The message is clear: Wash your hands in clean water after using the toilet and before preparing food.
This is the message from the National Institute of Communicable Diseases (NICD) and the Gauteng Department of Health after confirming four incidents of typhoid - including one death - over the past week.
What is typhoid?
Typhoid is caused by the Salmonella typhi and paratyphi bacteria and spread via faecal oral contamination, said Health24 resident doctor, Dr Heidi van Deventer.
"It is contagious when you come into contact with food or water that has been contaminated with the bacteria - or when you come into contact with food or water that has been prepared or contaminated by someone that has been infected with the bacteria."
The infective dose (the minimum number of organisms required to cause infection) is relatively high, at around 100 000 organisms.
Read: Typhoid scare in Joburg - 10 things you need to know
Symptoms of the illness include fever, muscle aches, abdominal pain and cramps, lethargy, loss of appetite, diarrhoea and bloody stools, said Van Deventer.
The cases of typhoid were identified in Hillbrow, Yeoville, Edenvale and Palm Springs. Two of the patients were admitted to the Charlotte Maxeke Academic Hospital and the other two patients to the Edenvale District Hospital.
A 27-year-old female Malawian patient died at the Charlotte Maxeke Academic Hospital on January 17. She travelled to Malawi for the festive season and returned to Johannesburg, through Mozambique, on January 12.
Patients are doing well
"The latest developments are that the condition of two babies - 2 and 3 years old - at Edenvale Hospital has improved drastically. An 11-year-old has since been discharged and the 16-year-old at Charlotte Maxeke is doing very well," Gauteng Department of Health spokesperson Steve Mabona told told Health24.
He said the outbreak response team that was dispatched to trace and manage the disease, was tasked with ascertaining the originality of the cases, the possible cause, identify precautionary measures to be taken, coordination with all health professionals and facilities, manage environmental health practitioners, facilitate necessary tests and then report to the executive.
The investigation has shown that there is no current outbreak of typhoid in Johannesburg, however additional laboratory studies will follow.
He also highlighted steps put in place to prevent the spread of the disease. These are:
- Daily surveillance of all the cases;
- Health education in communities about the disease;
- Visits to the homes of the victims to see if there are other cases and educate them on typhoid; and
- Alerting all health professionals about the disease and treatment options
The department advised the public to:
- Wash their hands before eating and after visiting the toilet;
- Boil any water that you are not sure of before drinking it;
- Wash fruits and vegetables before consumption.
There is no typhoid outbreak
Professor Lucille Blumberg, who is a deputy director at the NICD, told Health24 a typhoid outbreak could be defined by an increase above the expected normal incidents of the disease during a particular time in a specific area.
"An outbreak is when there is an increase, above the expected number, for typhoid cases in a particular area during a particular time. If there are a number of cases that are clustered then one would consider that as a possible outbreak.
"There are a few hundred cases in South Africa in a year, but you can get explosive outbreaks if the water source becomes contaminated."
This is what happened in late 2005 in Delmas, Mpumalanga, when four people died from typhoid and hundreds fell ill. At the time, state biologists found that human waste had contaminated one of the boreholes in the area.
Blumberg went on to praise the Gauteng health department for their swift work.
"The Gauteng department of health has done really well. They responded very quickly. They went out and looked at the cases and three out of the four cases were related to travel on the sub-continent."
Other than the two cases from the same family, there were no links between the cases.
Blumberg added that typhoid occured all the time in Africa. "We do have local cases. We do have sporadic cases, but we do have a number of imported ones."
How the illness is treated
She said that the disease usually attacked very specific white cells or the stem cells in the body. "It is a serious disease in a number of patients. Some people get it mildly, but it can be a very severe illness."
The illness is treated with antibiotics and some are given orally, while others may need intravenous treatment. "For the most part, the circulating strain does have antibiotics that will be effective."
Blumberg said the duration of treatment depends on the illness and what drug is being used. "It may be a short course of five days or it may need longer treatment depending on the severity of the illness."
The overuse of antibiotics generally can raise concerns about resistance; however Blumberg noted that at the moment there are highly effective antibiotics to treat cases of typhoid.
She cautioned that the diagnoses may not always be made in time, adding that symptoms may also not be specific.
"The tests can take anywhere between 16 hours + and there are so many infectious diseases that present in the same way that perhaps typhoid is not always considered and it needs to be."
She noted that a small percentage of people can become chronic carriers of typhoid. "They often don't have symptoms, but continue to excrete the bacteria in their stool or urine and are obviously a source of ongoing infection. But if you identify chronic carriers, you can actually treat it."
Blumberg reiterated that practising good hygiene when preparing food and after going to the toilet was essential. "The washing of hands in clean water is very important as for many infectious diseases."
Read: Is handwashing the cheapest vaccine ever?
An alarming survey by the Global Hygiene Council revealed that although South African adults worry about infectious diseases, they do not wash their hands properly.
The 2013 study found that only one out of every 20 people around the world washes their hands properly, adding that 83 percent of adults say they intend to wash their hands every time they go to the toilet, but just 68 percent do this with soap and water.
You need to always wash your hands:
- After using the toilet
- After changing a child’s nappy
- Before and after handling food
- Before putting in or taking out your contact lenses
- After touching commonly used surfaces or items
- After working in the garden
- after touching animals
- After taking care of sick people
- after blowing your nose, coughing or sneezing into your hands
- After taking out the garbage, touching household or garden chemical, or soiled shoes
Here are some hand-washing tips:
1. Wet your hands with water.
2. Lather your wet hands with soap.
3. Rub your hands palm to palm.
4. Make sure you interlace your fingers while you wash your hands.
5. Scrub under your fingernails using your palms.
6. Right palm over left hand and vice versa.
7. Rotational rubbing of left thumb clasped in right palm and vice versa.
8. Rinse hands with water.
9. Dry thoroughly with a single-use towel.
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