1) An investigation was conducted into an outbreak of typhoid fever in a remote village in Pakistan where over 300 people were infected and 3 died within a week. 2) Laboratory analysis found Salmonella enterica serovar Typhi in all water samples from the village well, which was suspected to be the source of contamination. 3) Clinical samples from 22 patients tested positive for multidrug-resistant Salmonella typhi, confirming it as the cause of the outbreak. The contaminated village well was identified as the source of the outbreak.

2. Investigation of a community outbreak of
typhoid fever assosiated with drinking water
Research Journal: BMC Public Health
(Published in december 2009)
www.biomedcentral.com/1471-2458/9/476
Researchers: Amber Farooqui*, Adnan Khan
and Shahana Urooj Kazmi.
Presented By: XIA MUJAHID

3. Introduction
Salmonella is the most commonly
involved bacteria in gastrointestinal tract
infections, its significant involvement in
human mortality and morbidity, morbidity
is a major health concern. The most
important pathogen of this genus is
Salmonella typhi. Which causes typhoid
fever in humans.
 All members of this genus are gram
negative short bacilli that occurs singly.
Motile by peritrichous flagella, they are
noncapsulated and nonsporing

4. Background
This report is based on the investigation of an
outbreak of typhoid fever occured in the Nek Muhahammad
village, situated 25km far from metropolitan city of Karachi.
In Oct. 2004, an outbreak of diarrhea and vomitting with
high grade fever hits this area. Onset of symptoms was
rapid, infected more than 300 people within a week!
Local people contacted EDHI Foundation, that immediately
set up a medical camp. They provide treatment and sent
severe patients to local hospitals. BUT...
Only in 5 days three people were DEAD...!!!
So, the team of microbiologists of Karachi Univesity
visited the vicinity.

5.  They found the village is so poor and have very limited
facilities of water, food, electricity and health care.
 They also discovered a Well, which was polluted with
dead and decaying bodies of birds & amphibians.
 This Well was cleaned 2 days before the onset of
symptoms.
 They interviewed the villagers, collected the
enviornmental & clinical samples.

6. Methods
 Sample Collection:
 100 Stool samples from patients (>38 C temp.)
 10 water samples from well
 90 water samples from houses which was collected from
contaminated well.

7. Laboratory diagnosis of Collected Samples
 Enviornmental samples:
The quality of collected water samples were checked by
standard methods:
 SPC
 MPN
 MFT

8.  Clinical samples:
For the Clinical specimens diarrheal stool samples were
collected and analyzed by following methods:
 Microscopic (for ova & parasites)
 Bateriology (for Salmonella, Shigella, E.coli (O157:H7), Yersinia &
Vibrio cholerae.
The following media were used for culture:
 MacConkey’s agar
 SS agar
 TCBS agar
 Sorbitol MacConkey’s agar (Oxoid)

9. For bacteriological identification following biochemical
reactions were performed:
 Oxidase
 TSI
 Sulfide
 Citrate
 Urease
 API20E strips (analytical profile index)
 Antisera (Specifically for Salmonella)

10. Results:
The typhoid fever hit the remort area of Nek village in Oct . 2004
typically after cleaning of “well” 2 days before the onset .
In the cleaning no chemical method was followed.
In the tatal 500 villagers 300 people showed the symptoms.
Enviornmental samples:
 Microbiological analysis showed the presence of Salmonella
enterica serovar Typhi in all well water samples.
 Gram positive and Gram negative bacteria were also detected as
normal flora.
 E.coli H157:O7 and other enteric pathogens were also observed.

11. Clinical Samples:
 Salmonella typhi was isolated as sole pathogen from ALL clinical
samples.
 22 patients were positive by MDR Salmonella typhi.
 No other significant pathogen was isolated from any patient stool
sample.
 No evidence of protozoal and parasitic involvement was observed
by microscopy .

12. Quality of Clinical & Eniornmental Samples
Samples No. Of samples (n) Average total Total coliform Sample positive Samples
viable count* Count*^ for Salmonella positive for
(CFU/ml or g) typhi Fecal idicators
(%) (%)
Clinical 100 - - 22 -
Samples (feces)
Well water 10 3 106 - 1 107 ≥1800 100 100
samples
Household 90 5 104 - 4 107 ≥1800 72 65
water samples
Cooked food 50 2 103 - 1 104 0 2 0
samples

13. Percent of typhoid patients showing symptoms during the outbreak. (n = 300)

14. Discussion:
 Drinking safe and healthy water is the right of every
human being.
 Unsafe drinking water and inadequate sanitary conditions
increase the risk of various public health hazards such as
typhoid fever.
 In Pakistan, 13.6% of total deaths are due to water
sanitation and hygiene.
 It is important to keep continuous vigilance in remote
areas where people still live under inhumane conditions
and provide them basic necessities of life.

15. Conclusion:
This study presented the link of contaminated well
water with the outbreak of typhoid fever in a remote
village which claimed three human lives and left more
than 300 people suffered within one week. In order to
avoid such incidences in future, they contacted the
local health authorities and urged them to
immediately make arrangements for safe drinking
water supply because...
for all livingbeings, specially humans..!!!