• Preller Square | Dan Pienaar | Bloemfontein
  • Mon - Fri: 06:00 - 17:00

Category Archives: Typhoid Fever


Is it a stomach bug or typhoid fever? How to tell the difference, according to an expert

There have been reports of cluster outbreaks of typhoid fever in the Western Cape and North West provinces.

At the same time, anecdotal evidence suggests that there are also currently cases of ‘gastro’ in the country.

The two are, however, not linked and symptoms are not the same, according to the NICD.

On 16 February, the National Institute for Communicable Diseases (NICD) announced an outbreak of enteric fever, also known as typhoid fever, in the Western Cape and North West provinces.

There were a total of four cluster outbreaks – three of them in the Western Cape and one in the North West provinces, said Dr Juno Thomas, head of the centre for enteric diseases at the NICD.

Thomas said the number of cases in each cluster was small, ranging from 11–16 cases, and that the provinces were aware of these cases and were investigating them.

Distinguishing between the two

While cases of enteric fever cannot be confirmed without a blood culture lab test that detects bacteria in a person’s blood, she said symptoms of the bacterial disease are not the same as that of the typical acute gastro stomach bug.

Said Thomas: “The symptoms of enteric fever include a fever, which is often high and can last for many days or even weeks; headache; lethargy and fatigue; nausea; in many cases abdominal pain; and in some cases, either diarrhoea or constipation.”

By contrast, symptoms of gastro mainly include watery diarrhoea, stomach cramps, nausea, and in some cases, a low-grade fever.

“During summer months, we often see an increase in acute gastroenteritis, so-called ‘tummy bugs’ – this is not typhoid fever,” said Thomas.

She added: “These sorts of gastroenteritis are caused by a range of other bacteria and viruses that commonly cause more disease in the summer months.”

More about SA’s typhoid outbreaks

The World Health Organisation estimates that up to 20 million people develop typhoid fever and up to 161 000 people succumb to the disease each year.

The last time there was a large outbreak of typhoid fever in South Africa was in 2005 in Delmas, said Thomas. Since then, the country has seen fewer than 150 cases per year across all provinces.

“During 2020 and 2021, the total number of cases reported across the country didn’t differ from the years before, but we did notice that there was a small increase in the Western Cape and North West provinces,” Thomas said.

Causes of typhoid fever

Thomas said the growing rate of urbanisation – which leads to overcrowded populations in small areas – coupled with inadequate water and sanitation systems, as well as climate change, will drive an increase of typhoid fever across many low- to middle-income countries, and that SA was no exception.

Once infected, people can become carriers of the bacteria for years. “Some people carry them in their gut lifelong, and they continue to replicate in the gut and get shed in the stools (faeces), and these people act as reservoirs and can continue contaminating food and water sources,” said Thomas.

Protecting yourself

Contaminated municipal water is unlikely to be the source of infection in any of these typhoid fever cluster outbreaks, said Thomas.

There are measures you can take to protect yourself from being infected.

Said Cohen: “It’s important to note that the most important preventive measures are having access to safe water and formal sanitation.”

People can also prevent themselves from getting infected by ensuring that they are practising good hand hygiene, especially after using the toilet and before eating and preparing food.

If you are concerned that the water you are using for drinking and cooking is unsafe, then it is recommended that you treat it yourself, said Cohen.

You can do this by bringing water to a boil for a minute and then letting it cool. Alternatively, you can treat it with household bleach by adding 5ml of household bleach to 20 litres of water, mixing and letting it stand for half an hour before drinking or using it for cooking, she explained.

“Food safety is also extremely important and people are reminded to practise the five keys to safer food that the WHO promotes,” said Cohen.



5 ways to prevent and control Typhoid fever

Durban – The National Institute for Communicable Diseases this week confirmed an outbreak of enteric fever also known as typhoid fever in the North West and Western Cape.

The NICD said typhoid is a potentially life-threatening infection.

“These bacteria only infect humans, and humans are the only reservoirs. Transmission of the infection is by the faecal-oral route – through ingesting food or water that has been contaminated with faeces of an infected person. It is a disease of poverty, because it is usually associated with a lack of clean drinking water and poor sanitation.

“The disease continues to be a public health problem in many lower and middle income countries in Africa, the Americas, South-East Asia and the Western Pacific regions,” the NICD explained.

The most characteristic symptom is a high fever which is usually prolonged, and other symptoms include fatigue, headache, nausea, abdominal pain, and constipation or diarrhoea. Severe disease may occur, and can lead to severe complications which can be fatal.

