Typhoid outbreak extends to capital hit by water supply problems

The typhoid outbreak in Gabon has spread to the capital Libreville, which has been grappling with water shortages for the past two weeks, Health Ministry officials said on Tuesday. The outbreak of this highly infectious water-borne disease began in the northern town of Oyem in December, but officials said there were now more than 100 cases nationwide, including 12 in Libreville. The city is home to more than half of Gabon's 1.2 million population. The number of confirmed typhoid cases nationwide has doubled from 50 two weeks ago, but so far only one death has been reported. Doctors from the Central Hospital of Libreville (CHL), the country’s largest public hospital, warned that difficulties in early diagnosis of typhoid and the fact that patients who had been treated for typhoid could remain carriers of the disease, meant that the full extent of the outbreak in the capital would not be evident for some time. “Typhoid fever takes hold gradually, first showing itself in a fever, a general feeling of ill-health: shivers, headaches and muscular pains,” Dr Hurbain Ndoumou told IRIN. “Diarrhoea is rare. Vomiting can occur – but only after the infection has taken hold for one week and then not amongst all victims,” he continued. But the problem does not stop with diagnosis: “Certain people who have already contracted typhoid fever and been treated, still carry the bacteria and remain potentially contagious,” Ndoumou warned. The Minister of Health, Paulette Missambo, immediately issued instructions for an education and sensitisation campaign in an attempt to improve hygiene standards and combat the spread of the bacteria. “Like all illnesses transmitted by faecal-oral ingestion, typhoid fever occurs mostly in areas and conditions of poor hygiene,” the Health Ministry warned in a statement. Typhoid fever is life threatening. The bacteria which causes the illness, Salmonella Tyhpi, lives in the blood and intestines of infected humans and is shed in their faeces. Contaminated water supplies and poor hygiene levels enable rapid transmission and infection. The disease first appeared in Oyem, a town of 35,000 people near the northern frontiers with Cameroon and Equatorial Guinea, following two months of disruption to the local water supply. Now the same problem has hit Libreville. Water company officials have blamed dry weather for water levels in the river which supplies the city, but they have also admitted that the main pump which lifts water from the river to the city's water treatment has broken down. Andre-Paul Apandina, the director general of the French-owned water and electricity company SEEG, said on state television last Sunday that the fault would take six months to repair. Since January 8, residents of Libreville have been forced to fetch water in buckets from temporary standpipes in the street. Water shortages were previously unknown in this densely forested country criss-crossed by large rivers, but the population of Gabon's main towns has increased rapidly in recent years and the water supply network has failed to keep pace with this expansion. Earlier this month, the deputy mayor of Oyem, Emmanuel Obame Ondo, blamed the privatisation of water supply services for the breakdown in water distribution in his town, saying SEEG had failed to extend water pipes to newly built areas. Many people from Oyem work in Libreville, 411 km to the southwest, but go home by car or plane at the weekends. This makes it likely that the infection spread to the capital from the north. Health officials said that within Libreville and other coastal towns, there was a strong risk of being spread through the consumption of raw shellfish, which is a popular food in the region. Poor hygiene among the city’s food and drinks sellers has also sparked cause for concern. A plethora of cold drinks and snacks prepared are consumed in the capital without access to running water and hand-washing facilities. The risk of typhoid infection can be greatly reduced by vaccination, but so far the government has not announced any plans for a vaccination campaign. The World Health Organisation (WHO) estimates there are about 16 million cases of typhoid a year worldwide, of which approximately 600,000 end in death. About 70 percent of all fatalities occur in Asia.