What is Enteric fever? Should you be worried?

The National Institute for Communicable Diseases (NICD) said a total of 115 cases of enteric fever had been reported in South Africa in 2022.

So let’s break it up and see what exactly enteric fever is and if we should be worried. 

WHAT IS ENTERIC FEVER? 

Typhoid fever, also called enteric fever, or simply ‘typhoid’, is a systemic illness caused by a bacterial infection with Salmonella enterica subspecies enterica serotype Typhi or serotypes Paratyphi A, B or C. In the pre-antibiotic era, typhoid carried a mortality of 5-20%. 

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However, there are currently very effective antibiotics for treatment. In South Africa, typhoid is a notifiable condition, as it has outbreak potential.

HOW IS ENTERIC FEVER TRANSMITTED?

Typhoid is transmitted by faeco-oral contact. The fecal–oral route (also called the oral–fecal route or orofecal route) describes a particular route of transmission of a disease wherein pathogens in fecal particles pass from one person to the mouth of another person.

The incubation period is usually 10-14 days (range 5-21 days). The infective dose is 100,000 organisms/ml

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WHAT ARE THE SYMPTOMS OF ENTERIC FEVER? 

• Fever that starts low and increases daily, possibly reaching as high as 104.9 F (40.5 C)
• Headache.
• Weakness and fatigue.
• Muscle aches.
• Sweating.
• Dry cough.
• Loss of appetite and weight loss.
• Stomach pain.

WHERE HAVE THE CASES BEEN CONFIRMED IN SA? 

A total of 115 cases of enteric fever have been reported nationally in 2022 to date (20 July 2022) from eight different provinces. 

Gauteng province reported most cases (51%; 59/115), followed by Western Cape province (18%; 21/115) and North West (14%; 16/115) as shown on table 1 below. Of the 59 cases reported from Gauteng province 53% (31/59) were reported from the City of Tshwane Metro. Most (68%; 21/31) of the cases reported from Tshwane were seen between May and July 2022.

PREVENTIVE MEASURES FOR THE PUBLIC: 

• 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: Contamination of municipal water is extremely unlikely to be the source of infection in any of these clusters. However, 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 (place water in a clean container and bring to a boil for 1 minute) or treating it with household bleach (add 1 teaspoon(5mls) of household bleach (containing 3 to 5% chlorine concentration) to 20 litres of water, mix well and leave it to stand for at least 30 minutes before use).

SHOULD YOU BE WORRIED? 

Enteric fever is endemic in South Africa and sporadic cases are reported in most provinces every year. Following the enteric fever outbreaks in 2005-2006, the number of culture-confirmed cases has remained stable with less than 150 cases per year. Most cases are locally acquired because of ongoing low-level transmission in affected communities, but imported travel-related cases are also identified. Although most cases are sporadic, small clusters and, infrequently, larger outbreaks do occur. Although persons of all ages are at risk for disease, children aged 5 to 14 years are usually most affected. There are usually more cases in the summer months. Paratyphoid fever remains uncommon in South Africa, with infrequent travel-related cases reported. 1.7 Antimicrobial