The prevention and control of enteric fever

The measures to prevent and control enteric fever have long been known, and proven to be very effective. They include:

  • Water and sanitation infrastructure: safe drinking water and improved sanitation
  • Public health measures: correctly diagnosing and treating cases, finding and treating carriers
  • Food safety
  • Health education: hand washing, food safety practices
  • Vaccination: the World Health Organization recommends that countries with very high burdens of disease or high burdens of antibiotic resistant S. Typhi include typhoid vaccination in their vaccination programmes. Typhoid vaccination can also be one of the tools used for controlling outbreaks, along with providing safe water and improved sanitation and other public health measures.

Should you find yourself experiencing any of the symptoms, you are advised to immediately seek treatment. Enteric fever is readily treatable with antibiotics, and most patients recover without complications. However, the fatality rate for patients with severe disease who develop serious complications can be up to 30%.

The results of WGS and cgMLST analysis are still pending for several isolates from cases detected in Western Cape and North West provinces during January 2022, so case numbers may change as these results become available. Picture: NICD

Preventive measures for the public include
  • Hand hygiene. Wash hands with soap and safe water before eating or preparing food, and after using the toilet or changing a baby’s nappy.
  • Food safety practice. Follow the World Health Organization’s five keys to safer food: keep clean; separate raw and cooked; cook thoroughly; keep food at safe temperatures; and use safe water and raw materials.
  • Using safe water. If people are concerned about the quality of water they use for drinking and cooking, then it is recommended to treat the water first by boiling it or treating it with household bleach by adding 1 teaspoon of household bleach to 20-25 litres of water, mix well and leave it to stand for at least 30 minutes before use.



Everything you need to know about typhoid fever and how to treat it

Enteric fever is a potentially life-threatening infection. It includes typhoid fever (caused by the bacterium Salmonella Typhi) and paratyphoid fever (caused by the bacterium Salmonella Paratyphi A, B and C). These bacteria only infect humans, and humans are the only reservoirs. Transmission of the infection is by the faecal-oral route (through ingesting food or water that has been contaminated with faeces of an infected person).

According to the World Health Organization (WHO), every year an estimated 11–20 million people develop enteric fever and between 128 000 – 161 000 people die as a result. In countries endemic for enteric fever (endemic meaning the constant presence of a disease in a population within a geographic area), children aged 5 to 15 years of age are typically at highest risk for disease and children under 5 years of age are at the highest risk of death.

Of concern is that the global phenomenon of urbanisation (leading to overcrowded populations and inadequate water and sanitation systems) and climate change (leading to flooding events and water shortages) are poised to increase the global burden of disease. Increasing antibiotic resistance and the recent emergence of extremely drug-resistant enteric fever is making it easier for typhoid to spread and more difficult to treat. Safe and effective typhoid vaccines are available, and the WHO recommends that countries with very high burdens of disease or high burdens of antibiotic resistant S. Typhi include typhoid vaccination in their vaccination programmes.

Cape Town: Last week, the National Institute for Communicable Diseases (NICD) announced an outbreak of enteric fever (commonly known as typhoid fever) in the Western Cape and North West provinces.

The Western Cape has reported 64 cases in three separate outbreaks in the Cape Town Metro health district, the Cape Winelands and the Garden Route. The North West has reported 18 cases in the Dr Kenneth Kaunda district.

Typhoid fever is endemic to South Africa and is caused by Salmonella Typhi.

The disease is usually spread through contaminated water or food. Once the bacteria has been ingested, it multiplies and enters the bloodstream and intestinal tract.

Typhoid fever can be confirmed through blood testing.

What are the symptoms?

Persons with typhoid fever will have the following symptoms: prolonged high fever, fatigue, headache, nausea, abdominal pain, and constipation or diarrhoea.

How can typhoid fever be treated?

Patients can treat the disease by taking antibiotics as prescribed by health professionals.

Washing hands with soap and water after using the bathroom or preparing food.

Not preparing or serving others food, the World Health Organization (WHO) believes this will lower the chance of passing the infection on to someone else.

Having a health-care professional test whether the Salmonella Typhi bacteria has remained in your body.

How can you arm yourself against typhoid fever?

Individuals can get vaccinated against the disease. An injectable vaccine based on the purified antigen is available for people aged two years and older. A live attenuated oral vaccine in capsule formulation is available for people aged five and older.

* Make sure all food consumed is properly cooked.

* Avoid consuming raw milk products, drink only pasteurised or boiled milk.

* Avoid ice, unless you’re sure the water is safe for drinking.

* If the safety of the water is questionable, boil the water before drinking.

* Wash hands thoroughly and frequently using soap.

* Wash fruit and vegetables carefully before consuming it.

* WHO advises fruits and vegetables eaten raw should be peeled.

Searching For Something?