Typhoid Outbreak in Bindura City, Zimbabwe: Emergency Response

By Alfred Mushonga, International Medical Corps Zimbabwe

April 5, 2012— A series of typhoid fever outbreaks have been surging through central and southern Africa since early November 2011. Typhoid usually occurs when water and food sources get contaminated; recent cases of typhoid fever in Zimbabwe can be directly attributed to water and sanitation problems. Symptoms of typhoid can include high fever, flu-like symptoms, abdominal pain, constipation or diarrhea, and even death.

Following a February 2012 typhoid outbreak in Bindura City, Zimbabwe, in the Mashonaland province, International Medical Corps mobilized a comprehensive emergency response to effectively treat existing cases, mitigate the spread of the highly-communicable disease, train local health workers to ensure sustainable care and educate vulnerable communities on healthy hygiene practices. The following illustrates the first critical days of International Medical Corps’ response.

Day 1 (Monday, February 20, 2012)
International Medical Corps receives a call from the province health director about a suspected outbreak of typhoid, with confirmation of one case. An emergency response meeting is called. International Medical Corps mobilizes resources, such as water sanitation tablets and typhoid information, education and communication materials. Cases reported: 4

Day 2 (Tuesday, February 21, 2012)
International Medical Corps leads a field investigation with our partners. The team traces the source of contamination to a shallow well located near broken sewer pipes in the suburbs. International Medical Corps provides fuel and other resources to enable Ministry of Health (MoH) personnel to identify active cases. We also provide technical assistance to the provincial laboratory and make a request for more typhoid-related educational materials. Cases reported: 3 new, 7 total

Day 3 (Wednesday, February 22, 2012) The MoH sets up typhoid isolation camps and sanitation zones to handle potential case loads. International Medical Corps orders single family water sanitation tablets for 8,000 families and sends new case blood samples to the laboratory to be tested for typhoid. Cases reported: 4 new, 11 total

Day 4 (Thursday, February 23, 2012)
International Medical Corps manages a sewer maintenance crew to repair plugged sewer systems and prevent further contamination. Our public health officer for Bindura district mobilizes for health and hygiene education in schools, and distributes water sanitation tablets and educational materials. Cases reported: 6 new, 17 total

Day 5 (Friday, February 24, 2012)
International Medical Corps public health officers are called in from outlying districts to begin community-wide health and hygiene messaging in schools. Eighty thousand water sanitation tablets are received by International Medical Corps. Cases reported: 3 new, 20 total

Day 6 (Saturday, February 25, 2012)
International Medical Corps trains community volunteers on community health and hygiene education. Cases reported: 2 new, 22 total

Day 7 (Monday, February 27, 2012)
International Medical Corps begins health and hygiene education in schools, reaching 14 schools and approximately 11,000 students. Sewer unblocking continues. International Medical Corps provides fuel for MoH motor bikes for further case identification and sends more samples to the lab for confirmation and antibiotic sensitivity testing. Door-to-door distribution of new water purification tablets in the target area begins, reaching 8,500 households with educational materials on typhoid and healthy hygiene practices. Cases reported: 7 new, 29 total

Week 3 (Monday March 12, 2012)
Due to blanket distribution of water purification tablets, health education and decontamination of shallow wells, the number of new typhoid cases tapers off in week two. By week three, the typhoid outbreak is deemed under control, with no other outbreaks occurring in the Mashonaland province.

International Medical Corps resumes normal health and hygiene activities, including training for community volunteers and health workers, to empower local residents to prevent future disease outbreaks.

Since our operations began in Zimbabwe in May 2009, International Medical Corps has worked to improve access to quality health services and reduce the spread of cholera and other waterborne diseases by increasing access to clean water and improving personal hygiene practices for more than 150,000 people in Mashonaland Central Province.