1.
EPIDEMEOLOGY
OF TYPHOID
FEVER
SANNIPATAJ JAWAR
PRESENTED BY
AYUSHI TAYAL
(BATCH -2019)

2.
CONTENTS
INTRODUCTION
PROBLEM STATEMENT
EPIDEMEOLOGICAL DETERMINANTS
CLINICAL FEATURES
LABORATORY DIAGNOSIS OF TYPHOID
CONTROL OF TYPHOID FEVER
AYURVEDIC CONCEPT OF TYPHOID FEVER

3.
WHAT IS TYPHOID FEVER?
• TYPHOID FEVER IS A BACTERIAL INFECTION THAT CAN SPREAD
THROUGHOUT THE BODY, AFFECTING MANY ORGANS.
• RESULT OF SYSTEMIC INFECTION CAUSED BY SALMONELLA TYPHI.
• CLINICALLY CHARACTERIZED BY TYPICAL CONTINUOUS FEVER FOR 3 TO 4
WEEKS, RELATIVELY BRADYCARDIA WITH INVOLVEMENT OF INTESTINAL
LYMPHOID TISSUES AND CONSIDERABLE CONSTITUTIONAL SYMPTOMS.
• "ENTERIC FEVER" INCLUDES BOTH TYPHOID AND PARATYPHOID FEVER.
MAY OCCUR SPORADICALLY, EPIDEMICALLY OR ENDEMICALLY. FOUND
ONLY IN HUMAN.

4.
PROBLEM STATEMENT
GLOBAL
DISEASE BURDEN IS 21 MILLION CASES ANNUALLY, (2,10,00,000 CASES). WITH DEATHS
OF 2,16,000-6,00,000 PER YEAR.
MAJORITY OF THIS BURDEN OCCURS IN ASIA.
INDIA:
TYPHOID FEVER IS ENDEMIC IN INDIA.
DATA SHOWS 1.53 MILLION CASES & 361 DEATHS IN 2013.
WORLD’S LARGEST OUTBREAK OF TYPHOID IN SANGLI ON DEC 1975 TO
FEB 1976

5.
EPIDEMIOLOGICAL DETERMINANTS
• 1. AGENT FACTORS
• 2. HOST FACTORS
• 3. ENVIRONMENTAL & SOCIAL FACTORS
• 4. INCUBATION PERIOD
• 5. MODE OF TRANSMISSION

6.
1 TYPHOID FEVER MAINLY CAUSED BY THE BACTERIUM SALMONELLA
TYPHI FROM THE FAMILY ENTEROBACTERIACEAE.
2 S. TYPHI IS A GRAM-NEGATIVE, FACULTATIVE AEROBIC, NON SPORE
FORMING BACTERIA THAT ISMOTILE DUE TO ITS PERITRICHOUS
FLAGELLA.
3 THE BACTERIA GROWS BEST AT 37 C.
AGENT FACTORS
-

7.
B- RESERVOIR OF INFECTION
HUMAN IS THE ONLY RESERVOIR
1 CASE
• - A CASE IS INFECTIOUS AS LONG AS
BACILLI APPEARS IN STOOLS OR URINE.
• CASE MAY BE MISSED, MILD OR SEVERE.
• 2. CARRIERS
• TEMPORARY/INCUBATORY EXCRETE BACILLI FOR
6 TO 8 WEEKS.
CLINICAL SYMPTOMS ARE NOT SHOWN IN PERSON
,BUT THEY ARE CAPABLE OF TRANSMITTING THE
INFECTION
• CHRONIC CARRIER -EXCRETE BACILLI FOR MORE
THAN A YEAR, ORGANISM PERSIST IN GALL
BLADDER/BILIARY TRACT. . E.G. "TYPHOID
MARRY" REAL NAME MARY MALLON
•

