Cape Town - Cases of enteric or typhoid fever are being investigated in the Western Cape and North West after outbreaks were reported by the National Institute for Communicable Diseases (NICD).
Although endemic and a constant presence throughout the country, with less than 150 cases reported annually, the NICD on Wednesday confirmed two distinct outbreaks in the two provinces.
Dr Juno Thomas from the NICD’s Centre for Enteric Diseases said three separate outbreaks were confirmed in the Western Cape, specifically in the Cape Town City metro, Cape Winelands and Garden Route.
“In the Cape, they did extensive water sampling and nothing was detected and so at the moment the focus is on trying to detect as many cases as possible, following up every case to try and see what any common linkages are,” Thomas said.
The potentially life-threatening infection is spread through contaminated food or water, with children at the highest risk of disease and death.
“It is, like many other ancient scourges, a disease of poverty, occurring predominantly in association with poor sanitation and lack of clean drinking water, and this is in both urban and rural settings.”
Diagnosis of typhoid fever is difficult due to non-specific symptoms, such as prolonged fever, fatigue, headache, nausea, abdominal pain, constipation and diarrhoea.
“The problem with typhoid is, even if you do develop a mild disease or develop a more severe disease and are treated and get better, you can still carry these bacteria in your gut for many years.
“In fact some people carry it in their gut lifelong and they continue to replicate in the gut and get shed in the stool or faeces and these people act as reservoirs that can continue contaminating food and water sources,” Thomas said.
Typhoid fever cases are under-represented due to diagnostic practices and accessibility to laboratory diagnostics, with a low awareness among health-care workers.
Western Cape Health Department spokesperson Mark van der Heever said laboratory confirmed cases in the province during 2021/2022 were higher than in previous years.
“Whole-genome sequencing of enteric fever isolates has identified specific ‘strains’ responsible for separate clusters in these districts, confirming that in those districts cases are linked and there is ongoing local transmission,” Van der Heever said.
“The identification and investigation of enteric fever cases and clusters involves ongoing surveillance and line listing, thorough case management, contact tracing and environmental investigations (food, water and sanitation), and health promotion activities.
“All recent single cases and clusters are currently under investigation by the districts, sub-districts and local authorities.”
Van der Heever said health-care workers were encouraged to be on alert for possible cases.
Meanwhile, the City has said its tap water is safe for consumption.
Mayoral committee member for Water and Sanitation Zahid Badroodien said all drinking water samples tested this week complied with the South African National Drinking Water Standard on Acute Health Determinants and posed no health risk to the public.
Mayco member for Community Services and Health Patricia van der Ross said: “The very hot conditions in the city have led to a noticeable increase in the number of children brought to health facilities with symptoms like diarrhoea, vomiting and dehydration.
“Unclean hands can spread viruses that cause diarrhoea. During hot summer days, food can easily get spoilt. If eaten, this can also cause diarrhoea, which can lead to dehydration. It is important to prepare and store food safely and to practise good hand hygiene at all times.”