There is no evidence that contaminated municipal water is implicated in the recent outbreak of typhoid in South Africa and the spreading of such “false information” on social media is causing “needless concern and panic”, said the National Institute of Communicable Diseases (NICD), reports MedicalBrief.
A number of cases have been detected in various provinces, but no causes had yet been identified, the NICD had said last week.
In a statement on Monday (21 February) the NICD confirmed there was no evidence “that recent cases of typhoid fever (or enteric fever) are linked to contaminated municipal water in any part of the country”.
“There are numerous social media posts with false information attracting widespread attention. They allege either that there are cases of enteric fever in certain towns or provinces that are being caused by contaminated municipal water, or that the bacteria causing enteric fever have been identified in certain municipal water sources.
“These statements are factually incorrect. There is no evidence linking recent cases to contaminated municipal water in any part of the country, and there is no evidence that the bacteria causing enteric fever have recently been identified in municipal water sources anywhere in the country. This includes those districts in Western Cape and North West provinces in which the clusters (small localised outbreaks) have been identified.”
The Institute said it was currently monitoring and tracking the recent cases, and was working with provincial authorities in the Western Cape and North West to contain three outbreaks.
At the moment there are 64 cases of enteric fever in the Western Cape, in three separate outbreaks; 18 in North West, 45 in Gauteng, 12 in Mpumalanga, nine in KwaZulu-Natal, seven in the Eastern Cape, four in the Free State and four in Limpopo.
Dr Juno Thomas from the NICD told Daily Maverick the last big outbreak of enteric fever in the country was in 2005, in Delmas, and was traced to a contaminated water supply.
Enteric fever is caused by a bacterium endemic to South Africa, which is potentially life-threatening, and is spread by contaminated water or food, but usually the country sees fewer than 150 cases a year, and boasts a lower infection rate than other countries in sub-Saharan Africa. “The numbers were unremarkable until 2022,” she said.
It is usually found in communities with inadequate sanitation or a lack of access to clean drinking water, with children running the highest risk of contracting it.
Diagnosing enteric fever was difficult because it can only be confirmed by a blood culture test not performed at all levels of healthcare, Thomas said, and typically only done once a patient was admitted to hospital.
The prevention and control of the disease were very simple, but boiling or adding a small amount of bleach to drinking water, as well as safe food practices, were important.
In the Western Cape, where outbreaks had been confirmed in Cape Town, the Winelands and the Garden Route, there had been a steady increase in infections since 2018. In North West, in the Kenneth Kaunda District around Klerksdorp, cases between 2021 and 2022 were “much higher than ever [before]”.
Genetic sequencing was used to track outbreaks, said Thomas, as had been done during the listeriosis outbreak in 2018. While Gauteng had more cases, they had not linked the cases to a similar source, as they had in the Western Cape and North West, although it could be that more cases were diagnosed there because of better access to laboratories.
“The Gauteng cases are widely distributed and we can see no distinct outbreak,” she said.
She added it was challenging to find the source of an outbreak, especially in the middle of one: there could be multiple sources, at household or a wider level.
Regarding a rise in stomach problems across the country, Thomas said the infectious causes of diarrhoeal disease are spread in different ways, the most important being contaminated water or food and person-to-person transmission.
“Some gastrointestinal infections have seasonality. In South Africa, we typically see an increase in some infections (like non-typhoidal salmonella, Shigella and norovirus) in summer.
“There are often informal reports during summer about increased ‘gastroʼ cases, but without recording the actual number of diarrhoea cases, or testing their stool samples, it is impossible to say what infection(s) are causing these, and if they can be attributed to the usual seasonal increase or are actually part of an outbreak due to contaminated water or food, for example,” Thomas told Daily Maverick.
But meanwhile, a crisis was declared in Nelson Mandela Bay on Wednesday (23 February) after the municipality admitted that the drinking water quality has been compromised.
One child has died, and another is in an intensive care unit after a suspected outbreak of E.coli infections due to the contaminated water.
Head of the Eastern Cape's health department Rolene Wagner said the one-year-old baby was one of three children from Kariega treated for E.coli infection. One of the three children had been discharged, while another was in the ICU at Gqeberha's Dora Nginza Hospital, reports News24.
She said there had been 96 reported cases of children under five treated for diarrhoea and dehydration at the department's hospitals in Nelson Mandela Bay in recent months.
"We are unable to confirm the cause, but, generally, such infections happen when people consume water that has been contaminated with faeces from humans or animals," Wagner said.
The municipality said an urgent joint operations committee has been established, and work is under way to bring about urgent remedial actions.
Wagner said 23 children were treated at Dora Nginza, Mabandla Clinic and Uitenhage Provincial Hospital in December, while in January, 73 children were treated for the same symptoms.
"We have confirmed with the National Health Laboratory Services that there have been no reported typhoid cases in Nelson Mandela Bay," she added.
The DA in the Eastern Cape has written to Public Protector Busisiwe Mkhwebane and the SA Human Rights Commission (SAHRC), to ask that the cause of the tainted water be investigated.
"The DA has been raising concerns over the discoloured water flowing from the taps of residents since January and has repeatedly challenged the municipality to provide the test results of water samples taken to prove that our water is safe," said the party's Dries Van der Westhuyzen.
He said, despite residents' justified concerns about the silted, cloudy water coming out of taps across the metro, the ANC-led coalition government assured residents that the water was safe to drink.
The DA submitted two PAIA applications to legally force the metro to give feedback on water sample test results, he said.
News24 article – Child dies after drinking suspected contaminated water (Open access)
Outbreaks of typhoid fever confirmed in Western Cape and North West (Open access)
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