Outbreak of enteric fever: a fact finding mission
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20200954Keywords:
Enteric fever, Outbreak, Sewage contaminationAbstract
Background: In September 2019, a large number of fever cases among troops and families in a military station in Maharashtra were admitted to the local Military Hospital. Detailed epidemiological investigations revealed the cause to be an outbreak of enteric fever due to sewage contamination of drinking water.
Methods: A detailed site survey was undertaken; and a descriptive epidemiological study was carried out. Routine haemogram, blood culture, antibiotic sensitivity test besides serotyping of the isolates were carried out.
Results: In all 28 cases who fulfilled the case definition criteria were admitted in the month of September 2019. Out of these 21 (75%) were confirmed by blood culture, while the remaining were probable cases. Bacteriological examination reports of water samples taken from various source as well as consumer end points both prior to beginning of the outbreak and during the outbreak revealed a high presumptive coliform count. Spatial and temporal clustering of cases was suggestive of common source outbreak. On 16 September 2019 exploration by digging was carried out undertaken which revealed massive leakage of water in close proximity to the overflowing manholes. The outbreak was promptly controlled after detection of this pipeline and provision of alternative source of water supply to the affected area.
Conclusions: Salmonella enterica serovar typhi has been implicated in many outbreaks through history. The present outbreak was a common source focal outbreak due to sewage contamination of drinking water in a few areas in the station.
References
DGAFMS. Review of Military Hygiene and Health. Manual of Health for the Armed Forces. Directorate General of Armed Forces Medical Services, Ministry of Defence, New Delhi; 2002:1-17.
National Institute of Communicable Diseases. Standard Case Definitions for epidemic prone diseases; CD Alert. 2001;5(3):1-8.
National Institute of Communicable Diseases. Investigation and Control of Water Borne Diseases. Directorate General of Health Services, 22 Shamnath Marg, New Delhi; 1998:1-33.
National Institute of Communicable Diseases. Outbreaks: Investigation and Control. Directorate General of Health Services, 22 Shamnath Marg, New Delhi; 1998: 1-44.
Divyashree S, Nabarro LE, Veeraraghavan B, Rupali P. Enteric fever in India: current scenario and future directions. Trop Med Int Health. 2016;21(10):1255-62.
Vanderslott S, Phillips MT, Pitzer VE, Kirchhelle C. Water and Filth: Reevaluating the First Era of Sanitary Typhoid Intervention (1840-1940). Clin Infect Dis. 2019;69(5):S377-84.
Obaro SK, Iroh Tam PY, Mintz ED. The unrecognized burden of typhoid fever. Expert Rev Vaccines. 2017;16(3):249-60.
Meiring JE, Giubilini A, Savulescu J, Pitzer VE, Pollard AJ. Generating the Evidence for typhoid vaccine introduction: considerations for global disease burden estimates and vaccine testing through human challenge. Clin Infect Dis. 2019;69(5):S402-7.
Kim S, Lee KS, Pak GD, Excler JL, Sahastrabuddhe S, Marks F, et al. Spatial and temporal patterns of typhoid and paratyphoid fever outbreaks: a worldwide review, 1990-2018. Clin Infect Dis. 2019;69(6):S499-509.
Grizhebovskii GM, Onishchenko GG, Taran VI,. Outbreak of typhoid fever in the Chechen Republic in 2000: epidemiological characterization. Zh Mikrobiol Epidemiol Immunobiol. 2001;6:45S-7S.
Adriani KS. The uncomfortable history of Mary Mallon and typhoid fever. Ned Tijdschr Geneeskd. 2019;163. pii: D4081.
Marineli F, Tsoucalas G, Karamanou M, Androutsos G. Mary Mallon (1869-1938) and the history of typhoid fever. Ann Gastroenterol. 2013;26(2):132-4.
Sorrell T, Selig DJ, Riddle MS, Porter CK. Typhoid fever cases in the U.S. military. BMC Infect Dis. 2015;15:424.
Michel R, Garnotel E, Spiegel A, Morillon M, Saliou P, Boutin JP. Outbreak of typhoid fever in vaccinated members of the French Armed Forces in the Ivory Coast. Eur J Epidemiol. 2005;20(7):635-42.
National Institute of Communicable Diseases. Outbreaks of water borne diseases. CD Alert; 2001;5(2):1-8.
Anand AC. The anatomy of an epidemic (the final report on an epidemic of multidrug resistant enteric fever in eastern India). Trop Gastroenterol. 1993;14(1):21-7.
Banerjee A, Kalghatgi AT, Singh PM, Nagendra A, Singh Z, Handa SK. Epidemiological investigation of an outbreak of enteric fever. Med J Armed Forces India. 2007;63(4):322-4.
Chang MS, Woo JH, Kim S. Management of typhoid fever- clinical and historical perspectives in Korea. Infect Chemotherapy. 2019;51(3):330-5.
Wang KY, Lee DJ, Shie SS, Chen CJ. Population structure and transmission modes of indigenous typhoid in Taiwan. BMC Med Genomics. 2019;12(1):126.
Fjaerli HO, Gundersen SG. Typhoid fever. Tidsskr Nor Laegeforen. 1993;113(24):3019-22.
Kambal AM, Al-Sugair S, Al-Ballaa SR, Al-Hedaithy M, Al-Balla SR, Saeed NS. Enteric fever due to multi-resistant Salmonella typhi. Ann Saudi Med. 1993;13(3):246-9.
Rasaily R, Dutta P, Saha MR, Mitra U, Lahiri M, Pal SC. Multi-drug resistant typhoid fever in hospitalised children. Clinical, bacteriological and epidemiological profiles. Eur J Epidemiol. 1994;10(1):41-6.
Saha MR, Dutta P, Bhattacharya SK, Rasaily R, Mitra U, Dutta D, et al. Occurrence of multi-drug resistant Salmonella typhi in Calcutta. Indian J Med Res. 1992;95:179-80.
Iperepolu OH, Entonu PE, Agwale SM. A review of the disease burden, impact and prevention of typhoid fever in Nigeria. West Afr J Med. 2008;27(3):127-33.
Ceylan A, Acemoğlu H, Hoşoğlu S, Gül K, Ilçin E, Efe M. Typhoid fever epidemic in Ahmetli village, Diyarbakir-Ergani. Mikrobiyol Bul. 2003;37(1):41-7.
Farooqui A, Khan A, Kazmi SU. Investigation of a community outbreak of typhoid fever associated with drinking water. BMC Public Health. 2009;9:476
Swaddiwudhipong W, Kanlayanaphotporn J. A common-source water-borne outbreak of multidrug-resistant typhoid fever in a rural Thai community. J Med Assoc Thai. 2001;84(11):1513-7.