Investigation of a typhoid fever epidemic in Moyale Sub-County, Kenya, 2014–2015

Abstract

AimTyphoid fever is a vaccine-preventable bacterial disease that causes significant morbidity and mortality throughout Africa. This paper describes an upsurge of typhoid fever cases in Moyale Sub-County (MSC), Kenya, 2014–2015.MethodsWe conducted active hospital and health facility surveillance and laboratory and antimicrobial sensitivity testing for all patients presenting with headache, fever, stomach pains, diarrhea, or constipation at five MSC health facilities between December 2014 and January 2015. We also conducted direct observation of the residential areas of the suspected cases to assess potential environmental exposures and transmission mechanisms. Demographic, clinical, and laboratory data were entered into, and descriptive statistics were calculated with, MS Excel.ResultsA total of 317 patients were included in the study, with mean age 24 ± 8.1 years, and 51% female. Of the 317 suspect cases, 155 (49%) were positive by Widal antigen reaction test. A total of 188 (59%) specimens were subjected to culture and sensitivity testing, with 71 (38%) culture positive and 54 (76%), 43 (60%), and 33 (46%) sensitive to ceftriaxone, cefuroxime, and ciprofloxacin, respectively. Environmental assessments through direct observations showed that commercial and residential areas had limited (1) clean water sources, (2) latrines, and (3) hygiene stations for street food hawkers and their customers.ConclusionsTyphoid fever is endemic in MSC and causes significant disease across age and sex groups. The local health department should develop policies to (1) assure community access to potable water and hygiene stations and (2) vaccinate specific occupations, such as food and drink handlers, against typhoid.

Factors Associated with Salmonella Infection in Patients with Gastrointestinal Complaints Seeking Health Care at Regional Hospital in Southern Highland of Tanzania

“…The association of Salmonella infection with eating in restaurant is an indication some restaurants do not observe proper hygienic conditions for food preparation and storage, hence increasing the likelihood of Salmonella infection. [3,6] The study found all Salmonella isolates sensitive to ceftriaxone and ciprofloxacin comparable to a study conducted in Kenya. [17] It should be noted that resistance of Salmonella spp to fluoroquinolones has been reported in Uganda and Japan.…”

“…[4,5,9] On the other hand, our finding was lower than the study conducted in Kenya. [6] The variation between studies on Salmonella infection could be due to differences in the type of patients enrolled such as age, immune status or underlying conditions, predisposing factors, as well as variations in bacteriological techniques and specimen used. In some studies, like the present one, only stool culture was performed, while other studies performed blood and stool cultures.…”

“…[12,16] The availability of clean and safe water has been a key determinant of the prevalence of Salmonella infection. [6] Therefore, the variations in different regions for clean, safe and scarcity of water could explain the variations in magnitude and contributing factors for Salmonella infection. The study found that drinking untreated water particularly from rivers or wells among people with gastrointestinal complaints had a high likelihood of being infected with Salmonella.…”

“…[3,4] Salmonella is among common food-borne pathogens predominantly found in poultry, eggs, dairy products, and vegetables, directly or indirectly from human or animal excreta. [1,5,6] The risk for infection is high in low-income countries due to poor hygiene and lack of access to safe water and food. [3,6,7] NTS infection accounts for 93.8 million cases of gastroenteritis and 155 thousand deaths per annum globally.…”

“…[1,5,6] The risk for infection is high in low-income countries due to poor hygiene and lack of access to safe water and food. [3,6,7] NTS infection accounts for 93.8 million cases of gastroenteritis and 155 thousand deaths per annum globally. [2] Studies conducted in Tanzania among patients with febrile illnesses revealed that Salmonella spp is among the predominant isolate causing either bacteremia or gastroenteritis.…”