Transcript
JOHN CRUMP: Typhoid in the Pacific has got less attention than typhoid in Asia and Africa. And that includes less attention to understand sources and modes of transmission, both of which are essential to design and inform typhoid prevention strategies in countries. So the Fiji Ministry of Health invited us and a number of other groups to work together with them to assist with typhoid research that would help inform Fiji's control strategy. We did a large case control study which compares exposures in people with typhoid to matched people without typhoid to identify risk factors. And we found that unimproved sanitation facilities appear to be the major source of typhoid in Fiji. And that transmission to people is through fecal contamination of surface water used for drinking and also unwashed produce.
JENNY MEYER: Can you just explain what exactly typhoid is and how people would feel if they contracted it?
JC: Sure, typhoid is a bacterial infection that only infects humans. There are no other animals involved in transmission. Infection is by ingestion of food or water contaminated with human feces. And the disease is an illness with fever predominantly, sometimes with abdominal symptoms. If it's not treated appropriately and in a timely manner the risk for complications and death increases. Complications include things like intestinal perforation and neuropsychiatric complications. And if untreated up to a third of people can die, but in most places treatment brings the case fatality ratio down below ten per cent, and in high income countries, well below one per cent.
JM: And how much of a problem is it in Fiji? It sounds like it probably affects people who are living in poverty more than those who aren't, given that it's connected with the sanitation issue?
JC: Yeah, typhoid is a problem in many Pacific Islands and has perhaps been overlooked because of the small size of the populations in Oceania. The incidence or the number of infections per 100,000 people per year though is among the highest in the world in many Pacific Islands, exceeding what we see in Asia and Africa. People with unimproved sanitation facilities and lack of access to improved water are at particular risk. And so in Fiji like in other parts of the world they tend to be people who are perhaps less well off or don't have the benefit of access to improved facilities that are available in urban areas. Typhoid fever in Fiji is interesting in that a lot of the disease is in rural areas where people more often have unimproved sanitation facilities and more often rely on surface water for drinking. In other parts of the world like Asia, those problems tend to be encountered more in urban slums.
JM: With this research, what difference do you hope that your findings can make to people in Fiji who are vulnerable to typhoid?
JC: Yeah so this work was requested by the Fiji Ministry of Health and Ministry of Health representatives are part of the study team. So we do expect the results are immediately available for policy decisions. The long term strategy to controlling typhoid anywhere really is control of human waste. And so that focusses on improving sanitation facilities or toilets that people have so that waste is controlled. But also preventing or mitigating fecal contamination of food or water, so disinfection of drinking water, cleaning raw produce and items before consumption can all help. All of these are relatively long term fixes. And so the more short term or medium term strategy is use of typhoid vaccine. And the World Health Organisation pre-qualified the new generation of typhoid-conjugate vaccines late last year. These protect at younger ages and for longer than the older typhoid vaccines. And so probably a combination of typhoid vaccine use with the long term efforts to improve sanitation and water would form the strategy.
