Description and Rationale
Typhoid Fever has become one of the Philippines’ worst problems especially in the squatter areas. The open sewers and collecting water makes it a breeding ground for this bacterium. Typhoid was first heard of in Athens Greece. It is unknown how it came to the Philippines but it has caused a lot of problems since its arrival. It is able to adapt the climate around it, and is able to live several years in water.
How many people does it infect in the Philippines? How can it be stopped? Is there a low cost way to prevent it? What are some simple ways to control it? What is the main cause here in the Philippines? Where in the Philippines are most of the people getting infected?
Are there not simple steps that can be taken to decrease the amount of typhoid cases in the Philippines? Through some observations near my church I have seen many sick people, it could be their living conditions, or that their food has not been cleaned properly. What are some reasons people are getting sick? Most of the population that is infected with typhoid fever lives in or near a squatter area. Squatter areas have open sewers and the food that is cooked there is loved by the local flies. If it were possible wouldn’t the people living in squatter areas like to know ways of preventing typhoid?
The main purpose to this project will be to research and see if there are better ways of getting rid or preventing typhoid fever before it happens. I will be doing research though books, the internet, and through first hand experiences such as interviewing doctors that know about typhoid fever.
It is hoped that the research done will help improve understanding of typhoid fever, and through the knowledge they have gained, will be able to show others how to prevent typhoid in their homes.
Biology
Common Names and Synonyms
Salmonella enterica serovar Typhi is the scientific name for Typhoid fever. It also has several other names such as enteric fever, bilious fever or Yellow Jack. Fiebre Tifoidea is Spanish, Fièvre typhoïde is French Tipus Kaalaban is Filipino; all of these words sound different, but they all mean the same thing…Typhoid Fever
Classification
Kingdom: Bacteria
Phylum: Proteotic bacteria
Class: Gamma Proteobacteria
Order: Enterobacteriales
Family: Enterobacteriaceae
Genus: Salmonella
Species: S. Typhi
There are at least four different species classified under the phylum proteotic bacteria. An example of the species would be Rikettsia Rickettsii, and Vibio Cholerae
Morphology and Physical Description
Typhoid fever usually develops one to three weeks after a person has consumed contaminated food or water; just like the food that some of the vendors in the Philippines sell. Most cases last about four weeks after the symptoms begin. During the first week, the person has a rising fever, with headaches and stomach pain. Fever peaks and remains high during the week. In many cases, rose colored spots appear on the chest and stomach. The person gradually improves during the end of the third week and during the fourth week.
Serious and sometimes fatal complications can develop. The bacteria may produce ulcers (open sores) in the intestine. If the ulcers become severe they can make holes in the intestinal wall. In such cases, the content of the intestines spill into the stomach, and serious stomach infections can follow. In other instances, the intestines may bleed severely. Blood transfusions may be necessary to prevent the death of the person with Typhoid.
Bacteria are classified by their shapes, Bacilli, cocci, and spiral. S. Typhi is rod shaped. Bacteria have different functions, but most of them have the same structure including the S. Typhi. It consists of the cell wall; this structure protects the bacteria from different kinds of antibiotics by preventing the entry to the cell.
Bacteria also have a structure called a Cell Membrane; the cell membrane regulates movement of materials into and out of the cell. The Cell Membrane contains enzymes important to cellular respiration. Unlike eukaryotic cells, bacteria cells do not have membrane bound organelles. The cytoplasm of bacteria cells is made of a solution of DNA, ribosomes, and other organic compounds that are needed to carry out the life process.
Bacterium cells also have functions to protect itself, such as the Capsule and slime layer. “The Capsule is made of polysaccharides that cling to the surface of the cell and protects it from drying or harsh chemicals.” The Pili are short hair like protein structures that help the bacteria attach itself to the host cell; they are also used by transferring genetic material from one bacterium to another. Endospores are a function in the cell that protects the cell from harsh environmental conditions, such as heat and drought.
Most of the bacteria use flagella to move around inside the host; some of the bacteria are surrounded completely in flagella.
Getting Food
S. Typhi is a heteratroph it feeds off of the blood from the host organism.
Reproduction
S. Typhi uses an asexual method of reproduction known as binary fission. This simply means that the cell divides into two separate cells; each new bacterium is an exact clone of the original one containing a copy of the same DNA. Bacteria can reproduce very quickly, at an enormous growth rate; one bacterium could become one Billion in 10 hours (in a laboratory environment), but luckily there is not enough nutrients of space to support this rapid growth or the entire world would be overrun with bacteria.
