Health

1. [a] Enteric fever includes typhoid fever [an infection caused by the bacteria Salmonella Typhi] and paratyphoid fever [bacterial infections caused by Salmonella Paratyphi A, B or rarely, C]. Paratyphoid fever is clinically indistinguishable from typhoid fever and the diagnosis and clinical management is identical. Enteric fever in South Africa is most commonly caused by Salmonella Typhi.

Salmonella Typhi only infects humans. Bacteria are shed in the faeces [stool] of an infected person. Infection occurs through the faecal-oral route [ingesting food or water that has been contaminated with faeces [poop] of an infected person]. Enteric fever occurs predominantly in association with poor sanitation and lack of safe drinking water [in both urban and rural settings]. There are two main patterns of transmission:

• Short cycle: contamination of food and water in the immediate household or work environment etc., by carriers who are shedding bacteria, when hygiene and sanitation are inadequate
• Long cycle: contamination of the broader environment, such as pollution of water supplies by sewage, inadequate treatment of water, or the use of raw human faeces or untreated sewage as a crop fertilizer. Large outbreaks of enteric fever are often associated with contamination of a drinking water source.

[b] We report the number of new laboratory confirmed cases of enteric fever. Reported cases significantly underrepresent the true number of cases; laboratory -confirmed disease depends on awareness of illness by healthcare workers, diagnostic practice [which samples collected for testing, and tests ordered], accessibility of laboratory testing.

 South Africa is endemic for enteric fever caused by S. Typhi [endemic: the constant presence of a disease in a population within a geographic area], although prevalence of disease is lower than most other countries in sub-Saharan Africa. After the Delmas outbreak in 2005, the number of enteric fever cases in South Africa has remained stable with less than 150 cases per year [an average of 97 cases per year].

© Table 1: Number of new cases of laboratory-confirmed enteric fever per month, Western Cape, 1 January 2021-28 March 2022

 

Year	Month	Total number of lab-confirmed cases	Districts
			Cape Town	Central Karoo	Cape Winelands	Garden Route	Overberg	West Coast
2021	Jan	2	0	0	1	1	0	0
	Feb	2	2	0	0	0	0	0
	Mar	8	5	0	1	2	0	0
	Apr	3	1	0	0	2	0	0
	May	3	1	0	1	1	0	0
	Jun	6	5	0	0	1	0	0
	Jul	4	2	0	1	1	0	0
	Aug	5	3	0	0	2	0	0
	Sep	4	2	0	0	2	0	0
	Oct	2	1	0	0	1	0	0
	Nov	6	3	0	0	3	0	0
	Dec	5	2	0	2	1	0	0
2022	Jan	6	3	0	3	0	0	0
	Feb	5	3	0	0	2	0	0
	Mar	1	0	0	0	0	1	0
Total		62	33	0	9	19	1	0

 

 Figure1: Number of laboratory confirmed enteric fever cases per district and month, Western Cape, 1 January 2020 – 28 March 2022, Western Cape

                               

                            

2. [a] One death with laboratory confirmed enteric fever, a 51 year old, male from Kuilsriver [Kalkfontein], Cape Town, passed away at Karl Bremer hospital on 17/02/2021. Presented with fever fatigue, myalgia, respiratory symptoms, loss of appetite, confusion on the 16^th of February 2021.  Complications.

One death with laboratory confirmed enteric fever, a 15 year old, male from George [Thembalethu], passed away at George Hospital on 13/03/2021. The case presented with fever, vomiting, abdominal cramps, headache, diarrhoea, epigastric pain and tender abdomen. Complications include salmonella typhi sepsis.

One death with laboratory confirmed enteric fever, a 51 year old, male from Worcester [Zwelenthemba], passed away at Tygerberg Hospital on 27 December 2021. He presented with gastro-intestinal bleeding, confusion, abdominal cramps and respiratory symptoms to Worcester Hospital.  Complications included renal failure and sepsis. Other problems listed were suspected pulmonary tuberculosis, leg DVT [deep vein thrombosis] amongst others.

 [b] The 3 deceased resided in Cape Winelands, Garden Route and Cape Town Districts.