8.
TYPHOID MARY
• MARY MALLON WAS A COOK IN OYSTER BAY, NEW YORK IN EARLY 1900 S
• AS A HEALTHY CARRIER OF SALMONELLA TYPHI HER NICKNAME OF “TYPHOID
MARY” HAD BECOME SYNONYMOUS WITH THE SPREAD OF DISEASE, AS MANY WERE
INFECTED DUE TO HER DENIAL OF BEING ILL
• A COMBINATION OF PEACH ICE CREAM AND MALLON'S POOR
HAND WASHING LIKELY SPARKED TYPHOID FEVER OUTBREAKS
• GAVE RISE TO MORE THAN 1300 CASES IN HER LIFE TIME.
• SHE DIED OF PNEUMONIA AFTER 26 YEARS IN QUARANTINE

9.
C SOURCE OF INFECTION
PRIMARY SOURCES
• FAECES & URINE OF CASES AND
CARRIERS.
• FAECAL CARRIERS ARE MORE
FREQUENT THAN URINARY
CARRIERS
SECONDARY SOURCES
CONTAMINATED
- WATER
- FOOD
- FINGERS
- FLIES

10.
• HOW DOES THE BACTERIA CAUSE DISEASE ?
• INGESTION OF CONTAMINATED FOOD OR WATER SALMONELLA BACTERIA
• INVADE SMALL INTESTINE AND ENTER THE BLOODSTREAM
• CARRIED BY WHITE BLOOD CELLS IN THE LIVER, SPLEEN, AND BONE MARROW
• MULTIPLY AND RE - ENTER THE BLOODSTREAM
• BACTERIA INVADE THE GALLBLADDER, BILIARY SYSTEM, AND THE LYMPHATIC
TISSUE OF THE BOWEL AND MULTIPLY IN HIGH NUMBERS
• THEN PASS INTO THE INTESTINAL TRACT AND CAN BE IDENTIFIED FOR DIAGNOSIS
IN CULTURES FROM THE STOOL TESTED IN THE LABORATORY

11.
2- HOST FACTORS
• (A) AGE- OCCUR AT ANY AGE BUT HIGHEST INCIDENCE IN 5-19 YRS. AGE
GROUP.
• (B) SEX- CASES MORE IN MALES THAN FEMALE
- CARRIER RATE IS MORE IN FEMALES
• (C) IMMUNITY- ANTIBODY MAY BE STIMULATED BY INFECTION OR IMMUNIZATION.
ANTIBODY AGAINST (O) ANTIGEN IS HIGHER IN PATIENT WITH THE DISEASE AND
ANTIBODY AGAINST (H) ANTIGEN IS HIGHER IN IMMUNIZED PERSON. S.TYPHI IS
INTRACELLULAR ORGANISM SO CELL MEDIATED IMMUNITY PLAYS A MAJOR ROLE IN
COMBATING THE INFECTION.

12.
3- ENVIRONMENTAL & SOCIAL FACTORS
TYPHOID FEVER REGARDED AS "INDEX OF GENERAL SANITATION" IN ANY COUNTRY.
• INCREASE INCIDENCE IN JULY-SEPTEMBER.
• OUTSIDE HUMAN BODY BACILLI FOUND IN
ICE & ICE CREAM- OVER A MONTH
WATER-2 TO 7 DAYS BUT NOT MULTIPLY
SOIL IRRIGATED WITH SEWAGE- 35 TO 70 DAYS
FOOD- MULTIPLY & SURVIVE FOR SOMETIME
MILK- GROW RAPIDLY WITHOUT ALTERING ITS TASTE
VEGETABLES GROW IN SEWAGE PLANT.
• POLLUTION OF DRINKING WATER SUPPLIES.
• OPEN AREA DEFECATION & URINATION.
• LOW PERSONAL HYGIENE.
• HEALTH IGNORANCE.

13.
INCUBATION PERIOD
• INCUBATION PERIOD – USUALLY 10-14 DAYS BUT IT MAY BE AS SHORT AS 3 DAYS
OR AS LONG AS 21 DAYS DEPENDING UPON THE DOSE OF BACILLI INGESTED.

