Epidemiological characteristics of typhoid fever and paratyphoid fever in China, 2004-2020 / 中华流行病学杂志

Objective: To analyze the incidence trend and epidemiological characteristics of typhoid fever and paratyphoid fever in China from 2004 to 2020, understand the high-incidence population and hotspot areas, and provide evidences to develop more targeted prevention and control measures. Methods: The descriptive epidemiological method and spatial analysis method were applied to analyze the epidemiological characteristics of typhoid fever and paratyphoid fever in China during this period by using the surveillance data collected from the National Notifiable Infectious Disease Reporting System of Chinese Center for Disease Control and Prevention. Results: A total of 202 991 cases of typhoid fever were reported in China from 2004 to 2020. More cases occurred in men than in women (sex ratio: 1.18∶1). Most cases were reported in adults aged 20-59 years (53.60%). The incidence rate of typhoid fever decreased from 2.54/100 000 in 2004 to 0.38/100 000 in 2020. The highest incidence rate was reported in young children aged <3 years after 2011, ranging from 1.13/100 000 to 2.78/100 000, and during this period the proportion of cases in this age group increased from 3.48% to 15.59%. The proportion of the cases in the elderly aged ≥60 years increased from 6.46% in 2004 to 19.34% in 2020. The hotspot areas existed in Yunnan, Guizhou, Guangxi and Sichuan Provinces and expanded to Guangdong, Hunan, Jiangxi, and Fujian Provinces. A total of 86 226 paratyphoid fever cases were reported from 2004 to 2020, the male to female ratio of the cases was 1.21∶1. Most cases were reported in adults aged 20-59 years (59.80%). The incidence rate of paratyphoid fever decreased from 1.26/100 000 in 2004 to 0.12/100 000 in 2020. The highest incidence rate of paratyphoid fever was in young children aged <3 years after 2007, ranging from 0.57/100 000 to 1.19/100 000, and during this period the proportion of the cases in this age group increased from 1.48% to 30.92%. The proportion of the cases in the elderly aged ≥60 years increased from 4.52% in 2004 to 22.28% in 2020. The hotspot areas expanded to the east, including Guangdong, Hunan and Jiangxi Provinces, from Yunnan, Guizhou, Sichuan, and Guangxi Provinces. Conclusions: The results showed a low level of incidence of typhoid fever and paratyphoid fever in China with a trend of decreasing per year. The hotspots were mainly in the of Yunnan, Guizhou, Guangxi and Sichuan Provinces, with an expanding trend to eastern China. It is necessary to strengthen the typhoid fever and paratyphoid fever prevention and control in southwestern China, among young children aged <3 years and the elderly aged ≥60 years.

Estandarización de un ELISA para la cuantificación de anticuerpos IgG contra vesículas de membrana externa de Salmonella Paratyphi A / Standardization of an ELISA for the quantification of IgG antibodies against outer membrane vesicle of Salmonella Paratyphi A

Salmonella Paratyphi A es un patógeno exclusivo de humanos, siendo la segunda causa más común de fiebre entérica en el sudeste asiático. Recientemente la incidencia en este continente ha aumentado, desplazando a Salmonella entérica serotipo Typhi como la primera causa de fiebre entérica. En la actualidad no existen vacunas licenciadas contra S. Paratyphi A. El Instituto Finlay de Vacunas se encuentra trabajando en la obtención de un candidato vacunal basado en vesículas de membrana externa (VME) contra S. Paratyphi A, por lo que se hizo necesario contar con una técnica para la evaluación de su inmunogenicidad. El objetivo de este trabajo fue la estandarización de un ELISA para la cuantificación de anticuerpos IgG contra VME de S. Paratyphi A. Para ello, se determinaron las mejores condiciones de este ensayo en cuanto a concentración óptima de recubrimiento y dilución de trabajo del conjugado. Además, se definió el intervalo y linealidad de la curva, la precisión intra e interensayo, la especificidad y el límite de detección. La curva de calibración se generó con un suero estándar interno y presentó un buen ajuste lineal con un R² =0.98. Los coeficientes de variación en los ensayos de precisión intra e interensayo estuvieron en los intervalos establecidos para cada uno (=10 por ciento, =20 por ciento respectivamente). Los resultados obtenidos avalan el empleo de este ELISA cuantitativo para la evaluación de la inmunogenicidad de formulaciones de VME de S. Paratyphi A en fases de investigación y desarrollo(AU)

