Multi-drug resistant typhoid on the increase in Sub-Saharan Africa

The incident of multi-drug resistance cases of typhoid is increasing in Sub Saharan Africa, making it difficlut and expensive for the disease to be treated.

Samuel Kariuki, a researcher with the Kenya Medical Research Institute, noted that about 60% of cases of typhoid recorded in Sub Saharan Africa are resistant to drugs.

Typhoid is an illness caused by the bacteria salmonella typhi that is spread to people through the consumption of water or food that is contaminated with faecal matter.

According to WHO about 21 million cases occur annually worldwide and the disease kills about 220,000 people each year, most of them children. Majority of those affected are in Asia and Sub-Saharan Africa.

In Uganda, a typhoid outbreak, involving 10,230, was reported in Kampala in February 2015. Subsequently, research carried out between February and June 2015 by Juliet Nsimire and others discovered that about 23% of the cases of typhoid reported in Uganda were resistant to the four commonly used anti-biotics.

This is what is referred to as multidrug resistance. In addition, all the cases showed resistance to one drug.

The disclosure was made at the 10th International Conference on Typhoid and other Invasive Salmonelloses (infections caused by salmonella bacteria) which is being held at the Serena Hotel in Kampala.

More than 300 scientists from 45 countries are meeting for the three day conference, which will end on Thursday, to discuss new interventions in the prevention and treatment of typhoid.

Participants at the conference noted that the major cause of multidrug resistance is abuse of anti-biotics. In many countries in Africa, the sale of drugs is not controlled and people can buy anti-biotics off the counter as they wish, even when they just experienced a slight fever.

Secondly, Kariuki noted that they were recording new strains of bacteria that cause typhoid and they are replacing the local strains that used to respond to drugs.

It was also noted that late access to treatment was a hindrance to managing typhoid.

This was attributed to the fact that it is difficult to diagnose typhoid because it does not present with any unique symptoms and the laboratory tests are usually not conclusive. As a result, patients are sometimes first treated for other conditions such as malaria.

Kariuki noted that resistance to the common drugs necessitates resorting to using alternatives, which are expensive.

WHO to discuss new guidelines to typhoid vaccination

The discussions at the Kampala conference are expected to inform a major meeting of the World Health Organisation Working Group on Typhoid Vaccine which is slated for April 27. The group is expected to review recommendations on the use of typhoid vaccines and come up with guidelines, which will be released next year.

High incident of typhoid in Sub-Saharan Africa

Kariuki noted that the high incident of typhoid in Sub Saharan Africa is attributed to the high rate of rural-urban migration, especially as people search for jobs. This has caused the setting up of informal settlements (slums) in towns which have little or no infrastructure such as sources of water and pit latrines and thus leading to high prevalence and frequent outbreaks for typhoid.

Other risk factors for typhoid outbreaks include overcrowding (having a high population density) and poor hygiene and sanitation facilities.

Typhoid can be prevented by improving hygiene, ensuring clean water and food supply, in addition to fighting overcrowding, especially in cities. The WHO also recommends vaccination of high risk populations.