14.
SIGNS AND SYMPTOMS
• CLASSICALLY, THE COURSE OF UNTREATED TYPHOID FEVER IS DIVIDED INTO FOUR DISTINCT STAGES, EACH LASTING ABOUT A WEEK.
OVER THE COURSE OF THESE STAGES, THE PATIENT BECOMES EXHAUSTED.
• CLINICAL FEATURES
• INITIAL WEEKS OF THE INFECTION: IN THE FIRST WEEK:
⚫ FEVER IN STEP LADDER FASHION
⚫ RELATIVE BRADYCARDIA, MALAISE,
⚫ HEADACHE
• COUGH, SORE THROAT.
• A BLOODY NOSE (EPISTAXIS) IS SEEN IN A QUARTER OF CASES, AND ABDOMINAL PAIN IS ALSO POSSIBLE WITH CONSTIPATION OR PEA
SOUP DIARRHOEA.

15.
LATER STAGES OF INFECTION
• SERIOUS COMPLICATIONS OCCUR IN UPTO 10% OF CASES, IF ILLNESS PROLONG
BEYOND 2 WEEKS.
• THIRD WEEK: INTESTINAL HAEMORRHAGE AND PERFORATION.
• SIGNS OF SHOCK, SUDDEN DROP IN TEMPERATURE , DARK OR FRESH BLOOD IN
STOOLS.
• • RARE COMPLICATIONS:
• URINE RETENTION, PNEUMONIA, MYOCARDITIS, CHOLECYSTITIS, NEPHRITIS.

16.
LABORATORY DIAGNOSIS
MICROBIOLOGICAL PROCEDURS
SEROLOGICAL PROCEDURS
NEW DIAGNOSTIC TESTS

17.
SEROLOGICAL PROCEDURES
FELIX-WIDAL TEST
MEASURES AGGLUTINATING ANTIBODIES LEVELS AGAINST
O & H ANTIGENS
SERUM AGGLUTININS RAISE ABRUPTLY DURING THE 2ND OR 3RDWEEK

18.
LIMITATIONS OF WIDAL TEST
• TEST HAS MODERATE SENSITIVITY AND SPECIFICITY.
• TEST CAN BE NEGATIVE IN 30% OF CULTURE PROVEN CASES.
• THIS TEST GIVES FALSE POSITIVE RESULTS DUE TO OTHER CLINICAL CONDITIONS.

19.
CONTROL OF TYPHOID FEVER
1. CONTROL OF:
• RESERVOIRS
• CASES
• CARRIERS
2. CONTROL OF SANITATION
3. IMMUNIZATION
• CONTROL OF RESERVOIRS
• IDENTIFICATION, ISOLATION, TREATMENT &
DISINFECTION.
• CONTROL OF CASES:
• EARLY DIAGNOSIS, NOTIFICATION, ISOLATION,
TREATMENT, FOLLOW-UP.
• CONTROL CARRIERS:
• IDENTIFICATION, TREATMENT, SURGERY,
SURVEILLANCE, HEALTH EDUCATION

20.
CONTROL OF CASES AND CARRIERS
• CONTROL OF CASES
• EARLY DIAGNOSIS: BLOOD & STOOL CULTURES ARE
IMP. IN DIAGNOSIS OF THE CASES.
• NOTIFICATION: INFORM THE OFFICIALS.
• ISOLATION: SEPARATE THE PATIENTS TO PREVENT
SPREAD OF INFECTION.
• TREATMENT: DRUG OF CHOICE:
FLUOROQUINOLONES.
• FOLLOW-UP: EXAMINATION OF STOOLS & URINE
FOR 3-4 MONTHS AFTER DISCHARGE.
• CONTROL OF CARRIERS
• IDENTIFICATION: TO PREVENT ULTIMATE SOURCE -
TYPHOID.
• TREATMENT: AMPICILLIN OR AMOXYCILLIN WITH
PROBENECID FOR 6 WEEKS.
• SURGERY: CHOLECYSTECTOMY, NEPHRECTOMY CAN BE
DONE.
• SURVEILLANCE: CARRIERS TO BE PREVENTED FROM
FOOD HANDLING.
• HEALTH EDUCATION: REGARDING HAND WASHING
AND SANITATION , ABOUT PERSONAL HYGIENE.