This picture below demonstrates binary fission
Environmental Factors
Bacteria have varying temperature requirements for growth. Some bacteria grow best in cold temperatures of 0-12 degree. Other bacteria grow best in cold temperatures that range from 20- 40 degrees C. Salmonella Typhi needs temperatures that range from 20-40 degrees C; it also needs a pH level of 6.5 to 7.5 (7.0 is neutral). S.Typhi has only 1 enemy; they are antibiotics. There are 5 different types of anitibiotics to treat Typhoid; these are ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, and ciprofloxacin.
Origin and Distribution
The first epidemic outbreak was in Athens around 430-426 B.C. when a scholar named Thucydides contracted the plague, and the symptoms he described matched the symtoms of Typhoid fever. The epidemic killed one third of the population of Athens, including their leader Pericles. After the death of Pericles, the balance of power shifted from Athens to the Spartans.
Hundreds of years later in the late 19th century, typhoid fever killed an average of 65 people per 100,000 people a year; these rates only apply for the city of Chicago. The worst year that typhoid fever struck was in 1891, when the death rate was 174 people per 100,000. The most infamous carrier of the typhoid fever was a woman named Mary Mallon, who was also known as Typhoid Mary. In 1907, she became the very first American person to be identified and traced. She was a cook in New York; some believe that by being a cook this spread the infection through several hundred people. Authorites told Mary to give up working as a cook or have her gall bladder removed. Mary quit her job, but returned later with a false name. She was then detained and quarantined after another typhoid outbreak. Twenty six years later she died of pneumonia, while she was still in quarentine.
Although it is unknown how Typhoid Fever came to the Philippines, it is thought that a immigrant carried the bacteria from another country. Carriers can be healthy while spreading the bacteria. They do not have any of the symptoms, even a healthy person coming in, who is carrying the bacteria, can spread it to others. Human body wastes that contain S.Typhi can contaminate food or water in several ways. For example, flies can carry the bacteria from feces to food. Food that has been handled by carriers is another common source of infection. In regions with poor sanitation like squatter villages, the bacteria often spreads after water supplies are contaminated by human wastes.
Importance to People
Out of the 16- 20 million cases that occur worldwide, about 500,000 people die each year of Typhoid fever. It can be easily contracted, and if not seen to immediately can be fatal. It is important to …
1. Get vaccinated for Typhoid.
2. Carefully select food while in a developing country.
3. Only use clean water. Buy bottled water, or make sure it has been boiled.
4. Ask for drinks without ice, unless the ice was made with clean water.
5. Only eat food that has been thoroughly cooked.
6. Do not eat food that has been sold by street vendors; many people get sick when they eat food sold from vendors.
These bacteria can be passed indirectly from one person to another, mostly through contaminated food or water.
Survivability and Endangered Status
With an estimated 16-33 million cases of annually resulting in 500,000 to 600,000 deaths in endemic areas, the World Health Organisation identifies typhoid as a serious public health problem. Most cases occur in children between 5 and 19 years old. These are the world statistics; fortunately the Philippine numbers are not as high. Reports have shown that 1400 people have typhoid fever, but this number is for Laguna alone.
Potential Solutions
Can the Philippines ever eradicate Typhoid fever? It is impossible for any country to be rid of Typhoid fever as the bacteria S.Typhi can be passed through humans and animals. Meanwhile it may not infect the carrier; this makes it impossible to find and exterminate the bacteria. But there are some ways to lessen the effects of the typhoid, and possibly decrease the cases of Typhoid fever. Below there are 3 possibilities, with an analysis of advantages and disadvantages for each.
Possibility 1
Vaccinations.
Although there is no known cure for the contagious Typhoid fever, there are 2 types of vaccinations currently on the market; these vaccinations are found nearly all over the world.
Advantages
1. For people that have good stable jobs, getting the vactionation should not be a problem. Most of the medical facilities in the Philippines have the vaccinations for Typhoid fever. Examples of the vaccinations are Ty21a (Vivotif Berna, Swiss Serum and Vaccine Institute) and ViCPS (Typhim Vi, Pasteur Merieux).
