Rains may increase typhoid risk

Following a serious outbreak of typhoid in the Tajik capital Dushanbe last month, with over 400 confirmed cases, UN officials warned on Tuesday of a further possible spread of the disease as heavy rains strike the city. "Even if the outbreak is in decline now, there is a danger that it might flare up again if there is severe flooding," Paul Handley, officer in charge for the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) in Dushanbe told IRIN, citing possible cross contamination between the city's drinking water and sanitation systems. According to the OCHA official, although the initial source of last month's outbreak had been identified and been treated with chlorine, the problem of an antiquated water and sanitation infrastructure in the city of close to one million remained. "Even if you treat the source, the pipes are still full of holes. We just started to experience heavy rains [Monday night] and there is a lot of concern about further spread of the disease due to potential flooding," he explained. And while the Tajik Ministry of Health had reported a decline in the number of new cases presenting themselves in hospitals, many people had been receiving treatment at home, or might not know they had been infected at all, he added. As of part of the latest outbreak, there had been 444 confirmed cases of the disease reported on Monday, with another 1,022 suspected cases currently hospitalised, Dr Nazira Artykova, liaison officer for the World Health Organisation (WHO) in Dushanbe told IRIN. "Statistics on this remains a bit of a challenge," Handley observed, noting that many people were being treated at home as opposed to being hospitalised. Many people preferred to stay with their families during the holy month of Ramadan, while not all people who had been infected with typhoid would test positive. "Some of the people may have taken antibiotics before the test which can seriously skew the results," Handley observed. Meanwhile on the ground, the Tajik Ministry of Health was still maintaining an emergency operation to deal with the outbreak and the international community was continuing to provide assistance. Among those were the UK-based international medical relief charity Merlin, currently working with regional hospitals to meet additional drug needs, along with the Red Cross Federation and the Tajik National Society of the Red Crescent, who were working with city health authorities to support their house to house detection activities, the Central Asia Development Agency (CADA), a Seattle-based international NGO, as well as the German Embassy for their mobilisation of financial assistance. Handley noted that the doctors were the ones fighting the fire and the approach they had taken, in terms of active case finding and getting people to come to hospitals, along with providing health education messages, on boiling water, etc, was the right one. "They've done the right thing. The outbreak is seemingly receding," he said. Last month's outbreak is thought to have started in the Frunze district of the capital, after a major piped water source became contaminated. Tajik authorities were quick to treat the source of the contamination, but the incident again underscored the deteriorating state of the country's antiquated water supply systems, since it gained independence following the collapse of the Soviet Union in 1991. And while typhoid is hardly unusual in the impoverished country of five million, there remain numerous steps that could be undertaken to mitigate the risks, Artykova explained. Included in these were the regular chlorination of water, the health expert said, coupled with daily home visits and an enhancement of public awareness. "More efforts are required for laboratory control of drinking water and the rehabilitation of the water supply system," she remarked, warning that unless this happened, another outbreak could occur soon. She added a greater regional approach would work to thwart its spread. "Regional support will be necessary for (identification) of the type of typhoid bacillar." An infection marked by intestinal inflammation and ulceration; caused by Salmonella typhosa ingested with food or water, typhoid, affecting some 17 million worldwide each year and resulting in approximately 600,000 deaths, is described as endemic in the mountainous Central Asian state. According to media reports, at least 80 people died of typhoid in an epidemic in 1997, after authorities failed to halt its spread.