Highlights
– Typhoid outbreak hits 18 villages surrounding Metro Manila
– Water contamination likely cause of outbreak
– Proximity to Manila indicates a larger scale, more deadly outbreak possible if health standards not met
In February 2008 Philippine health officials in Calamba City noticed a spike in the number of patients admitted to hospitals with typhoid-like symptoms. The number continued to grow until the local government placed the city under a state of calamity on March 3, 2008.
Calamba City is located approximately 60 kilometers south of the Philippine capital Manila and with more than 18 villages in the vicinity of Calamba City affected by the outbreak officials have indicated concern that the disease could impact the capital causing a potential medium scale epidemic.
Although officials report that the latest outbreak is now under control, the slow response and severity of the epidemic, in addition to its proximity to Manila, raises concerns that a more deadly outbreak may surface in the near-term.
Typhoid Casualties
Salmonella bacteria, which live in contaminated water or food that humans ingest, typically trigger typhoid fever. Patients experience high-grade fever, stomach cramps, diarrhea or constipation and a lack of appetite. If the patient is not treated, the small intestine can perforate, leading to death.
More than 1,700 people displayed typhoid symptoms in less than one month in Calamba City, causing the government-run hospital to experience overcrowding. The city took more than one week to confirm the outbreak because many patients who displayed symptoms of typhoid fever were not given an expensive blood test to confirm the diagnosis. Additionally, on March 8, 2008, a 14-year old girl died of a hemorrhage caused by typhoid fever.
On March 10, 2008, the Department of Health (DoH) reported that contaminated water originating from the city’s central distribution system caused the typhoid outbreak. Water samples taken from the Bukal Pumping Station in the Calamba Water District tested positive for coliform, a bacterial indicator of poor sanitary conditions. Water district officials argued that the findings were not conclusive and the DoH agreed to conduct and release new tests within two to three days.
Many people affected by the outbreak waited several weeks before consulting health officials, most likely compounding the severity of the outbreak.
Outbreak Control
Although, officials were slow to report the typhoid outbreak in Calamba City, DoH recently made significant strides in disease prevention. In August 2007, several countries in Southeast Asia experienced major dengue outbreaks. Following a slight increase in reported cases of dengue fever in northern Luzon, on March 3, 2008, DoH authorities began clearing densely populated mosquito areas in an effort to halt a possible outbreak. The steps taken by DoH demonstrate positive steps toward improving outbreak containment procedures (Previous Report).
Further, the Philippine Ecological Sanitation Network, led by the DoH, declared 2008 the “International Year of Sanitation” to raise awareness of the importance of sanitation and hygiene. The project was created to encourage investment in sanitation programs and convince policymakers to create a feasible plan to address growing public health concerns.
Epidemic Outlook
While the Philippine DoH is exhibiting signs of progress toward achieving improved sanitation and hygiene procedures throughout the country, emergency preparedness remains slow and unorganized. The recent outbreak illustrates that the high cost of the typhoid tests served as a detriment to doctors, resulting in inadequate care for many patients. As such, the government will likely remain incapable of successfully containing any large-scale epidemic if an outbreak were to occur in a densely populated area such as Manila.
Incidents of typhoid fever will likely subside in the near term as health officials use emergency funds to treat patients; however, diseases linked to poor water sanitation will likely reappear during the rainy season, typically beginning in late-May or June.
