2008 Georgia data summary: Typhoid/Paratyphoid

2008 Georgia Data Summary

TYPHOID/PARATYPHOID

Typhoid Quick Fact: Salmonella Typhi and Paratyphi occur most often in persons who have travelled to endemic countries.

OVERVIEW
Salmonella Typhi and Paratyphi are considered separately from other types of Salmonella due to their distinct epidemiologic and clinical characteristics. These illnesses frequently (Typhi more than Paratyphi) cause systemic illness, affecting the bloodstream, liver, and other organs. Symptoms may include headache, high fever, malaise, anorexia, constipation or diarrhea, and signs include a characteristic rash and relative bradycardia. This clinical presentation is termed "Typhoid fever" or "enteric fever". In contrast to other types of Salmonella, S. Typhi and Paratyphi are transmitted by person to person spread, or through food or water contaminated by an affected person. Patients may carry this bacterium in stool for a prolonged period after recovery from illness. In the U.S., these infections are diagnosed primarily in travelers. Improvements in sanitation in the United States led to dramatic decreases in incidence of S. Typhi during the 20th century (1).
SURVEILLANCE
All Georgia physicians, laboratories and other health care providers are required by law to report both lab-confirmed and clinical diagnoses of cases of S. Typhi and Paratyphi.
Laboratories submit isolates for additional testing--serotyping and Pulsed Field Gel Electrophoresis.
Outbreaks of these infections are unusual in the United States but strict public health follow up and preventive measures are important to prevent disease spread, so all reports are investigated.
Public health staff interviews every S. Typhi or Paratyphi case with a standardized CDC case report form.
Active Surveillance for all types of Salmonella is conducted through FoodNet, a component of the Emerging Infections Program (EIP). For more information, please visit: http://health.state.ga.us/eip/ http://www.cdc.gov/foodnet/
INCIDENCE
In 2008, 10 reports of S. Typhi and 5 of S. Paratyphi were received by the Georgia Acute Disease Epidemiology Section (figures 1 and 2).

Figure 1. Reported S. Typhi Cases in Georgia

Rate per 100,000 population

Cases

Salmonella Typhi, 1998-2008

18

0.2

16

14

0.15

12

10 8

0.1

6

4

0.05

2

0

0

19981999200020012002200320042005200620072008 Year

cas es

rate

Figure 2. Reported S. Paratyphi Cases in Georgia

Rate per 100,000 population

Cases

Salmonella Paratyphi 1998-2008

12

0.14

10

0.12

8

0.1

0.08

6 0.06

4

0.04

2

0.02

0

0

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year

cases

rate

DEMOGRAPHICS AND TRAVEL HISTORY
In 2008, most reported cases of S. Typhi/Paratyphi occurred among Asians (figure 3) and among children and younger adults (figure 4).
Among the 4 S. Paratyphi cases with known travel history, 3 had travelled to India, and one did not have a clear travel history.
Among the 8 S. Typhi cases with known travel history, 7 had travelled to India, Pakistan or Bangladesh. One patient reported travel to Columbia, but this was not within the typical disease incubation period (one month).

Figure 3
S. Typhi and Paratyphi Race/Ethnicity, 2008

White 13%
Other 20%

Asian 67%

Figure 4

S. Typhi and Paratyphi Gender and Age Groups, 2008

3.5 3
2.5 2
1.5 1
0.5 0 <1 1-<5 6- 10- 18- 30- 40- 50+ <10 <18 <30 <40 <50

Female Male

PREVENTION AND RESEARCH
Persons travelling to endemic countries should consider obtaining a Typhoid vaccine per CDC recommendations (2). Vaccination should also be considered among close household contacts of chronic carriers. When travelling to endemic countries (2), food should be cooked and only fruits or vegetables that can be peeled or washed in water confirmed to be clean should be eaten. Questionable sources of water should be filtered, boiled, or chemically treated.
Ill persons and treating physicians should comply with public health recommendations that require patients to not participate in high risk occupations (food handling) and obtain the appropriate testing after treatment to confirm a state of chronic carriage has not occurred. Clinicians should be aware of the possibility of antimicrobial resistant infections among travelers to Southern Asia (3).
The Georgia EIP collaborates with FoodNet and the National Antimicrobial Resistance Monitoring System (NARMS) to monitor the development of antimicrobial resistance and its effects.
Data sources: 1) http://www.cdc.gov/mmwr/PDF/wk/mm4840.pdf 2) http://wwwn.cdc.gov/travel/yellowBookCh4-Typhoid.aspx 3) http://www.cdc.gov/ncidod/eid/vol11no01/04-0145.htm
For more information:
http://health.state.ga.us/epi/foodborne

IMPACT OF S. TYPHI/PARATYPHI
Although these infections are uncommon in Georgia and the rest of the country, they result in high proportions of hospitalizations due to the illness severity. Of the 15 reported S. Typhi and Paratyphi cases, all but two patients were hospitalized at least overnight. No deaths were reported. One S. Typhi patient required public health monitoring for 6 months, until repeated testing results demonstrated that the patient had not developed into a chronic carrier.

Date updated: February 2009