Communicable Diseases (NICD) has issued an alert for typhoid fever to those returning from Zimbabwe.
The Health Department is already on high alert following an outbreak of typhoid cases up north across the Limpopo.
Head of the Outbreak Response Unit at the institute, Kerrigan McCarthy says health care practitioners and returning travellers need to be aware of the symptoms.
"The NICD has received reports of an increased number of cases of typhoid in Harare in Zimbabwe."
"We are very at risk of having acquired typhoid and we really want to release an awareness and alert to clinicians and also returning travellers to be aware of the symptoms."

Citizens blame erratic water supplies and poor sanitation for the spread of the water-borne disease.

https://www.dailynews.co.zw/articles/2016/12/28/typhoid-outbreak-strikes-harare

So what is typhoid?

Typhoid fever is a systemic infection caused by Salmonella Typhi, usually through ingestion of contaminated food or water. The acute illness is characterized by prolonged fever, headache, nausea, loss of appetite, and constipation or sometimes diarrhoea. Symptoms are often non-specific and clinically non-distinguishable from other febrile illnesses. 
However, clinical severity varies and severe cases may lead to serious complications or even death. It occurs predominantly in association with poor sanitation and lack of clean drinking water. According to the most recent estimates (published in 2014), approximately 21 million cases and 222 000 typhoid-related deaths occur annually worldwide. A similar but often less severe disease, paratyphoid fever, is caused by Salmonella Paratyphi A, B or C.

Two typhoid vaccines are currently recommended for use by:

• an injectable polysaccharide vaccine based on the purified Vi antigen (known as Vi-PS vaccine) for persons aged two years and above;
• and a live attenuated oral Ty21a vaccine in capsule formulation for those over five years of age.

WHO recommends the use of the Vi-PS and Ty21a vaccines to control endemic disease and for outbreak control. WHO further recommends that all typhoid fever vaccination programmes should be implemented in the context of other efforts to control the disease, including health education, water quality and sanitation improvements, and training of health professionals in diagnosis and treatment. 

(extracted from WHO http://who.int/immunization/diseases/typhoid/en/

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