Epidemiology investigation of typhoid incidence in senior high school X in Magelang District

Abstract

Background: In Indonesia, typhoid is an endemic disease, often affecting school age children. On October 15, 2016, the Magelang District Health Office received a report from the school that several students had typhoid fever. The first investigation by staff on 17 October 2016 found 60 cases of fever, 4 of which were positive for IgM anti salmonella typhi. Objective: To know the magnitude of the outbreak, cause of the outbreak, describe the outbreak based on person, place, time and implement control measure. Method: This study uses descriptive epidemiology and looks for active cases to find additional cases. Cases were students who had fever with or without any of the additional symptoms: dizziness, nausea, vomiting, headache, stomachache, diarrhea, and chills from September 28 to November 28. Data collection was carried out by interview using a standard questionnaire. We took clean water, drinking water and blood samples. The water sample was sent to the Environmental Health Laboratory and the blood sample was sent to a private laboratory in Magelang for IgM anti salmonella thypi test. Results: The number of cases was 150 students. The highest attack rates were women 72/359 (20.1%) and first year students 139/381 (36.48%). The onset of the disease starts from 28 September to 26 October 2016. There are outbound activities on the river on 26 September attended by all first year students and second and third year students as the activity committee. This activity is followed by eating together and before eating without washing hands with soap. All cases attended outbound activities. IgM was positive in 51 students and water samples were negative for Salmonella typhi. Conclusion: There was an outbreak of typhoid fever with 150 cases in schools from 28 September to 28 November 2016. The outbreak was caused by outbound activities and not washing hands with soap when eating. We provide medical and health education to students about typhoid fever. The recommendation is to make school rules about the behavior of washing hands with soap and if you take a bath in the river, before eating it is necessary to wash your body and wash your hands with soap.