Typhoid fever in Fiji: a reversible plague?

Abstract

The country of Fiji, with a population of approximately 870 000 people, faces a growing burden of several communicable diseases including the bacterial infection typhoid fever. Surveillance data suggest that typhoid has become increasingly common in rural areas of Fiji and is more frequent amongst young adults. Transmission of the organisms that cause typhoid is facilitated by faecal contamination of food or water and may be influenced by local behavioural practices in Fiji. The Fijian Ministry of Health, with support from Australian Aid, hosted a meeting in August 2012 to develop comprehensive control and prevention strategies for typhoid fever in Fiji. International and local specialists were invited to share relevant data and discuss typhoid control options. The resultant recommendations focused on generating a clearer sense of the epidemiology of typhoid in Fiji and exploring the contribution of potential transmission pathways. Additionally, the panel suggested steps such as ensuring that recommended ciprofloxacin doses are appropriate to reduce the potential for relapse and reinfection in clinical cases, encouraging proper hand hygiene of food and drink handlers, working with water and sanitation agencies to review current sanitation practices and considering a vaccination policy targeting epidemiologically relevant populations.

Keywords: Fidji; Fiji; Fiyi; enteric fever; epidemiology; epidemiología; fiebre entérica; fièvre entérique; tifus; transmisión; transmission; typhoid; typhoïde; épidémiologie.

Figure 1

Average annual laboratory-confirmed incidence of S. Typhi cases per 100 000 population in Fiji by subdivision, January 2008–August 2012. Incidence per 100 000 population is indicated by colour, with darker colours reflecting higher incidence. The capital of Fiji, Suva, is shown by the black star.

Figure 2

Age distribution of laboratory-confirmed typhoid fever cases in Fiji, 2008–2011. (a) Total number of reported cases by age and sex, blue: male cases; red: female cases. (b) The age-specific incidence per 100 000 population.