EPIDEMIOLOGY OF

TYPHOID FEVER

By :

Arulita Ika Fibriana, M.D.

Lecturer in Public Health Program,
Semarang State University

INTRODUCTION
INTRODUCTION
TYPHOID FEVER (TF) is an intestinal disease
which is still widely in developing countries, include
in Indonesia.
High incidence depends on many factors,
(In Indonesia 350-810 cases/100.000/years).
Many types of potential sources of transmission
infection.
Mortality is still high, may be caused by
complication.

INTRODUCTION
INTRODUCTION
Hygiene sanitation, personal hygiene and
ignorancy are important role on transmission.
Any problems on Era Post-Chloramphenicol
treatment :
(1) Relaps
(2) Drug resistency
(3) Clinical picture insidious
(4) Complications >>
In Indonesia : endemic, young adult, sex ratio no
difference.

DEFINITION
DEFINITION OF
OF TF.
TF.
Systemic infectious disease in
human, characteristic clinical
signed by continual fever, roseole,
toxemia, enlargment of spleen,
intestinal lymfadenopathy and
intestinal complication and/or nonintestinal.

TF. CAUSATIVE AGENT

EBERT (1880) discovered of TF causes Erbethella typhosa --> Salmonella typhi.
(WILLIAM BUDD, identified 1886), ACARD dan
BESANDI (1896) --> discovered of paratyphoid
bacteria.
S.typhi and S.paratyphi --> Salmonella group -->
Enteric Fever.
Paratyphoid fever is the same symptom and sign
with TF, mild sign, and duration of fever is short
time, diarrhae is dominant symptom.

SHEATH (Vi antigen)

FLAGELLUM
(H antigen)
SEXUAL PILUS
NUCLEUS

PLAMID (DNA)

CELL WALL
(O ANTIGEN)
CYTOPLASM

MORPHOLOGY OF AGENT
Gram negative bacteriae
Aerobic, nonsporing, motile coliform
Active motility by spiral
Easily destroyed by sunlight and desinfectan
Thermal death point in water is 60oC in
boiling water in 15 minutes
In faecal masses are protected
In septic tank can survived for 14 days.
Bacteria could be identified by antigenic
characteristic with the biochemical reaction.

EPIDEMIOLOGY OF TF
World-wide distribution,
Frequency of Paratyphoid fever
A, B and C is 10-30% of TF.
Climate & season are important
role.
No ethnic immune for TF/PTF.
Young Adult is frequent (< 30

EPIDEMIOLOGY OF TF
Global Annual Inc. 33 million
cases; case fatality is 500.000
cases/ year.
In developing countries 4-5
times greater than in developed
countries
Potential sources of infections :
active patients and carriers.

EPIDEMIOLOGY OF TF
Transmission to a new host
occurs directly or indirectly
Contamination may occurred
by :
(a) carriers patients,
(b) water supply, milk, ice,
(c) food, flies, fingers and
fomites.

INGESTION OF BACILLI (>105)

INTESTINAL

ABSORPTION

MULTIPLICATION IN MESENTRIC
LYMPHATIC GANGLIA
Bacterical lysis
liberation of endotoxin
into the blood

Bacterical reach the

blood by the
lymphatic system

ENDOTOXINS
AUTONOMIC HEART
NERVOUS
SYSTEM

SEPTICEMIA
DIGESTIVE
TRACT

HEMORRHAGE
INTESTINAL PERFORATION
CARDIOVASCULAR INSUFFICIENCY
AUTONOMIC DISTURBANCES
TYPHOID STATE

DISEMINATION
SPLENIC
BILIARY GLAND
HEPATIC
MENINGEAL
BONE
PULMONARY

SYMPTOM & SIGN OF

TF
Headache, malaise, confusion
Anorexia, nausea, vomitus
High fever (continues,
remittent)
Low of pulse rate (relative
bradicardia)
Spleen enlargement