21.
CONTROL OF SANITATION
• PROTECTION & PURIFICATION OF DRINKING WATER SUPPLIES.
• IMPROVEMENT OF BASIC SANITATION.
• PROMOTION OF FOOD HYGIENE.
• SANITATION COMBINED WITH HEALTH EDUCATION RESULTS IN REDUCTION OF TYPHOID
MORBIDITY

22.
IMMUNIZATION
VACCINATION RECOMMENDED TO:
• ANY PERSON ABOVE 2 YRS OF AGE
• THOSE LIVE IN ENDEMIC AREA
• HOUSEHOLD CONTACTS
• GROUP AT RISK LIKE SCHOOL CHILDREN AND HOSPITAL STAFF ETC.
• THOSE ATTENDING MELAS & YATRAS

23.
THREE TYPES OF VACCINES
1 INJECTABLE TYPHOID VACCINE (TYPHIM -VI, TYPHIVAX)
2. THE LIVE ORAL VACCINE (TYPHORAL)
3. Cl as s i c al v ac c i ne
FACTS OF VACCINES Fo r Ty p h o i d
IMMUNITY LASTS FOR 3 YEARS NEED A BOOSTER after ever y vaccine.

24.
TYPES OF VACCINES
• INJECTABLE TYPHIM -VI VACCINE
• 1. THIS SINGLE-DOSE INJECTABLE
TYPHOID VACCINE, FROM THE
BACTERIAL CAPSULE OF S. TYPHI
STRAIN OF TY21A.
• 2. THIS VACCINE IS RECOMMENDED
FOR USE IN CHILDREN OVER 2 YEARS
OF AGE.
• 3. SUB-CUTANEOUS OR
INTRAMUSCULAR INJECTION
• 4. EFFICACY: 64% -72%
• TYPHORAL VACCINE
• 1. THIS IS A LIVE-ATTENUATED-BACTERIA VACCINE
MANUFACTURED FROM THE TY21A STRAIN OF S. TYPHI.
• 2. THE EFFICACY RATE RANGES FROM 50-80%
• 3. NOT RECOMMENDED FOR USE IN CHILDREN
YOUNGER THAN 6 YEARS OF AGE
• 4. THE COURSE CONSISTS OF ONE CAPSULE ORALLY,
TAKEN AN HOUR BEFORE FOOD WITH A GLASS OF
WATER OR MILK (1STDAY, 3RD DAY & 5TH DAY)
• 5. NO ANTIBIOTIC SHOULD BE TAKEN DURING THIS
PERIOD

25.
lassical vaccine
t is a kille vaccine
o mo e than six month baby
ubcutaneously use
i st ose at six months
econ ose afte fou to six weeks

26.
CORRELATION OF SANNIPATAJ SANTATA
JWARA AND TYPHOID FEVER
(IN ACCORDANCE WITH CHARAK CHIKITSA 3)
• वर्तमान काल में टाईफड्ड (TYPHOID FEVER) का समय 3 सप्ताह का माना जार्ा है। सन्निपार् सन्तर् ज्वर
को TYPHOID FEVER माना जा सकर्ा है। सन्निपार्ज ज्वर में दोष क
े र्ारर्म्य से कफप्रधान, वार्प्रधान,
न्नपत्तप्रधान ये ३ प्रकार होर्े हैं। कफ में 'अत्यर्त शीर्न्नपडका भृशमङ्ग
े भ्य उन्नत्तष्ठन्तन्त यह बार् न्ननयानस्र्ान में
बर्ाई गई है। कफ का वर्त श्वेर् होर्ा है। इसन्नलए ये न्नपन्नडकाएँ भी श्वेर् वर्त की होोंगी। टाईफाइड में श्वेर् वर्त
की न्नपन्नडका न्ननकलर्ी है।