Typhoid outbreak expected to hit 1,000 cases

The number of typhoid cases in the Tajik capital, Dushanbe, is expected to hit 1,000 as health officials work to curb its spread. This latest outbreak to strike the impoverished Central Asian state, appearing two weeks ago, has already resulted in at least one death. "We are now talking about 800 [cases]. The numbers keep rising and we are expecting it to go over 1,000," Paul Handley, the officer-in-charge of the UN Office for the Coordination of Humanitarian Affairs (OCHA) in Dushanbe, told IRIN on Thursday, noting, however, that assistance, both international and local, had been put in place. "There is the potential that many hundreds of people were infected before the outbreak was first detected," he said, defining this as OCHA's main concern now. "It's just a case of finding these people now and making sure that they get adequate treatment." At least five hospitals are already reportedly working to capacity. The outbreak began in the central Frunze district of the city after a major source of piped water in the north of the city became contaminated. "It wasn't being chlorinated at the time. Water treatment is in a poor state here," Handley said, noting, however, that the outbreak source had since been controlled. "In this case, we are talking about the urban water supply system just falling into disrepair. The country simply lacks the resources to maintain it at an adequate level," he observed. Typhoid has been endemic in Tajikistan, with numerous cases occurring, especially after the collapse of the former Soviet Union in 1991, which, along with five years of civil war, has had a knock-on effect on the country's health and water supply systems. Such outbreaks occur every year, Handley noted, particularly in the summer months when people were forced to drink water from poor supply sources. Moreover, in the winter, pipes often cracked, thereby allowing sewage to seep into drinking water supplies, he added. Whereas it was not unusual to see another typhoid outbreak in the country, what was unusual was the scale of this one. "Obviously, with a typhoid outbreak in a city where there are many people living in close proximity, sharing hygiene and sanitation facilities, you have a high risk of it spreading quickly. And that, seemingly, is what has happened here," the OCHA official said. Meanwhile, a prompt response by the government appears to already be paying dividends. "They [the authorities] have a handle on it and it's just a case of managing the situation," Handley said. Some 500 personnel were mobilised, travelling door-to-door, for active detection and health education, around the worst-affected areas of this city of close to 1 million. Ministry officials claim the teams are reaching up to 200,000 people a day. On Tuesday, the health ministry appealed to a number of international organisations for assistance, including the World Health Organisation (WHO), the World Food Programme, the UK-based international medical relief charity Merlin, and the International Federation of Red Cross and Red Crescent among others. And as of Thursday, the government began broadcasting radio and television programmes on the risk factors for infection and how to mitigate them. "The basic hygiene promotion method is going out," Handley said. According to the WHO, typhoid is contracted when people eat food or drink water that has been infected with Salmonella typhosa. Generally recognised by the sudden onset of sustained fever, severe headache, nausea and severe loss of appetite, typhoid is sometimes accompanied by a hoarse cough and constipation or diarrhoea. Case-fatality rates of 10 percent can be reduced to less than 1 percent with appropriate antibiotic therapy. Paratyphoid fever shows similar symptoms, but tends to be milder and the case-fatality rate is much lower. The annual occurrence of typhoid fever is estimated at 17 million cases, with approximately 600,000 deaths. Some strains of Salmonella typhosa are resistant to antibiotics.