A public health failure

Typhoid is not commonly used in the medical vocabulary of New Zealanders but suddenly, the word, the disease has become a point of concern after an outbreak in Auckland.

By last Friday, 18 people were confirmed as having typhoid following a gathering in Auckland more than two weeks ago, following which a woman died.

But, her family and friends were kept in the dark about the disease for several days after her death. Visitors who kissed and touched her as she lay dying were unaware she had typhoid fever.

No progress has been made in identifying the source of the disease.

The concern revolves around why health officials took so long to alert people close to the woman of the risk? Also, why did it take so long for Health Minister Jonathan Coleman to be alerted? He found out through the media.

The name of the church where the dead woman, friends and her family gathered for a weekend celebration was incorrect when released to the media. Although there are similarities in the names of the two churches, the differences had a huge impact on the incorrectly named church and its congregation.

Dr Siouxsie Wiles, one of New Zealand's leading experts on antibiotic resistance, says typhoid is an infection caused by the bacterium Salmonella enterica subspecies enterica serovar Typhi, usually abbreviated to Salmonella Typhi, or S. Typhi.

Humans are this bacteria's only known host. The bacteria can be passed from person to person through the faecal-oral route. That is why it is so important for everyone to wash their hands properly after they have been to the toilet, or changed any nappies.

Typhoid can also be caught by eating contaminated food or drinking contaminated water. The symptoms of disease are a high fever, which can last for weeks, as well as nausea, tiredness, headaches and the loss of appetite. Some people may have diarrhoea, constipation or a rash.

The symptoms may not sound much different from other types of food poisoning but typhoid can be serious. If not treated, between one and three in 10 infected people can die. The good news is the majority of infected people can be treated with antibiotics.

The reason the latest outbreak is getting so much attention is because usually New Zealand only has one or two cases at a time. Most of the cases are from people having been infected overseas.

People with typhoid are infectious before they show any symptoms and, also, while they have symptoms. According to Dr Wiles, some people can also carry on shedding the bacteria for months after they have recovered.

And a small number of people become chronic carriers of S. Typhi, spreading bacteria while showing no signs of infection.

The Auckland Regional Public Health Service says it delayed announcing the death to enable funeral arrangements to be concluded at the family's wishes. In hindsight, the decision was not taken with the best interests of the family and public at heart.

Health officials in Samoa have warned anyone who has been to Auckland in the past three weeks to be tested for typhoid.

But that surely is no consolation to the rest of the group which may have come in contact with a wider circle. It is understood some of the people attending the gathering have returned to Australia.

It is not acceptable for a public health service to hide the facts from the public and, importantly, its own minister. Shared food is customary at many funerals, more so in this case.

If others start showing typhoid symptoms, it will be inexcusable for any details to be not revealed immediately.

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