2. The two vaccinations come in capsule and injection form; the capsule lasts longer than the injection. If the vaccination is taken, the patient won’t have to take another vaccine for at least 2- 5 years.
Disadvantages
1. The Typhoid fever vaccinations do not prevent the Typhoid fever; they only help treat the sickness.
2. Some people, mainly squatter people, cannot afford the vaccinations that are provided by the big hospitals, such as Saint Lukes. If they had no other choice but to try and buy the vaccination, they would have to borrow some money and would eventually go into debt.
3. People that live in the mountains (e.g. the Ayta people) live hours away from hospitals. By the time they get to a hospital, the person that is infected with the sickness could get worse, or if the Typhoid fever was really bad, they could die.
Possibility 2
Avoid street vendors.
Sometimes, street vendors don’t cook their food properly, and they get their food from places that sell old produce. Often they leave food in places where the flies can reach it (such as the side of a street), and most of the streets in the squatter villages are not clean. The flies that land on the food most likely have landed on human and animal waste and the bacterium is then transferred to the food. When the food is consumed, Typhoid bacteria will cause the person to get sick.
Advantages
1. Do not eat from street vendors’ stalls unless you have recommendations from people who have eaten there, and have not become ill. And if the street vendor is someone you know and trust, it should be okay.
2. By avoiding places like this you can be sure that the food you have eaten is fresh and has been cooked properly.
Disadvantages
1. Some of the Filipinos that live in the Philippines make a living by selling food on the street. If people stop buying their food, they will lose business and become more destitute.
2. People living in squatter areas have no other source of food, or they cannot afford to eat at the fast food restaurants we take for granted. By taking the street vendors away we take away their source of food, resulting in malnutrition.
Possibility 3
Eat and Drink Smart
Some of the restaurants here in Manila do not use fresh food. They leave food in storage for a long time, serving unsuspecting customers old, spoiled food. Knowing where your food comes from and how long it’s been there is a very important aspect in healthy eating. Knowing where your water comes from is also very important; making sure that the water you drink has been purified and boiled.
Advantages
1. Knowing were your food comes from and how well it is cooked can also prevent other serious diseases. For example salmonella, which can result from uncooked eggs; food poisoning can result from food that has not been cooked thoroughly.
2. This will encourage more people to eat at home, serving healthier more nutritious food.
Disadvantages
1. While eating in a restaurant nobody wants to ask waiters or the chief how long their food has been stored, or where they get their water. They just want to enjoy a peaceful meal without being disturbed by the thoughts of where their food came from.
2. A lot of people in this generation have jobs that are very demanding; they do not have enough time to go home and cook proper food. They need to go to a restaurant and eat food quickly in order to get back to work.
Bibliography
"Typhoid Fever." World 66. Google. 12 Apr. 2008 <http://www.world66.com/africa/sudan/lib/health/typhoidfevert>.
Butler, T. "Typhoid Fever." EMedicine From Web MB. 24 July 2006. 24 Apr. 2008 <http://www.emedicine.com/MED/topic2331.htm>.
"Immunizaton History." Sanofi Pasteur. 3 Dec. 2007. 15 Apr. 2008 <www.sanofipasteur.com.ph/>.
"Travelers." National Travel Health Netword and Center. 7 Mar. 2007. 20 Apr. 2008 <http://www.nathnac.org/travel/news/typhoid_070308.htm>.
"Typhoid Fever." Center for Disease Control and Prevention. 24 Oct. 2005. USA.Gov. 16 Mar. 2008 <http://www.cdc.gov/ncidod/dbmd/diseaseinfo/typhoidfever_g.htm>.
"Typhoid Fever." MedicineNet.Com. 20 Mar. 2008. 4 May 2008 <http://www.medicinenet.com/typhoid_fever/page2.htm>.
Harrison, Noel G. "Typhoid Fever." Wikipedia the Free Encyclopedia. 2 May 2008. 15 Apr. 2008 <http://en.wikipedia.org/wiki/Typhoid_fever>.
"Salmonella and Salmonellosis." Todar's Online Textbook of Bacteriology. 2 Apr.-May 2005. 2 May 2008 <http://www.textbookofbacteriology.net/salmonella.html>.
Schwab, Daniel. Personal interview. 29 Apr. 2008.