Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jan 5;17(1):23.
doi: 10.1186/s12889-016-4002-0.

A large and persistent outbreak of typhoid fever caused by consuming contaminated water and street-vended beverages: Kampala, Uganda, January - June 2015

Steven Ndugwa Kabwama  1 , Lilian Bulage  2 , Fred Nsubuga  2 , Gerald Pande  2 , David Were Oguttu  2 , Richardson Mafigiri  2 , Christine Kihembo  2 , Benon Kwesiga  2 , Ben Masiira  2 , Allen Eva Okullo  2 , Henry Kajumbula  3 , Joseph K B Matovu  4 , Issa Makumbi  5 , Milton Wetaka  5 , Sam Kasozi  5 , Simon Kyazze  5 , Melissa Dahlke  5 , Peter Hughes  6 , Juliet Nsimire Sendagala  6 , Monica Musenero  7 , Immaculate Nabukenya  7 , Vincent R Hill  8 , Eric Mintz  8 , Janell Routh  8 , Gerardo Gómez  8 , Amelia Bicknese  8 , Bao-Ping Zhu  8   9
Affiliations

A large and persistent outbreak of typhoid fever caused by consuming contaminated water and street-vended beverages: Kampala, Uganda, January - June 2015

Steven Ndugwa Kabwama et al. BMC Public Health. .

Erratum in

Abstract

Background: On 6 February 2015, Kampala city authorities alerted the Ugandan Ministry of Health of a "strange disease" that killed one person and sickened dozens. We conducted an epidemiologic investigation to identify the nature of the disease, mode of transmission, and risk factors to inform timely and effective control measures.

Methods: We defined a suspected case as onset of fever (≥37.5 °C) for more than 3 days with abdominal pain, headache, negative malaria test or failed anti-malaria treatment, and at least 2 of the following: diarrhea, nausea or vomiting, constipation, fatigue. A probable case was defined as a suspected case with a positive TUBEX® TF test. A confirmed case had blood culture yielding Salmonella Typhi. We conducted a case-control study to compare exposures of 33 suspected case-patients and 78 controls, and tested water and juice samples.

Results: From 17 February-12 June, we identified 10,230 suspected, 1038 probable, and 51 confirmed cases. Approximately 22.58% (7/31) of case-patients and 2.56% (2/78) of controls drank water sold in small plastic bags (ORM-H = 8.90; 95%CI = 1.60-49.00); 54.54% (18/33) of case-patients and 19.23% (15/78) of controls consumed locally-made drinks (ORM-H = 4.60; 95%CI: 1.90-11.00). All isolates were susceptible to ciprofloxacin and ceftriaxone. Water and juice samples exhibited evidence of fecal contamination.

Conclusion: Contaminated water and street-vended beverages were likely vehicles of this outbreak. At our recommendation authorities closed unsafe water sources and supplied safe water to affected areas.

Keywords: Case-control; Outbreak; Typhoid fever; Uganda.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
An intensity map showing treatment centers (green dots) and geographical distribution of suspected case-patients by place of residence during an outbreak of typhoid fever: Kampala, Uganda, 17th February 2015 – 14th April 2015 (n = 9325)
Fig. 2
Fig. 2
Distribution of suspected cases of typhoid fever by date of symptom onset during an outbreak of typhoid fever: Kampala, Uganda, 1 January 2015-12 June 2015 (n = 9515)*
See this image and copyright information in PMC

References

    1. Heymann DL. In: Control of Communicable Diseases. An Official Report of the American Public Health Association. 20. Heymann DL, editor. United States of America: Alpha Press; 2014.
    1. World Health Organization. The diagnosis, treatment and Prevention of Typhoid Fever. World Health Organisation, Department of Vaccines and Biologicals: CH-1211 Geneva 27; 2003. WHO/V&B/03.07.
    1. Crump JA, Luby SP, Mintz ED. The global burden of typhoid fever. Bull World Health Organ. 2004;82:346–353. - PMC - PubMed
    1. Centers for Disease Control. Typhoid Fever 2013. Available from: https://www.cdc.gov/typhoid-fever/index.html. Accessed 27 July 2015.
    1. Mogasale V, Maskery B, Ochiai RL, Lee JS, Mogasale VV, et al. Burden of typhoid fever in low-income and middle-income countries: a systematic, literature-based update with risk-factor adjustment. Lancet Glob Health. 2014;2:e570–e580. doi: 10.1016/S2214-109X(14)70301-8. - DOI - PubMed

MeSH terms