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                                KATHMANDU, NEPAL - APRIL 30: Sanjhana Tamang takes care of her daughter Simran Tamang, 3, as she lays in bed at a temporary hospital suffering from Typhoid fever after the earthquake in Shanku on April 30, 2015 in Kathmandu, Nepal. A major 7.8 earthquake hit Kathmandu mid-day on Saturday, and was followed by multiple aftershocks that triggered avalanches on Mt. Everest that buried mountain climbers in their base camps. Many houses, buildings and temples in the capital were destroyed during the earthquake, leaving over 5500 dead and many more trapped under the debris as emergency rescue workers attempt to clear debris and find survivors. Regular aftershocks have hampered recovery missions as locals, officials and aid workers attempt to recover bodies from the rubble.
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                                  Typhoid fever is a life-threatening systemic infection caused by the bacterium Salmonella enterica serovar Typhi (commonly known as Salmonella Typhi). Typhoid is usually spread through the ingestion of contaminated food or water.

                                  Typhoid occurs predominantly in association with poor sanitation and lack of clean drinking water, in both urban and rural settings. However, urbanization, with associated overcrowded populations and inadequate water and sanitation systems, as well as climate change have the potential to further increase the global burden of typhoid. In addition, increasing antibiotic resistance  is making it easier for typhoid to spread and be treated.

                                  Every year, an estimated 11–20 million people get sick from typhoid and between 128 000 and 161 000 people die from it worldwide. Poor communities and vulnerable groups including children are at highest risk.

                                  Travellers are at risk of developing typhoid fever in many typhoid endemic countries, particularly in Asia and sub-Saharan Africa. Elsewhere, travellers are usually at risk when exposed to low standards of personal hygiene or food hygiene and poor water quality.

                                  Even vaccinated travellers should take care to avoid consumption of potentially contaminated food and water as vaccination does not confer 100% protection.

                                  Symptoms and treatment

                                  Salmonella Typhi lives only in humans. In persons with typhoid fever the bacteria initially enter through the intestinal tract and eventually invade the  bloodstream. The resulting illness is often non-specific and clinically non-distinguishable from other febrile illnesses. Symptoms include:

                                  • prolonged high fever
                                  • fatigue
                                  • headache
                                  • nausea
                                  • abdominal pain
                                  • constipation or diarrhoea
                                  • rash, in some cases.

                                  Severe cases may lead to serious complications or even death.

                                  Typhoid fever can be treated with antibiotics. As resistance to antibiotics has emerged including to fluoroquinolones, newer antibiotics such as cephalosporins and azithromycin are used in the affected regions. However, increasing resistance to cephalosporins has been reported, including the emergence in 2017 of an extensively drug resistant strain of Salmonella Typhi. Resistance to azithromycin has been reported sporadically.

                                  Even when the symptoms go away, approximately 2-5% of cases can go on to become chronic carriers and contribute to the spread of typhoid through ongoing faecal shedding of the bacteria and contamination of water and food. It is important for people being treated for typhoid fever to do the following:

                                  • Take prescribed antibiotics for as long as the doctor has prescribed.
                                  • Wash their hands with soap and water after using the bathroom, and  avoid preparing or serving food to other people. This will lower the chance of passing the infection on to someone else.
                                  • Have their doctor test (after the antibiotic course) to ensure that no Salmonella Typhi bacteria remain in their body.

                                  Prevention and control

                                  Access to safe water and adequate sanitation, health education, appropriate hygiene among food handlers, and typhoid vaccination are all effective strategies for prevention and control of typhoid.

                                   Vaccines have been used for many years to prevent typhoid:

                                  • a newer injectable typhoid conjugate vaccine, consisting of the Vi antigen linked to tetanus toxoid protein, for children and adults from 6 months up to 45 years of age
                                  • an injectable vaccine based on the purified antigen for people over 2 years of age
                                  • a live attenuated oral vaccine in capsule formulation for people over 6 years of age.

                                  These vaccines do not provide long-lasting immunity and are not approved for children younger than 2 years.

                                  In December 2017, WHO prequalified the first conjugate vaccine for typhoid. This new vaccine has longer-lasting immunity than older vaccines, requires fewer doses, and can be given to children from the age of 6 months.

                                  This vaccine is prioritized for countries with the highest burden of typhoid disease. This will help reduce the frequent use of antibiotics for typhoid treatment, which will slow the increase in antibiotic resistance in Salmonella Typhi.

                                  11-20 million


                                  got sick from typhoid

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                                  More than 128 000


                                  die from typhoid each year

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                                  There are 3 vaccines

                                  that can prevent typhoid

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