What raises the risk of Typhoid among children living in crowded areas

Children living in crowded areas are at an increased risk of infections like typhoid. Typhoid is a bacterial infection usually seen in the tropics and caused by bacteria called salmonella typhi. This infection basically spreads through the consumption of unhygienic food and water. The risk is especially increases high in places where the clean water supply and sanitation are jeopardized. Such a condition is more common in areas with overcrowding, especially urban slums.

Challenges of Clean Water and Sanitation in Crowded Places
In crowded places where clean water supply and sanitation is a big challenge, children are more likely to drink untreated water and consume unhygienic food and cut fruits. They also don’t have access to treated water or boiled water. The chances of water contamination are pretty high due to the mixing of drinking water with sewerage water, especially due to damaged pipelines. During monsoons, drinking water contamination increases due to overflowing flood water. The risk is also high during summer, especially when there is a scarcity of water. Thus, boiling of water plays an important role in preventing typhoid – public awareness regarding the same is crucial too. Since the sanitation is poor, especially if open defecation or unhygienic toilet practices are followed, salmonella bacteria can be easily transmitted.

Unhealthy and Unhygienic Food:
Another mode of transmission is through unhealthy, unhygienic food consumption, especially previously cooked, stored food, or chilled foods. The practice of eating street food also is common among these children which can increase the risk of transmission. Food handlers who are silent carriers of typhoid infection can also be a source of infection, spreading to their customers. Such an incident occurred in the past in the United States, when a cook transmitted typhoid fever to many people. He was popularly known as “Typhoid Mary”.


Use of Antacid & Overcrowding:
Unnecessary use of antacids can further make an individual susceptible to typhoid infection. Antacids reduces the acid content in the stomach, which is a natural protective factor against the infection. Thus, self-medication or unnecessary antacid usage should be discouraged. Overcrowding also acts a fuel for transmission, as typhoid can spread through fomites. These risks can be reduced by providing boiled water for drinking, and consuming well-cooked home food.

Importance of Sanitation and Toilets at Home:
Toilets and latrines at the household is mandatory and hand washing techniques have to be taught for all children at schools to prevent the transmission of typhoid fever. Open defecation should be banned as it increases the contamination of food and water, during monsoon, which also acts as driving force for increased spread of typhoid. Handwashing plays a crucial role in preventing this mode of transmission. This can be achieved by opting for personal hygiene by handwashing with soap and water for 30 - 45 seconds and educating the public and children in schools.

Role of Typhoid Vaccination:
Typhoid fever can be prevented by typhoid vaccination. This vaccine can also reduce the severity of the infection. But, currently, it is not inclusive of the universal immunisation program provided by the government. Thus, the public should be educated about the availability of conjugated typhoid vaccine, which can be administered as a single dose from 6 months of age.
(Author: Dr. Archana M, Consultant - Paediatric Infectious Diseases, Manipal Hospital Old Airport Road)