TYPHOID-FEVER IN SOUTH VIETNAM, 1990-1993

In South Viet-nam, typhoid fever remains a considerable intestinal inf ection. Between 1990 and 1993, among 15 districts in the South of the country, a total per year of 3,853 to 9,179 cases was registred: from 8 to 31 led to death. Recently a large epidemic of typhoid fever broke out in the An Minh district (territory of KienGiang, South Viet-nam), affecting 3,049 people and bringing on two cases of death. Among the 574 blood samples, 266 strains of S. Typhi, 22 S. Paratyphi A and 2 S. Choleraesuis have been isolated. Our investigations on the spot led t o some epidemiologic and clinical reflexions and enabled us to estimat e the effectiveness of quinolones (?) in the treatment for typhoid fev er. The epidemic may be ascribed to different causes: lack of pure wat er supply in rural area; fecal pollution caused by inhabitants of this endemic area defecating directly in the waterways; ingestion of conta minated food, especially vegetables sprayed with polluted water; quite low level of public sanitation and individual hygiene. Clinically, th e disease consists in prolonged fever, with digestive disorders (anore xia, diarrhoeae, diffuse abdominal aches). Splenomegalia and hepatomeg alia are inconstant. The dissociation of the pulse from the temperatur e is not frequent and the rosy spots are rare. The antibiogramm applie d on the isolated strains of S. Typhi revealed their resistance (R) to usual antibiotics (chloramphenicol, ampicillin, Bactrim(R)), but S. T yphi is very sensitive to quinolones (ofloxacin, fleroxacin, R = 0). T he ofloxacine (15 mg/kg/24 h, twice a day during 3 days or 10 mg/kg/24 h, twice a day during 5 days) altered the evolution: thermic deferves cence in 3-5 days, regression of the digestive disorders. In Viet-nam, the preventive measures against intestinal infections, such as typhoi d fever include: 1) sanitary education; 2) environmental purification (constructions of latrines with tank, of sunk wells with lever-pump un der UNICEF standard), first of all in the endemic rural areas; 3) rest ructuration of mobile antiepidemic teams within the districts and of t he regional laboratories. 4) specific vaccinations (type typhim-Vi vac cine, Pasteur-Merieux) according to the epidemiologic indications.