TYPHOID-FEVER IN CHILE 1977-1990 - AN EME RGENT DISEASE

The emergence of old and new communicable diseases is becoming an impo rtant public health problem in industrialized and developing countries worldwide. Chile experienced, as the end of the seventies and during the eighties, epidemics of several emergent communicable infectious di seases whose relevance as public health problems had steadily decrease d in the previous 25 years. The most striking of these epidemics was a severe outbreak of typhoid fever that lasted at least 10 years. The m ajority of the cases ocurred in the urban setting of Santiago. Several investigators suggested in light of apparently good sanitation statis tics, that factors responsible for this outbreak of typhoid were an in crease in the number of chronic carriers of salmonella typhi, the lack of microbiological food controls and the consumption of vegetables ir rigated with waste water contaminated with S typhi. However there is a dearth of epidemiological information and field work confirming the r ole of these factors in this typhoid outbreak. Moreover, the sudden, m assive and urban characteristics of this epidemic, coupled to contempo rary information regarding shortcomings on the preparation of drinking water and on decreased availability of drinking water to the populati on in Santiago regardless of good sanitation statistics, suggest that this outbreak may have been partially waterborne. The beginning of thi s typhoid outbreak also coincided with increased rain fall, with rapid ly deteriorating economic and social conditions manifested in high rat es of unemployment, and with decreased government investment on social services, including sanitation and health. All these factors are know n to influence the epidemiology of typhoid and other emergent diseases worldwide.