Travnik refugees hit by typhoid fever

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The Independent Online
AN EPIDEMIOLOGIST will today begin a full investigation of the outbreak of typhoid fever among Muslim refugees in the town of Travnik, central Bosnia, an expert from the World Health Organisation (WHO) said last night.

Dr Dina Pfeifer said in Zagreb yesterday that the WHO had been informed of 13 confirmed cases and that reports of around 100 people affected would not be unlikely given the way typhoid is spread. 'A local epidemiologist will be taking samples for analysis and will investigate the whole issue,' she said.

Typhoid fever is caused by drinking water contaminated with the bacterium Salmonella typhi. It is infectious, passed on via oral-faecal transmission. Poor sanitation and overcrowding, and contamination of the water supply by sewage are classic conditions for typhoid. Dr Pfeifer said there had been an outbreak previously in the area.

Earlier yesterday it was feared that typhus had broken out in Travnik, but this was not confirmed.

Health experts have long feared an epidemic in the region, which could have catastrophic results. Typhus, a disease of war, is passed on by body lice infected with the organism Rickettsia prowazeki. After the Second World War, tens of thousands died in the Balkans. It is still endemic in Bosnia, with a few cases reported annually. Lack of water and fuel making it hard to wash bodies, clothes or bedding, and crowding together for warmth and shelter create perfect conditions. Rickettsia enter the blood stream from scratching because of the lice.

But Dr Pfeifer said a typhus outbreak would have been somewhat suprising in Travnik because the town is relatively peaceful and sanitation had been well monitored.

Both diseases can be fatal. Keith McAdam, a professor at the School of Hygiene and Tropical Medicine, said: 'Both are associated with a high fever but they are quite distinct and not easy to confuse.'

Typhoid symptoms can be mild or very severe. The disease has an incubation period of about two weeks, which is also the length of time it should be treated with antibiotic drugs. Professor McAdam said: 'You get a high fever, headache but not diarrhoea as many people think. Constipation, in fact, is one of the symptoms.

'It is spread through the body by the blood so that it can affect all parts of the system and cause pneumonia or meningitis. In rare cases the gut will perforate so that you get a condition like peritonitis.'

With early diagnosis and treatment, most patients recover, although there is a risk of repeat symptoms within a few weeks.