Typhoid may become more widespread during the month of Ramadan

With the fast of Ramadan upon us, we thought it might be useful to look at ways of trying to maintain a healthy body while fasting. To be healthy, you must consume food from the major food groups (bread and cereal, milk and dairy products, meat and protein, vegetable and fruit) from good hygienic sources. 

“I advise all Muslims in this month to avoid consuming the unsafe kinds of food, such as street foods, which become more prevalently purchased and eaten during Ramadan. Such foods can lead to infection by many diseases especially typhoid fever,” said Dr. Ahmed al-Safani, an internist. 

Typhoid fever is a potentially life-threatening illness that is caused by the bacteria Salmonella typhi (S. typhi). Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract and can spread the infection directly to other people by contaminating food or water. Anyone can get typhoid fever if they drink water or eat food contaminated with the S. typhi bacteria. 

“Fasting during the Islamic month of Ramadan can be good for one’s health and personal development. But people should be careful of having such kinds of street foods, which are mostly contaminated and cooked in bad hygiene, to maintain their bodies in good health during the month of Ramadan,” Dr. al-Safani said. “People also must maintain their personal hygiene to avoid health problems.”

Typhoid  fever is a common problem in developing areas, such as India, Africa and South America, where food hygiene and sanitation standards may not be as high as in developed countries. The World Health Organization estimates that there are approximately 16 million cases a year, which result in 600,000 deaths. Many of those infected contract the disease in Asian countries.

You can get typhoid fever by eating or drinking contaminated food or water. Food or water can be contaminated by a food handler with S. typhi, or may be contaminated if sewage accidentally gets into the food or water. Some infected persons may not show any symptoms of typhoid fever but can shed the S. typhi bacteria in their feces for many years. These persons are called typhoid fever “carriers”. S. typhi is only found in humans.

Dr. al-Safani also calls upon all owners of restaurants and their workers to pay more attention to the hygiene conditions inside their work places, not only in Ramadan but during the whole year. “They can maintain their customers in good health and prevent them from contracting many serious diseases by good hygiene inside their restaurants and when they cook food,” he said. 

The incubation period of the disease is usually 10-14 days following ingestion of contaminated food, milk or water. The onset is insidious, with a  headache being a prominent symptom. The fever is remittent and gradually increases in severity in a stepwise fashion over 3-4 days.  Cough, sore throat, and altered behavior may also be present.  Constipation is usually present initially and diarrhea occurs late in the disease. 

Diagnosis of typhoid fever is made by laboratory tests to detect the presence of Salmonella typhi from a blood or stool sample.

Typhoid fever can be effectively treated using antibiotics. The usual case-fatality rate of 10% can be reduced to less than 1%  if prompt antibiotic treatment is received. Relapses can occur following treatment.

Fluid replacement, good nutrition and antibiotic treatment are essential. Prevention  measures include: vaccination, provision of safe drinking water, sanitary disposal of excreta and proper attention to hygiene when handling food.

Travelers to countries with inadequate water and sewage treatment are at risk of acquiring typhoid and should take precautions to avoid consumption of potentially contaminated food and water. Drinking only boiled water or carbonated beverages and eating only cooked food, lowers the risk of infection. 

There are vaccines available which have been shown to give 70-90 percent protection to those vaccinated. Vaccination may be recommended for long-stay travelers to developing countries or for those international travelers with pre-existing health conditions that may increase their susceptibility.

According to Dr. al-Safani, government also plays an important role in struggling against this disease by raising awareness among people of this disease and its hazards and to mobilize the responsible authorities to play their role in inspecting restaurants on a regular basis to be sure of the hygiene conditions and to stop street sellers from selling the unsafe foods to people.

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