Typhoid Outbreak Investigation Conducted in Lundazi District, Zambia, 2019

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In February 2019, Lundazi District Health Office received a report of a suspected typhoid outbreak at a zonal clinic catchment area. We investigated to confirm the outbreak, identify the causative agent, identify the source and contain the outbreak.
We defined a suspected case of typhoid as the occurrence of fever (temperature > 38°C) for one or more weeks among residents of a remote region of Lundazi from 29th January to 5th March 2019. We conducted active case search in affected villages, reviewed out-patient registers and clinical records to abstract data on demographic characteristics, clinical symptoms, laboratory investigations, and outcome. We interviewed suspected case-patients and collected blood samples from three suspected case-patients who had not taken antibiotics for culture and sensitivity. We collected data on sanitation facilities, cleanness of the environment and main sources of drinking water. We collected two water samples from a common source and tested using Hydrogen Sulphide and laboratory-based bacteriological tests.
We identified 34 suspected case-patients, (incidence rate 17 per 1,000). Three deaths occurred during the outbreak (case fatality rate=9%). More than 50% of suspected cases were children between 1-14years (attack rate=17.5 per 1,000). Females (56%) were slightly more affected than males. We isolated Salmonella typhifrom three cases by blood culture. The index case was seen on January 29th and the outbreak peaked in February. Clinical symptoms included fever (100%), malaise (91%), abdominal pain (88%), and diarrhea (79%). Affected villages had no toilets so open defecation was common. Both water samples were hydrogen-sulfide test positive and culture showed fecal coliforms and E.coli.
The outbreak investigation suggested that the outbreak was due to the consumption of contaminated water, poor sanitation, and poor personal hygiene. We recommended interventions such as health education on water safety, hand hygiene and sanitary disposal of fecal matter to prevent future typhoid outbreaks.

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