The Typhoid Endemic
According to the Malaysian Society of Infectious Diseases and Chemotherapy, typhoid has become endemic. Typhoid fever is a recurrent water and foodborne disease in this country.
Studies have found that there are more incidence rates amongst the rural population than in urbanised areas. There are more reported typhoid cases in Kelantan and Sabah.
From 2011-2015, a total of 507 typhoid fever cases were reported in the Klang Valley.
The majority of them were between 21 to 30 years old. Of the reported cases, 86.3% were Malaysian, and around half of them were men (55.6%).
Even with good sewage and water management, typhoid still remains a public health threat.
Typhoid is more prevalent in lower-income countries with poor public cleanliness and water sanitisation. Countries include developing areas of South-East Asia, Africa, certain parts of America and the Western Pacific regions.
Thankfully, with the advancement of our healthcare system and facilities, the mortality rate is still relatively low in Malaysia compared to other countries.
What Is Typhoid?
Typhoid is a bacterial infection caused by the organism Salmonella Enterica Typhi. It has actually been around for longer than we think.
It was first discovered in 1829 when a doctor incidentally discovered lesions in abdominal lymph nodes in patients who died from ‘stomach fevers’.
How Do We Get it?
Unlike diseases like dengue (Aedes mosquito) or leptospirosis (infected animals like rodents, pigs or cattle), typhoid is transmitted from human to human.
Typhoid comes from the bacteria- Salmonella typhi, which is passed through the faeces and urine of infected humans.
To put it simply, we can get infected by consuming foods or drinks that have been contaminated by the faeces or urine of those who are infected or are chronic carriers of typhoid bacteria.
This rod-shaped, flagellated organism will travel through the gastrointestinal tract, infecting the stomach and intestines. It then multiplies and spreads to other parts of the body, infecting organs like the bone marrow, spleen and liver.
If left untreated, typhoid can be fatal.
We may ask, how then, can food or water be contaminated by urine or faeces?
Some causes include poor hygiene, overcrowding (too many people living under one roof) and contaminated water supply.
In Malaysia, typhoid is classified under Food and Waterborne Diseases. Other infectious diseases include dysentery, cholera, food poisoning and hepatitis A.
If someone is infected with typhoid, our national public healthcare system must be alerted under the Prevention and Control of Infectious Diseases Act 342. Only registered healthcare professionals can access this portal: e-Notification, previously known as Communicable Disease Control Information System (CDCIS).
A thorough investigation will then be conducted to identify the source of the infection.
Annual Floods
The severe flooding in certain areas of Malaysia heralds a risk of potential water-borne disease outbreaks.
This could be due to overflowing sewages and contaminated water sources. Mishandling of food and drinks to flood victims at relief centres can increase the likelihood of a typhoid outbreak.
We can reduce our risk of getting infected by educating ourselves on the risks and symptoms and being vigilant during the rainy season!
Travelling Overseas
Typhoid is also classified as a travel disease.
We can take preventative measures, like booking an appointment for a typhoid vaccination prior to travelling to an endemic country.
While travelling, we can try to avoid restaurants or stores with poor cleanliness.
Other precautions include:
- Avoiding seafood, salads or shellfish
- Avoiding ice in drinks or desserts containing ice
- Washing raw fruit and vegetables in clean water
- Eat only cooked foods
- Only drinking recently boiled water or bottled water
What are the Signs and Symptoms?
It takes about 3-60 days before an infected person starts to show symptoms.
Symptoms include:
- Persistent fever
- Generalised body aches
- Fatigue
- Headache
- Severe tummy pain
- Vomiting
- Loss of appetite
- A rose-like rash around your trunk
- Constipation or diarrhoea
- Dizziness
- Slow heart rate
Typhoid fever is life-threatening. Thankfully, antibiotics have greatly reduced the mortality rate among those who are infected.
If you present with any of these symptoms and have been in contact with someone who was infected, do see a doctor immediately!
