Typhoid cases in Tuburan verified

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Sunday, March 9, 2014

CEBU -- Four residents in the mountain barangay of Montealegre, Tuburan tested positive for typhoid fever, the same public health problem that hit some villages of the town two years ago.

Medical officers have yet to get the test results of 16 other patients, who suffered from typhoid fever symptoms last week in Purok Virgen sa Regla.

A team from the Department of Health (DOH) will return to the mid-western Cebu town tomorrow, March 10, to teach residents how to protect themselves from typhoid fever, which struck more than 500 residents in March 2012.


Three of those who were confirmed this week to have typhoid fever are minors, ages 4, 11 and 13, while one is an adult, said Renan Cimafranca of the Regional Epidemiology Surveillance Unit (Resu).

Typhoid fever is an “acute and often life-threatening febrile illness” caused by infections of the salmonella enteric bacteria. Its symptoms include sustained fever, chills, abdominal pain, nausea, diarrhea or constipation and headache.

Water supply in Tuburan, Cebu
CEBU. A resident of Barangay Montealegre in Tuburan uses a handkerchief as a filter for her family’s water supply from a spring. (Allan Cuizon)

In 2010, there were an estimated 13.5 million typhoid fever episodes worldwide, reported the Journal of Global Health.

In Tuburan, where four persons died of typhoid fever in March 2012, sanitary inspector Marivic Ruelan reminded residents to boil the water they get from a concrete boxed spring source.

Cimafranca went with a DOH doctor and engineer to the town to check on patients in the hospital and visit three out of eight sitios in Montealegre, some 20 kilometers from the town proper.

Because the sitio went from zero to 20 patients with typhoid fever symptoms, Cimafranca categorized it “of epidemic proportions” in that community, but not the entire town.

He said the cases were distributed, with one to two episodes in the affected households.

“Ug mo-cluster, mao na ang delikado (It would be alarming if the cases were clustered),” he said.

Inside the hospital, Nerissa Aris, 39, tried to cope with her fever. She held her two-year-old son Alexander and 12-year-old daughter Jonalyn on the bed beside her. Both have also shown typhoid symptoms.


The boy, however, already felt well enough to eat on Saturday.

Jesus Mondejar, 39, and his wife Elvira, 38 were brought to the hospital last March 6.

Elvira was still receiving fluids intravenously while Jesus, who was taking antibiotics after his meals, was already walking around a day after being brought in.

Most residents from Montealegre went to the local hospital at the same time last March 5.

Dr. Nelson Elle of DOH, who checked on the patients, on Saturday said early detection, early medical management and complete doses of medicine are the keys to an effective treatment.

“But prevention is the best,” he said.

Some patients confined in the Tuburan District Hospital blamed the abrupt change in temperature—and not the quality of their water supply—for their ailment. One of them is 34-year-old motorcycle driver Allan Dumagan.

“Tungod sa bugnaw ang panahon, buntag sayo mag-abon, dayon kalit moinit (I got sick because it’s so cold that it fogs in the morning, then it suddenly gets hot),” he said.


Another patient, Victor Bicada Jr., 29, is from Barangay Cogon and their water comes from Barangay Marmol. He, too, is not convinced their water supply has anything to do with his symptoms.

“Problema lang kung menos ang response; kinahanglan receptive sila (It’s going to be a problem if they don’t respond; they have to be receptive),” said Cimafranca of Resu.

He said that when he returns with DOH officers tomorrow, Monday, the team will show the neighborhood ways to prevent the disease.

Cimafranca went with Elle and DOH engineer Vivencio Ediza to Montealegre yesterday to inspect water sources in adjacent neighborhoods (purok) Virgen sa Regla, San Isidro and San Jose. This week’s patients with typhoid symptoms are from these three places. Most are from Virgen.

DOH officials will suggest improvements in the design of the spring boxes and install chlorinators on them, said Cimafranca. The three sitios have different sources.

Cimafranca last Thursday distributed 45 “life straws”, which are flute-like devices that can filter water to remove bacteria.

Open springs

Vice Mayor Danilo Diamante was already in the sitio when the DOH team arrived, giving rice and canned goods to the families of patients who are confined in the hospital.

Their water sources are “unimproved spring boxes,” described Ruelan, the sanitary inspector. These are open pool-like concrete boxes that serve as reservoirs beside a shallow river.

Plastic pipes, about three inches in diameter, protrude from the riverside and bring water into the concrete boxes.

Ruelan said the town officials treated the water inside the open boxes with chlorine last Wednesday and will repeat the process.

Vice Mayor Diamante assured that the water system network in previously hit areas, like Barangays Calangahan, Marmol and Alegria, has chlorinators. Water quality is reportedly tested twice a month.

High fever in several households was detected by Montealegre barangay health worker Araceli Talaugon last March 4. She immediately informed Mayor Democrito Diamante, who sent vehicles to ferry patients to the Tuburan District Hospital.

Quick response

“Di man unta sila magpa-confine kay layo kuno og wala’y kwarta, pero gipasakay gyud sila sa mayor ug gidala dinhi (Some of them didn’t want to be confined because the hospital is far and they didn’t have any money, but the mayor insisted),” said Talaugon.

There were 558 suspected typhoid fever cases in Barangays Calangahan, Marmol and Alegria last March 2012. Of the 558, four died.

Diagnostic methods need to be improved and surveillance systems implemented, in order to prevent typhoid fever, said a paper by Geoffrey Buckle, Christa Fischer Walker and Robert Black of the Johns Hopkins University Bloomberg School of Public Health in Maryland.

“Typhoid and paratyphoid fever are major public health problems, especially in the developing world,” they wrote. One risk they identified was the continued increase in multi-drug resistant strains of the bacteria that causes typhoid fever. (OCP/Sun.Star Cebu)

Published in the Sun.Star Cebu newspaper on March 09, 2014.

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