A study into the source and transmission of typhoid fever, which has been increasing in Pacific countries such as Fiji over the past decade, has revealed that poor sanitation is a major source of Salmonella Typhi, the cause of the disease.

It is believed that the study, conducted by the University of Otago, is the first to investigate sources and modes of transmission for typhoid fever in Fiji.  The majority of previous research on typhoid fever risk factors have been done in Asia demonstrating huge variations in major sources and modes of transmission by location.

The study, conducted by the University of Otago in Fiji, concluded that two key actions would contribute to controlling typhoid. Firstly, sanitation facilities need to be improved, and secondly, surface water sources and produce should be protected from contamination by human faeces.

Co-Director of the Otago Global Health Institute, Professor John Crump - an international typhoid fever expert who led the study, said that according to their research, typhoid is transmitted mainly through consumption of contaminated surface water and unwashed produce.

The result of the study also revealed that typhoid is common in both the rural and urban population in Fiji. At particular risk were people with no access to improved sanitation facilities or with damaged ‘improved’ sewerage systems.

It also found that people with typhoid fever were more likely to have someone within their household build their toilet. A common ‘improvement’ to sewerage systems in Fiji is using buried steel drums as the sewage vessel, which are subject to flooding, corrosion and leakage, causing contamination by human faeces to surface water and crops.

Related research shows that patients with typhoid fever had gardens more often located near the household toilet or septic tank than in controlled households. A majority of cases had vegetables located directly on or below the toilet drainage area.

Oceania

Professor Crump says the research also highlights the serious concern that Oceania has fallen behind both Asia and sub-Saharan Africa to become the region with the lowest coverage of improved drinking water and improved sanitation.

In many low and middle-income countries, he said typhoid fever is a substantial cause of morbidity and mortality and that it was important to conduct the study.

“We are delighted to help shed light on the neglected problem of typhoid fever in Oceania.”

“Even more to be able to provide evidence to inform much-needed non-vaccine control measures,” he said.

Tonga

On an annual basis, typhoid fever is also reported in Tonga. At the end of last year, Tonga's Ministry of Health ran a campaign highlighting the importance of better sanitation and good hygiene to avoid catching the disease.