100 Years of Typhoid: South Africa

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Epicentre is taking on Typhoid testing in our Walk-in Lab, so let’s take a look at the virus that’s on the rise in South Africa. Typhoid is getting a lot of people very worried and making some big headlines, but this bacterial infection is not new. We have battled with these bacteria for a very long time.

What is typhoid fever?

Typhoid fever is caused by bacteria called, Salmonella Enterica Serovar Typhi. This bacterium is a nasty one. It has a big footprint on developing countries with an estimated 10.9 million people getting sick and 116 800 deaths every year world-wide (Keddy et al., 2018).

What does having typhoid fever look like?

You’ll probably have a high fever (going as high as 39 to 40 °C) that lasts a long time. Some people also get a rash that looks flat, with rose-coloured (pink) spots. People also get symptoms like weakness, stomach pain, a headache, diarrhoea or constipation, a cough and a loss of appetite.

What did typhoid look like in SA 50 years ago?

Typhoid fever used to be much more deadly. Now days, if you get medical treatment, typhoid fever stops making you feel ill in just a few days. It’s still a deadly disease, if left untreated, but nothing like before.

Between 1945 and 1977, the fatality rate of reported Typhoid fever cases dropped from 15.5% to just 1.1% (Keddy et al., 2010).

Although modern laboratory based research studies say the true modern mortality rate is around 6.8% (Keddy et al., 2010).

When we look back at what typhoid looked like in SA before, we can see that the virus behaved in a very differently (Keddy et al., 2018). According to Keddy et al., (2018), typhoid fever cases were much more common in SA, with about 4,000 cases reported every year which is 4x more than all the people who got sick in the big outbreak of 1993 (Keddy et al., 2010).

What did typhoid look like in SA 100 years ago?

In April 2002, employees in the Free State, at the Koffiefontein Diamond Mine, made a shocking discovery (L’Abbe, 2003). Thirty-six skeletons were uncovered in mines that were last worked on in 1896 (L’Abbe, 2003).

These skeletons were victims of a typhoid epidemic that ripped through the early diamond rush mine workers, and reportedly killed 7 people each week… for 7 months (L’Abbe, 2003). This outbreak was later linked to a contaminated local water source, which is unsurprising as sanitation was a big problem during this time (L’Abbe, 2003).

But these skeletons showed evidence of far more than just the typhoid that killed them (L’Abbe, 2003). Their bones speak to the strenuous labour they endured, in conditions we know were overcrowded, violent and had poor nutrition (L’Abbe, 2003). These skeletons were African people, who also most likely endured rough conditions characterised by exploitation and violence from their overseers at these mines (L’Abbe, 2003). Something which would have made them, and others under the same conditions, vulnerable to an infectious disease like typhoid (L’Abbe, 2003).

What does typhoid look like in SA today?

In recent history, we’ve had alarming outbreaks in Cape Town in 2018 & 2017, and big waves in 2005 and in 1993.

In the past, parts of South Africa have been identified as highly endemic for the disease (Keddy et al., 2018). This means that it’s always kind of around, like an annoying and murderous neighbour.

But what’s great is that in the last 50yrs, and particularly after 1990, the number of typhoid fever cases that are reported suddenly decreased in SA (Keddy et al., 2018).

No one really knows for certain why there was such a sudden drop (Keddy et al., 2018).

But there’s been several theories thrown around. These include improvements in our water treatment plants, our GDP, sanitation, and female literacy (Keddy et al., 2010; Keddy et al., 2018).

But it cannot be ignored that improving politics in SA with the arrival of democracy certainly had an impact (Keddy et al., 2018).

The HIV rate is also a significant factor for policy around typhoid now days, as typhoid can swiftly kill people with this virus (Keddy et al., 2018). This threatens the well-being of many communities in South Africa (Keddy et al., 2018).

But we shouldn’t lose sight of how far we’ve come since the start of our democracy and the tangible difference that’s made to the health of many people in South Africa vulnerable to this disease.

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