Typhoid cases on decline in the capital

The number of reported typhoid cases is decreasing in the Tajik capital, Dushanbe, mainly due to community awareness raising efforts, health ministry officials say. "The situation [with regard to typhoid in Dushanbe] is stable and is actually improving," Davron Pirov, head of the sanitary and epidemiological department of the Tajik health ministry, told IRIN from Dushanbe on Tuesday. Echoing that view, Latif Dustov, deputy chief doctor at the Tajik sanitary and epidemiological surveillance service, told IRIN that everything with regard to typhoid was well under control in the city, adding that the number of registered cases of the disease had been four times less compared to the previous year. "Clearly, the situation is improving," he said. As of the first five and a half months of 2004, 35 cases were registered in Dushanbe, while over the same period of 2003 that figure stood at 140, the government official explained. The most recent typhoid outbreak in Dushanbe - one of the largest outbreaks to strike the former Soviet republic in years - occurred last October when more than 440 people were infected after a major piped water source in one of the city's districts became contaminated. According to the World Health Organization (WHO), typhoid is contracted when people eat food or drink water that has been infected with Salmonella typhosa. Generally recognised by a 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, with the case-fatality rate much lower. Commenting on the decline in typhoid cases, Dustov said that it was related to health education activities aimed at preventing the disease, still under way. "We conduct awareness raising activities so that the population consumes only boiled water. The sewage system's work has improved and all these factors contribute to the decrease in the number of typhoid cases," the deputy chief doctor explained. "We hope that the situation will further improve during the second half of the year as all our staff members are working hard for that," he maintained. However, further efforts on typhoid eradication will pretty much depend on the quality of piped water in Dushanbe. A humanitarian worker told IRIN that the quality of the running water in the city was far from good, stating upon his arrival in Dushanbe he got sick with diarrhoea - apparently from poor quality water. "For further improvement of the situation the water supply system needs to be improved as well as the quality of water. There needs to be huge investments, particularly in water purification of the centralised water supply network," Pirov said. But this requires million of dollars, something the Tajik government simply doesn't have. "We are not in a position to implement these projects yet, therefore we will mainly focus on awareness raising among the population, urging them to consume only boiled water," the health official said. The annual occurrence of typhoid fever in the world is estimated at 17 million cases, with approximately 600,000 deaths. Some strains of Salmonella typhosa are resistant to antibiotics.