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Typhoid Fever: No outbreak, but a cause for concern

There are eight confirmed typhoid fever cases in the territory, according to LBJ hospital Pediatrician Dr. Mike Favazza during a press conference called by the Department of Health yesterday. The press conference was led by DOH Director Motusa Tuileama Nua, who noted the recent cases of typhoid are a concern that needs to be addressed and the public should be informed.


During the press conference, Dr Favazza noted that there were several cases earlier this year, beginning in January, with the last case in June, and that is a child currently being held at the Pediatric Ward. Dr Favazza pointed out that it's not an outbreak and the public should not panic, however they just want to inform the public that typhoid is present and they are trying to “nip it in bud”.  


According to a handout by DOH officials, while typhoid fever is not common in American Samoa, the health community is doing its best to protect the island from this life threatening disease, especially among children. Typhoid fever is a life-threatening illness caused by the bacterium Salmonella Typhi bacteria.


It’s an infection caused by bacteria that infects the intestines, blood or other parts of the body and it may cause death if it is untreated.  Dr Favazza noted that typhoid fever is nothing new to American Samoa, with recognized recent cases and several hospitalized cases, the DOH and LBJ want the public to be aware of the symptoms of typhoid fever, what to look out for and when to seek treatment.


“Typhoid —if not treated —can be potentially fatal. We haven't seen any fatal cases in  recent history, because we are very good at treating the disease but what we want is to inform you that if you have a fever longer than three days, you should be seeing a health care professional.


How does one get typhoid fever? By eating contaminated food, drinking contaminated water, handling infected pets or animals, swallowing dirty water while swimming, being exposed to human feces through contaminated food or water or being exposed to human feces through sexual contact.


According to the DOH, both adults and children can get typhoid fever, but it is more common where human or animal waste is not thrown away safely, and it contaminates the water. Once the bacteria is eaten or drunk, they multiply and spread into the blood stream.


"The symptoms are high fever (103-104 degrees), headache, loss of appetite, stomach pains, severe weight loss, rash and constipation.”


He assured the public that this is not an outbreak however they just want to inform everyone to be cautious.


Dr. Favazza also noted that the current case of typhoid is a child who was very sick at home and the parents did not know the child had typhoid. Then, because treatment was not given the first few days of the disease, it progressed to sepsis and that is something very serious, which may cause death if it’s not treated quickly and appropriately.


The pediatrician noted that the child is now recovering and will be healthy and back to normal, but this does illustrate the importance of taking care of these problems, earlier rather than later.


“In my experience patients at LBJ and in the territory tend to come to the hospital and present to their health care providers later in their diseases, meaning it takes a while before parents will bring their children to the hospital— after three, four or five days of being ill at home.  Whereas, if you have a child with fever and diarrhea or any of the typhoid symptoms, “I encourage you to bring your child to the hospital a little earlier so we can test to make sure that your child is not infected” he said.


DOH Medical Director Tamasoali’i Dr Joseph Tufa, noted that if you are consuming water, buy it bottled, or bring it to a rolling boil before you drink it. Also, avoid popsicles and flavored ices that may have been made with contaminated water.


Eat foods that have been thoroughly cooked and that are still hot and steaming. Avoid raw vegetables and fruits that cannot be peeled. Vegetables like lettuce are easily contaminated and are very hard to wash well. When you eat raw fruit or vegetables that can be peeled, peel them yourself. (Wash your hands with soap first.) Do not eat the peelings.


Avoid foods and beverages from street vendors. It is difficult for food to be kept clean on the street, and many travelers get sick from food bought from street vendors.


He also noted that other groups at higher risk are children at day care centers as well as food service handlers and restaurant personnel.


He noted that when changing baby diapers, dispose of them properly and always wash your hands.


Victoria Cowger, with the Epidemiology Team with the Department of Health, noted that there are people that are at high risk for typhoid fever and children are one of those high risk groups,  because they tend to play outside and they don’t keep up with hygienic measures. Therefore,  it’s important for parents to encourage children to do so, to keep their hands clean after play, because they are at higher risk.


Cowger noted that DOH and LBJ are working closely together to investigate the source to assure that this does not become more serious. She reiterated that the best prevention against typhoid bacteria are preventative hygiene measures such as washing hands thoroughly before eating.