Salmonella Paratyphi A, is an exclusive pathogen of humans, being the second most common cause of enteric fever in Southeast Asia. Recently the incidence of this disease in this continent has increased, displacing Salmonella enterica serotype Typhi as the first cause of enteric fever. Currently there are no vaccines licensed against S. Paratyphi A. The Finlay Institute of Vaccines is working on obtaining a vaccine candidate based on outer membrane vesicles (VME) against S. Paratyphi A, so it became necessary to develop a technique for the evaluation of its immunogenicity. The objective of this work was the standardization of an ELISA for the quantification of IgG antibodies against VME of S. Paratyphi A. The best conditions of this assay were determined in terms of optimum concentration of coating and working dilution of the conjugate. In addition, the interval and linearity of the curve, the intra- and inter-assay precision, the specificity and the limit of detection were defined. The calibration curve was generated with an internal standard serum and presented a good linear fit with an R² =0.98. The coefficients of variation in the intra- and interassay precision tests were in the intervals established for each one (=10 percent, =20 percent respectively). The results obtained support the use of this quantitative ELISA for the evaluation of the immunogenicity of VME formulations of S. Paratyphi A in research and development phases(AU)

Enteric Fever in a Tertiary Paediatric Hospital: A Retrospective Six-Year Review

<p><b>INTRODUCTION</b>Enteric fever is a multisystemic infection which largely affects children. This study aimed to analyse the epidemiology, clinical presentation, treatment and outcome of paediatric enteric fever in Singapore.</p><p><b>MATERIALS AND METHODS</b>A retrospective review of children diagnosed with enteric fever in a tertiary paediatric hospital in Singapore was conducted from January 2006 to January 2012. Patients with positive blood cultures for Salmonella typhi or paratyphi were identified from the microbiology laboratory information system. Data was extracted from their case records.</p><p><b>RESULTS</b>Of 50 enteric fever cases, 86% were due to Salmonella typhi, with 16.3% being multidrug resistant (MDR) strains. Sixty-two percent of S. typhi isolates were of decreased ciprofloxacin susceptibility (DCS). Five cases were both MDR and DCS. The remaining 14% were Salmonella paratyphi A. There were only 3 indigenous cases. Ninety-four percent had travelled to typhoid-endemic countries, 70.2% to the Indian subcontinent and the rest to Indonesia and Malaysia. All patients infected with MDR strains had travelled to the Indian subcontinent. Anaemia was a significant finding in children with typhoid, as compared to paratyphoid fever (P = 0.04). Although all children were previously well, 14% suffered severe complications including shock, pericardial effusion and enterocolitis. None had typhoid vaccination prior to their travel to developing countries.</p><p><b>CONCLUSION</b>Enteric fever is largely an imported disease in Singapore and has contributed to significant morbidity in children. The use of typhoid vaccine, as well as education on food and water hygiene to children travelling to developing countries, needs to be emphasised.</p>

Low Compliance with National Guidelines for Preventing Transmission of Group 1 Nationally Notifiable Infectious Diseases in Korea

