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Typhoid fever cases in US linked to foreign travel
August 26, 2009Antimicrobial-resistant strains among US patients increasing
Infection with an antimicrobial-resistant strain of typhoid fever among patients in the United States is associated with international travel, especially to the Indian subcontinent (India, Pakistan, and Bangladesh), according to a study in the August 26 issue of JAMA. The study also shows an increase in certain strains of typhoid fever that are resistant to the most commonly used medications for treatment.
"Infection with Salmonella ser Typhi causes an estimated 20 million cases of typhoid fever and 200,000 deaths annually worldwide," the authors provide as background information. Typhoid fever is a rare disease in the United States with approximately 300 clinical cases reported each year. Improvements in municipal water and sewage treatments in the U.S. resulted in dramatic declines in the incidence of and deaths from typhoid fever at the beginning of the last century. The majority of the cases in the U.S. are now associated with foreign travel. "Over the last 20 years, emergence of S Typhi strains resistant to antimicrobial agents has complicated treatment of infected patients." In addition, the authors report that "identification of nalidixic acid-resistant S Typhi (NARST) and reports of infection with S Typhi strains resistant to ciprofloxacin from typhoid-endemic areas have generated concern that strains resistant to fluroquinolones may become more prevalent."
Michael F. Lynch, M.D., M.P.H., and colleagues from the Centers for Disease Control and Prevention (CDC), Atlanta, reviewed data from 1999 to 2006 for 1,902 persons with typhoid fever who had epidemiologic information submitted to the CDC and 2,016 S Typhi isolates from public health laboratories sent to the CDC for antimicrobial susceptibility testing.
The median (midpoint) age of patients with typhoid fever was 22 years. The authors report that "1,295 (73 percent) were hospitalized and 3 (0.2 percent) died. Foreign travel within 30 days of illness was reported by 1,439 (79 percent). Only 58 travelers (5 percent) had received typhoid vaccine." Together, three countries accounted for more than two-thirds of all travel associated cases of typhoid fever-India (47 percent), Pakistan (10 percent) and Bangladesh (10 percent). Two-thirds of these travelers reported visiting friends and relatives as the primary reason for their travel, followed by tourism (9 percent) and business travel (3 percent), which was reported much less frequently. In addition, "272 (13 percent) of 2,016 isolates tested were resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole (multidrug-resistant S Typhi [MDRST]); 758 (38 percent) were resistant to nalidixic acid (nalidixic acid-resistant S Typhi [NARST]) and 734 NARST isolates (97 percent) had decreased susceptibility to ciprofloxacin. The proportion of NARST increased from 19 percent in 1999 to 54 percent in 2006."
"Patients with resistant infections were more likely to report travel to the Indian subcontinent: 85 percent of patients infected with MDRST and 94 percent with NARST traveled to the Indian subcontinent, while 44 percent of those with susceptible infections did," the authors write.
The authors conclude: "Since most typhoid fever among patients treated in the United States is acquired abroad, ongoing surveillance may also help track global patterns of antimicrobial resistance of S Typhi. Reducing the burden of typhoid fever in the United States will require increased attention to prevention measures by travelers, including improved vaccination coverage among travelers to typhoid-endemic areas," particularly among travelers visiting friends or family in India or its neighbors. "Further reductions in typhoid fever among travelers will depend on increased availability of safe drinking water as well as improved sanitation and food hygiene in typhoid endemic areas, measures that would go a long way toward reducing the global burden of typhoid fever."
JAMA and Archives Journals
Michael F. Lynch, M.D., M.P.H., and colleagues from the Centers for Disease Control and Prevention (CDC), Atlanta, reviewed data from 1999 to 2006 for 1,902 persons with typhoid fever who had epidemiologic information submitted to the CDC and 2,016 S Typhi isolates from public health laboratories sent to the CDC for antimicrobial susceptibility testing.
The median (midpoint) age of patients with typhoid fever was 22 years. The authors report that "1,295 (73 percent) were hospitalized and 3 (0.2 percent) died. Foreign travel within 30 days of illness was reported by 1,439 (79 percent). Only 58 travelers (5 percent) had received typhoid vaccine." Together, three countries accounted for more than two-thirds of all travel associated cases of typhoid fever-India (47 percent), Pakistan (10 percent) and Bangladesh (10 percent). Two-thirds of these travelers reported visiting friends and relatives as the primary reason for their travel, followed by tourism (9 percent) and business travel (3 percent), which was reported much less frequently. In addition, "272 (13 percent) of 2,016 isolates tested were resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole (multidrug-resistant S Typhi [MDRST]); 758 (38 percent) were resistant to nalidixic acid (nalidixic acid-resistant S Typhi [NARST]) and 734 NARST isolates (97 percent) had decreased susceptibility to ciprofloxacin. The proportion of NARST increased from 19 percent in 1999 to 54 percent in 2006."
"Patients with resistant infections were more likely to report travel to the Indian subcontinent: 85 percent of patients infected with MDRST and 94 percent with NARST traveled to the Indian subcontinent, while 44 percent of those with susceptible infections did," the authors write.
The authors conclude: "Since most typhoid fever among patients treated in the United States is acquired abroad, ongoing surveillance may also help track global patterns of antimicrobial resistance of S Typhi. Reducing the burden of typhoid fever in the United States will require increased attention to prevention measures by travelers, including improved vaccination coverage among travelers to typhoid-endemic areas," particularly among travelers visiting friends or family in India or its neighbors. "Further reductions in typhoid fever among travelers will depend on increased availability of safe drinking water as well as improved sanitation and food hygiene in typhoid endemic areas, measures that would go a long way toward reducing the global burden of typhoid fever."
JAMA and Archives Journals
Typhoid Fever Current Events and Typhoid Fever News RSSTraDIS technique tackles typhoid
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Defining DNA differences to track and tackle typhoid
For the first time, next-generation DNA sequencing technologies have been turned on typhoid fever - a disease that kills 600,000 people each year. The results will help to improve diagnosis, tracking of disease spread and could help to design new strategies for vaccination.
Nepalese researchers identify cost-effective treatment for drug-resistant typhoid
New research carried out by researchers in Nepal has shown that a new and affordable drug, Gatifloxacin, may be more effective at treating typhoid fever than the drug currently recommended by the World Health Organisation.
Nepalese researchers identify cost-effective treatment for drug-resistant typhoid
New research carried out by researchers in Nepal has shown that a new and affordable drug, Gatifloxacin, may be more effective at treating typhoid fever than the drug currently recommended by the World Health Organisation.
New bacterium discovered -- related to cause of trench fever
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Malaria vaccine prompts victims' immune system to eliminate parasite from mosquitoes
Researchers at the National Institutes of Health have developed an experimental vaccine that could, theoretically, eliminate malaria from entire geographic regions, by eradicating the malaria parasite from an area's mosquitoes.
Researchers map spread of pathogens in the human body
Researchers at the University of Cambridge have discovered a new, more accurate, method of mapping how bacteria spread within the body, a breakthrough that could lead to more effective treatments and prevention of certain bacterial infections.
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