CLINICAL EVOLUTION OF TYPHOID FEVER

INCUBATION
-asymptomatic

INVASION
PHASE
- ascillating fever
- dissociated pulse
- headache
- asthenia

STATUS
PERIOD

- intestiinal disturbances

- constant fever
- typhoid state
- diarrhea
- splenomegaly

EVOLUTION
long period of
convalescence
even with
suitable
and early
therapy

Temperature
400 C

370 C
D15
Contage

DO

D7

D21

BIOLOGICAL DIAGNOSIS OF TYPHOID FEVER

COPROCULTURE

1/800-1/1600

HEMOCULTURE

Anti--H Ab

1/400
WIDAL AND FELIX
SERODIAGNOSIS
8th
day

D15
Contage

D0

D7

12th
day

Anti-0 Ab

D21

CONTROL OF TYPHOID FEVER

Applying the principle of hygiene
Depend of the improvement of income
Cultural changes of personal hygiene
Many effort for control of TF, are :
(1) Treatment and control of sources
infection:
Adequate
antibiotic
treatment for active patients and
carriers, special isolation in the
hospital (?), desinfections of the
excreta, sterilization of the patients
linen etc.

CONTROL OF TYPHOID FEVER

(2) Improved on environment health
:
- To trace the source infection
- To investigate of routes
transmission
- Water purification/chlorination
- Control of all exposed foods for
sale in the market and store.
- Reduction the house-flies density
- To avoid of having open

CONTROL OF TYPHOID FEVER

(3) Supervision on food industries and
restaurant
. Supervision on sanitation of places work and
food processing, equipment etc.
. Prohibition to employ people who infected.
. Routine examination of stool culture.
. To trace of food, if as medium suspected
. All milk and milk products should be
pasteurized or boiled.

CONTROL OF TYPHOID FEVER

(4) Control of healthy population
. Supervision on hygiene of food and drink
. Serving the food in hot condition
. Health education for community
. Providing the places for washing hand
. Conducting vaccination of TF in
endemic
area, however, improvement of
sanitation and health system is very
important role.

CONTROL OF TYPHOID FEVER

Criteria of vaccination programme :
.
.
.
.

Having a highly efficacious vaccine

Having practical use
Having minimal side-effects
Relatively inexpensive

Recommended vacccination to :
. Community of TF highly endemic
. Individual travelling to endemic area
. Persons working in laboratories

CONTROL OF TYPHOID FEVER

Many type of TF vaccine :

. TAB Vaccine (Acetone killed vaccine) :
partial protection, more side effects.
. Wholle cell killed parenteral vacccine
(Acetone and heat phenol inactivated
vaccine, protective efficacy is 51-88%,
side effects >).
. Oral live attenuated vacccine (Ty21a) :
trial has been done in Egypt, Chile,
Indonesia.
. Vi parenteral vaccine : bacterial
subcomponent

CONTROL OF TYPHOID FEVER

Result of the Ty21a Trial

. Efficacy related to the TF incidence
. Related to the number of doses
ingested
. A short interval, better protection
. The liquid form is better than capsule
. Protective effects at least 3 years
. Minimal side-effects
. Possibility of developing herd
community
. Able to induce cellular and humoral
immune response.

CONTROL OF TYPHOID FEVER

Vi Parenteral Vaccine

. Adverse reactions is minimal

(systemic reaction may be observed)
. Other advantages of the Vi vaccine :
- Single dose administered
- Relatively inexpensive
- Can be used to infants and children
- Could be mixed with other vaccine
- Personal compliance is good
- Booster is done after 3 years

SUMMARY OF TF CONTROL

TF most prevalent in developing countries.

In Indonesia incidence still high.
Transmission most of indirectly route.
The strategies of TF Control are :
. Detection and control of source,
. Disease survaillance,
. Health education in community,
. Improvement of sanitation,
. Promotion of food hygiene,
. Prevention contamination in food production,
. Conducting TF vaccination.