PURPOSE: This study was performed to evaluate the compliance with, and adequacy of, the Korean national guidelines which had been recommended until 2011 for isolation of patients with group 1 nationally notifiable infectious diseases (NNIDs), namely cholera, typhoid fever, paratyphoid fever, shigellosis, and enterohemorrhagic Escherichia coli (EHEC) infection. MATERIALS AND METHODS: We evaluated the clinical and microbiological characteristics of confirmed cases of group 1 NNIDs and compliance with the guidelines in 20 Korean hospitals nationwide in 2000-2010. We also compared the Korean guidelines with international guidelines. RESULTS: Among 528 confirmed cases (8 cases of cholera, 232 of typhoid fever, 81 of paratyphoid fever, 175 of shigellosis, and 32 EHEC infections), strict compliance with the Korean guideline was achieved in only 2.6% to 50.0%, depending on the disease. While the Korean guidelines recommend isolation of all patients with group 1 NNIDs, international guidelines recommend selective patient isolation and screening for fecal shedding, depending on the type of disease and patient status. CONCLUSION: Compliance with the previous national guidelines for group 1 NNIDs in Korea was generally very low. Further studies are needed to evaluate whether compliance was improved after implementation of the new guideline in 2012.

Evaluation on the effects of prevention and control programs regarding typhoid fever and paratyphoid fever in Guizhou province, from 2007 to 2012 / 中华流行病学杂志

<p><b>OBJECTIVE</b>This study was to evaluate the effects of prevention and control regarding programs on typhoid fever and paratyphoid fever, in Guizhou province, from 2007 to 2012, to provide evidence for the improvement of related programs.</p><p><b>METHODS</b>Data on typhoid fever and paratyphoid including information on epidemics, individual, cases, measures for prevention and control programs taken and relative government documents were collected and analyzed in Guizhou province, from 2007 to 2012. Information related to the average annual incidence, nature of outbreaks, time span before confirmed diagnosis was made, unit which carried the case report, proportion of laboratory confirmed diagnosed cases and case-management were compared between 2007-2009 and 2010-2012 descriptively while chi-square test with Excel and EpiInfo software were used for data analysis.</p><p><b>RESULTS</b>In the period of 2007-2009, a total of 5 978 typhoid fever and paratyphoid fever cases were reported in Guizhou province with the average yearly incidence as 5.29/100 000. In the period of 2010-2012, 2 765 cases were reported with the average yearly incidence as 2.57/100 000. When compared to the former, data from the latter period showed that the average yearly incidence had declined 51.31% in all the prefectures. There were still some outbreaks appeared but the total number of cases involved reduced 87.50%. The time span before the confirmation of diagnosis became shorter but the difference was not statistically significant (χ² = 0.08, P = 0.99). Number of cases reported by hospitals at county or above had 11.51% of increase while those cases reported at the township hospitals or below decreased for 61.47% . The proportion of laboratory diagnosed cases increased 23.63%. Rates of timeliness on cards being filled in, input and audited showed increase of 8.44%, 6.76% and 2.40% respectively.</p><p><b>CONCLUSION</b>Successful measures for prevention and control on typhoid fever and paratyphoid fever had been remarkably taken in Guizhou province, but the potential risk of outbreaks still existed in some areas, suggesting that health education and surveillance programs including laboratory diagnosis, should be strengthened.</p>

Fever monitoring program in areas with high incidence of typhoid and paratyphoid fever in Guizhou province / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the incidence rates of both typhoid fever and paratyphoid fever in the high prevalent areas of Guizhou province so as to provide evidence for the development of programs on comprehensive intervention and effectiveness evaluation.</p><p><b>METHODS</b>Six townships in Pingba county were selected as intervention areas while six townships in Kaiyang county were taken as control. All hospitals and clinics were classified into A, B and C types according to its level and the capacity of the blood culture. Surveillance on typhoid and paratyphoid fever was conducted based on all population and all hospitals, clinics and county CDCs among the patients with unknown fever.</p><p><b>RESULTS</b>In the surveillance area in those two counties, there were 12 944 blood samples from patients with unknown fever which have been tested and cultured. Among them, 200 strains of Salmonella including 16 typhoid strains, 184 paratyphoid A strains were identified, with the total positive rate as 1.55%. The positive rate before the intervention program was higher than the after. The detection rate was 1.91% in the type A hospitals. 39 strains of Salmonella have been cultured from 2039 samples which accounting for 19.50% (39/200) of the total strains. 4315 blood samples were cultured at the 'Class B' sites which isolated 82 strains of Salmonella, accounting for 41.00% (82/200), with a detection rate as 1.90%. 6590 samples were cultured at the 'Class C' sites, which identified 79 strains of Salmonella, accounting for 39.50% (79/200), with a detection rate as 1.20%. The detection rate was much higher before the use of antibiotics than after using them (P < 0.05). The annual peak time of positive detection was in spring and fall. The outbreaks or epidemics often appeared in the same places, with farmers, students as the high-risk populations. Symptoms of both typhoid and paratyphoid fever were not typical.</p><p><b>CONCLUSION</b>Typhoid and paratyphoid monitoring programs which covered primary health care institutions in the high incidence area seemed to be effective in reflecting the pictures as well as the burden of both typhoid and paratyphoid.</p>

