Johannesburg - South Africa remains on high alert following the recent outbreak of highly infectious typhoid in neighbouring Zimbabwe. But the National Institute for Communicable Diseases (NICD) says this is only a precautionary measure because the chance of an outbreak in our country is slim.Kerrigan McCarthy, head of outbreak response at the NICD, says that while an outbreak is not anticipated, “the NICD co-ordinates a surveillance network that will pick up each case of typhoid and ensure that appropriate investigations are done to prevent an outbreak. "It has also issued an awareness message to healthcare practitioners and the public regarding signs of typhoid symptoms – including fever, headache, chills and sweats, abdominal pain, constipation or diarrhoea – and the need to go to a healthcare facility as soon as possible for diagnosis and treatment. “In addition, a typhoid preparedness notification has been distributed to clinics and healthcare facilities reminding clinicians about signs, symptoms, diagnostic procedures and public health steps necessary to following detection of cases.”Typhoid is endemic to southern Africa, with seasonal increases in January and February.HOW TO AVOID TYPHOID INFECTION. Wash your hands thoroughly before eating or preparing food. Drink water from safe water sources. If you get your water from a river, boil it before drinking. Food obtained from street vendors is safe to eat if it is hot and freshly cooked. Wash your fruit before eating itThe disease caused by the bacterium Salmonella typhi spreads by faeco-oral contamination, direct contact or through swallowing food or water contaminated with the bacteria.In Zimbabwe, the typhoid outbreak was apparently caused by the contamination of water supplies, said McCarthy.“There has been a breakdown of both water supply, because of the drought, and sanitation/sewerage systems, leading to contamination of open-water sources."Consequently, when people have obtained their water from these open sources, the spread of typhoid has occurred. "This has led to very large numbers of typhoid cases in the city and many in rural areas,” she said.“No one seems really sure about how many cases of typhoid there have been in Harare or the whole of Zimbabwe, but it is clear – there are many cases.”South Africa does record a few cases of typhoid every year. In 2013, there were 69 confirmed cases, and 115 in 2014, 81 in 2015 and 124 in 2016.Water contamination“These case numbers represent a minimum estimate of the disease as they do not include cases treated empirically, or cases where people have passed away. "Most cases in 2016 were identified in January and February, or in April and May, reflecting time periods when travellers returned from home or holiday destinations and when warm environmental temperatures support transmission,” said McCarthy.She explained that, in South Africa, we have not seen the same kind of spread of typhoid through water contamination, but rather “isolated cases, mainly through person-to-person contact”.The last time South Africa had an outbreak was in Delmas, Mpumalanga in 2005 when 400 people contracted the disease and three died. Although it was not proven, it appeared the outbreak was associated with contaminated ground water. After the outbreak, Delmas obtained its municipal water from Rand Water and since then, no cases have been reported in the area.