Abstract
AimTyphoid fever is a vaccine-preventable bacterial disease that causes significant morbidity and mortality throughout Africa. This paper describes an upsurge of typhoid fever cases in Moyale Sub-County (MSC), Kenya, 2014–2015.MethodsWe conducted active hospital and health facility surveillance and laboratory and antimicrobial sensitivity testing for all patients presenting with headache, fever, stomach pains, diarrhea, or constipation at five MSC health facilities between December 2014 and January 2015. We also conducted direct observation of the residential areas of the suspected cases to assess potential environmental exposures and transmission mechanisms. Demographic, clinical, and laboratory data were entered into, and descriptive statistics were calculated with, MS Excel.ResultsA total of 317 patients were included in the study, with mean age 24 ± 8.1 years, and 51% female. Of the 317 suspect cases, 155 (49%) were positive by Widal antigen reaction test. A total of 188 (59%) specimens were subjected to culture and sensitivity testing, with 71 (38%) culture positive and 54 (76%), 43 (60%), and 33 (46%) sensitive to ceftriaxone, cefuroxime, and ciprofloxacin, respectively. Environmental assessments through direct observations showed that commercial and residential areas had limited (1) clean water sources, (2) latrines, and (3) hygiene stations for street food hawkers and their customers.ConclusionsTyphoid fever is endemic in MSC and causes significant disease across age and sex groups. The local health department should develop policies to (1) assure community access to potable water and hygiene stations and (2) vaccinate specific occupations, such as food and drink handlers, against typhoid.
Highlights
Typhoid fever, caused by the bacterium Salmonella typhi (S. typhi), sickens millions of people each year and remains a significant public health problem in low-income countries [1]
Laboratory Of the 317 patients, 155 (49%) were positive via the Widal rapid diagnostic test, with 87 (56%) < 18 years old
Antimicrobial testing on culture-positive samples showed sensitivity to ceftriaxone [54 (76%)], ciprofloxacin [33 (46%)], and cefuroxime [43 (60%)], which is the drug of choice for treatment of typhoid in Moyale Sub-County (MSC) (Table 1)
Summary
Typhoid fever, caused by the bacterium Salmonella typhi (S. typhi), sickens millions of people each year and remains a significant public health problem in low-income countries [1]. Annual incidence in Africa ranges from 13 to 845 cases per 100,000 population, but its epidemiology in Kenya is poorly characterized [2]. In 2014, Moyale Sub-County (MSC), the northernmost point of Marsabit County, reported 3498 cases of typhoid—an annual incidence three times higher than the highest estimates in African countries [1]. MSC (population 130,000) shares a border with Ethiopia and is served by 90 health facilities comprised of 4 hospitals, 17 health centers, 54 dispensaries, 13 private health facilities (nursing homes), and 2 functional clinical laboratories (Fig. 1). This report describes a hospitaland health facility-based epidemiological investigation of suspected typhoid cases at five health facilities in MSC, from December 2014 to January 2015
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