Get Vaccinated
Parenteral (injected) Vi Polysaccharide vaccine
This is an inactivated vaccine that contains the purified Vi capsular polysaccharide of S. Typhi (Ty 2 strain).
It is given intramuscularly (common sites of injection are your arm or buttocks). Children can opt for this vaccine too, as it can be administered to anyone above the age of 2 years old.
This vaccine works by sending signals to our bodies to generate antibodies that will prevent us from falling ill if we do get infected with typhoid bacteria.
Should We Get Vaccinated?
According to the local guidelines, Malaysians are recommended to get vaccinated if they are
- A food vendor or handling food
According to regulation 11 of the Food Hygiene Regulations 2009, it is mandatory for all food vendors and handlers to get vaccinated against typhoid.
Food authorities actually have a right to request medical certificates for proof of vaccination to verify that the food served is prepared safely and under good circumstances.
- Travelling to an endemic area
For travellers, it is recommended that we take the parenteral vaccine at least 2 weeks prior to travelling. On the other hand, our doctor might suggest we take the oral vaccine at least one week before travelling.
However, we still need to take precautions with consuming water and food, as the vaccines cannot fully protect us from getting infected.
- Close contact with someone who is an S. Typhi carrier.
Do consult your doctor for more information in regard to whether you ought to take the typhoid vaccine.
How Long Does the Vaccine Last For?
Your doctor might recommend that you come in for a booster once every 3 years.
Can We Take This Vaccine with a Different Vaccine at the same time?
The good news: the answer is yes, we can!
It can be given simultaneously with other vaccines.
Are there any Side Effects?
Like most other vaccines, you might experience:
- Generalised body aches
- Tiredness
- Headaches
- Soreness at the injection site
- Mild fever
- Diarrhoea
- Vomiting
The degree of severity of symptoms can vary from person to person.
You can report your side effects to the National Pharmaceutical Regulatory Agency (NPRA) here: www.NPRA.gov.my
Allergic reactions from typhoid vaccinations are rare. However, If you start to have trouble breathing, notice rashes breakout over your skin or see your face swelling, seek medical attention immediately!
Groups that Cannot Take the Vaccine
If you:
- Previously developed an allergic reaction from taking the typhoid vaccine
- Are currently having a fever
Your doctor might ask you to come back again to get the jab after your fever resides.
- Are immunocompromised
For example, if you are currently undergoing chemotherapy or have HIV.
Your doctor might also not allow you to take the typhoid vaccine if you have:
- A mild sickness – with or without fever
- A bleeding disorder
- Are currently pregnant or breastfeeding- your doctor will recommend you take a different type of vaccine to protect your baby.
If you have any concerns or doubts about whether you can take the vaccine, do clarify it with your doctor.
Protecting Ourselves and Loved Ones
Typhoid vaccinations are extremely important in reducing mortality rates and our risk of getting infected. It is equally as important for us to be vigilant and take preventative measures.
Let us continue to practise proper hand hygiene and be mindful of where we consume food and beverages.
Here at Kantha Medical Group, we are committed to providing the best healthcare for you.
Every person deserves a right to equal and affordable healthcare and proper education on health.
Book yourself a doctor’s consultation with us today!
Interested in booking a typhoid vaccination? Make an appointment with us today!
References
- Vaccine, Typhoid https://www.mims.com/malaysia/drug/info/vaccine,%20typhoid?mtype=generic
- Diseases to watch out for during flood http://www.dailyexpress.com.my/interest/1306/diseases-to-watch-out-for-during-flood/
- Typhoid fever https://www.nhs.uk/conditions/typhoid-fever/
- The burden of typhoid fever in Klang Valley, Malaysia, 2011–2015 https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-05500-x
- Typhoid Fever (Salmonella Typhi) http://www.bccdc.ca/health-info/diseases-conditions/typhoid-fever-salmonella-typhi Salmonella Typhi https://www.ncbi.nlm.nih.gov/books/NBK519002/
- Available Vaccines: Typhoid https://adultimmunisation.msidc.my/typhoid/
