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Typhoid fever

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  1. 1. Typhoid Fever
  2. 2. Definition <ul><li>An acute, highly infectious disease caused by a bacillus  (Salmonella typhi)  transmitted chiefly by contaminated food or water and characterized by high fever, headache, coughing, intestinal hemorrhaging, and rose-colored spots on the skin. Also called  enteric fever . </li></ul>
  3. 3. Signs and Symptoms <ul><li>Sudden onset of sustained fever. </li></ul><ul><li>Severe headaches </li></ul><ul><li>Nausea </li></ul><ul><li>Stomach pain </li></ul><ul><li>Severe loss of appetite. </li></ul><ul><li>Insomnia and feverishness </li></ul><ul><li>Temperature of the body is slightly high in the morning, then it gradually becomes normal in the afternoon and then again rises in the evening. The temperature of sustained fever may go up to as high as 103° to 104° F (39° to 40° C ). </li></ul>
  4. 4. Other Signs and Symptoms <ul><li>Sore throat </li></ul><ul><li>Myalgia </li></ul><ul><li>Mild vomiting </li></ul><ul><li>Lassitude and discomfort </li></ul>
  5. 5. Mode of Transmission <ul><li>Typhoid fever is transmitted through contaminated water and food. </li></ul><ul><li>Salmonella is transmitted by contaminated water and food and rarely by direct contact. Water, ice (if unboiled water used), raw vegetables, salads and shellfish are important sources for travelers. The disease commonly occurs in association with poor standards of hygiene in food preparation and handling. </li></ul>
  6. 6. Period of Communicability <ul><li>It is communicable as long as typhoid or paratyphoid bacilli are present in excreta. Some patients become permanent carriers. </li></ul><ul><li>Susceptibility and Resistance </li></ul><ul><li>Everyone is susceptible to infection. Immunity following clinical disease or immunization is insufficient to protect against a large infectious dose of organisms. </li></ul>
  7. 7. Methods of Control <ul><li>Preventive measures: </li></ul><ul><li>Vaccination </li></ul><ul><li>-Vaccination is not routinely recommended, except for travelers who will be exposed to potentially contaminated food and water in countries such as in Asia, the Middle East, Africa, Latin America and the Pacific Islands. </li></ul>
  8. 8. <ul><li>-Vaccination does not offer full protection from infection and travelers should be advised to exercise care in selecting food and drink. </li></ul><ul><li>-No vaccine is available against paratyphoid fever. </li></ul><ul><li>Control of Case: </li></ul><ul><li>Hospitalization </li></ul><ul><li>-Hospitalization is usually required for acute infections. </li></ul><ul><li>-Antibiotic therapy may include one or more to the following agents: ciprofloxacin, ceftriaxone, chloramphenicol, amoxycillin or co-trimoxazole. However, strains resistant to chloramphenicol, amoxycillin and co-trimoxazoleare common in south Asia. Failure to respond to ciprofloxacin has-been reported from Vietnam. In the UK decreased susceptibility to ciprofloxacin has been exhibited with increasing numbers of treatment failures particularly in patients with a travel history to India and Pakistan. A similar picture is emerging in Victoria with ongoing S.typhi and S. paratyphi after treatment being noted. </li></ul>
  9. 9. <ul><li>Education </li></ul><ul><li>-The community should be educated about personal hygiene, especially thorough hand washing after toilet use and before food preparation. </li></ul><ul><li>-Education should be given to the patient regarding the importance of completing the course of antibiotics, the possibility of relapse, persisting excretion, the need for good personal hygiene and precautions in food preparation. </li></ul><ul><li>-Follow-up of all patients is conducted by the Department of HumanServices to identify possible sources of infection, other cases, andto manage ongoing risks. </li></ul>
  10. 10. <ul><li>If the patient is a food-handler or works in a profession that posses a high risk of transferring infection to others, such as health care workers, or child care workers, they should be advised to cease work until advised by the Department. </li></ul><ul><li>The Department arranges the collection and testing of weekly faecal specimens for S. typhi or S. paratyphi to be taken over three consecutive weeks, commencing no sooner than at least 48 hours after cessation of antibiotic treatment. Food handlers and workers in high risk professions are generally excluded from high risk work or patient care until they have had three consecutive negative faecal specimens. </li></ul><ul><li>Control Contacts </li></ul><ul><li>Contacts should be educated about the disease so as to reduce the risk of transmission and to allow for early identification if they develop symptoms. </li></ul><ul><li>The decision to screen contacts of cases is dependent upon the extent of contact and the likely source of the patient's infection. Faecal screening is generally arranged for: </li></ul><ul><li>Household contacts of a case who are food-handlers or in a high risk profession. Screening is more intensive and includes the entire household if the patient has no history of travel to a typhoid-endemic area. </li></ul><ul><li>Fellow travelers. </li></ul><ul><li>Use of typhoid vaccine for contacts is not generally recommended. Typhoid vaccination is only recommended for persons with intimate exposure to a documented typhoid fever carrier, such as occurs with continued household contact. </li></ul>
  11. 11. <ul><li>Control of environment A public health investigation is carried out to determine the most likely source of infection. A history of travel to an endemic area is usually found. </li></ul><ul><li>If there is no history of travel, local sources of infection are investigated to identify further cases, asymptomatic carriers, and contaminated food items. </li></ul><ul><li>Food industry If a case is involved in commercial food preparation, the Department will determine the appropriate management of the workplace on an individual basis. </li></ul>
  12. 12. Programs for Prevention <ul><li>Food and Waterborne Diseases Prevention and Control Program </li></ul><ul><li>-The Food and Waterborne Disease Prevention and Control Program (FWBDPCP) established in 1997 but became fully operational in year 2000 with the provision of a budget amounting to PHP551,000.00. The program focuses on cholera, typhoid fever, hepatitis A and other food borne emerging diseases. Other diseases acquired through contaminated food and water not addressed by other services fall under the program. </li></ul>
  13. 13. Thank you!! Xiexie!! END:)