The Pharmaceutical Journal
Vol 280 No 7495 p357
29 March 2008

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Pharmacists can play a role in identifying patients at risk of typhoid

Incidence of typhoid and paratyphoid among UK travellers visiting friends and relatives in the Indian subcontinent is increasing, according to the Health Protection Agency. Community pharmacists have a key role in identifying at-risk patients and raising awareness of the need for thorough hygiene as well as pre-travel vaccination.

Almost 500 cases of typhoid and paratyphoid (enteric fever) were reported in England, Wales and Northern Ireland in 2006, the highest level for 10 years.

HPA data collected during a pilot study of enhanced surveillance between May 2006 and April 2007 show that most cases occurred in people of Indian, Pakistani or Bangladeshi ethnicity, whether UK or non-UK born, who had travelled from the UK to visit friends and family. This group were also least likely to have sought pre-travel health advice.

Most cases were reported in London, followed by the West Midlands, Yorkshire and Humber, and the South East — all regions with a large population of migrants, particularly from the Indian subcontinent, says the HPA. Risk of infection was six-fold greater for those travelling to visit friends and relatives than for those travelling for other reasons. The highest rate of infection was in Bangladesh.

The symptoms of typhoid and paratyphoid include sudden onset of fever, severe headache, nausea, loss of appetite, constipation and sometimes diarrhoea. Around two-thirds of cases were infected with strains that were resistant to first-line antibiotics, the HPA points out.

Typhoid, but not paratyphoid, can be prevented by vaccination, which is available free at most GP practices in the UK. However, it is also important that health professionals emphasise the importance of food and water hygiene, including handwashing, to prevent paratyphoid and other gastrointestinal infections, the HPA advises.

Jane Jones, head of the HPA’s travel and migrant health section, which co-ordinated the study, said: “Healthcare professionals have a key role here to identify their at-risk patients and raise awareness of the simple steps necessary to protect their health when travelling.”