Opinions of Infectious Disease Specialists on the Current Method for Isolation of Group 1 Nationally Notifiable Infectious Diseases in Korea / 감염과화학요법

The purpose of the study was to collect the opinions of doctors who are specialists in infectious disease with regard to the current method used for isolation of patients with group 1 nationally notifiable infectious diseases in Korea. A web-based survey was conducted from June 27 to July 7, 2011. Relevant questions included: 1) adequacy of the current policy of forced hospital isolation; evaluation of current guidelines for release from hospital isolation; and 3) priority for policy switching from forced hospital isolation to home isolation. The rate of response to the survey was 28.4% (40 out of 140). First, the majority of infectious disease specialists in Korea believed that the current method of forced hospital isolation for patients with group 1 infectious diseases should be changed to the home isolation method. Second, if the Korean government changes its policy to home isolation, the top priority of the policy switch would be typhoid fever, followed by paratyphoid fever, shigellosis, cholera, and EHEC (enterohemorigic Escherichia coli). Regarding current guidelines for release from hospital isolation, in cases of shigellosis, EHEC, and hepatitis A, the majority of respondents supported the current guidelines, while they were not able to make collective opinions in cases of cholera and typhoid/paratyphoid fever. We were able to confirm that the majority of specialists want to change the current isolation method. Therefore, the Korean government should consider switching their policy from forced hospital isolation to home isolation.

Association between the incidence of typhoid and paratyphoid fever and meteorological variables in Guizhou, China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Typhoid/paratyphoid fever (TPF) is endemic in Guizhou. We conducted wavelet analysis and Spearman's rank correlation analysis to explore the impact of meteorological variations on TPF infection in Guizhou, in an attempt to assess the risk factors associated with TPF epidemics.</p><p><b>METHODS</b>We examined the association between TPF incidence in Guizhou and temperature, precipitation and relative humidity using 24 years of data from 1984 to 2007. Periodicities of TPF incidence and the impact of climate factors on the TPF were detected by Spearman's rank correlation and wavelet analysis,</p><p><b>RESULTS</b>Temperature and precipitation with a 1-month lag were positively correlated with the monthly incidence of TPF. The multiyear incidence pattern of TPF in Guizhou was explicitly periodic. Moreover, the association and driving effect of precipitation on TPF were observed, and the results showed that the incidence of TPF in Guizhou had a closer correlation with precipitation than with temperature.</p><p><b>CONCLUSIONS</b>Safe water supply is the key issue for TPF control in Guizhou. Moreover, climate variation might impact the enteric infections, which may inform policy assessment for TPF control in Guizhou.</p>

Computed tomography features in enteric fever

<p><b>INTRODUCTION</b>Enteric fever is a common infection in endemic areas; however, there are few reports describing the computed tomography (CT) manifestations of enteric fever. We aim to describe and illustrate CT findings in enteric fever in this study.</p><p><b>MATERIALS AND METHODS</b>A retrospective search of medical records in our institute for patients with positive blood cultures for Salmonella typhi, and Salmonella paratyphi organisms yielded 39 cases. Among these patients, 12 had undergone a CT study of the abdomen. The CT images, laboratory and clinical findings of these 12 patients were reviewed.</p><p><b>RESULTS</b>The most common clinical presentation was fever (100%). Typical features of gastroenteritis were present in only over half of the patients. Liver function tests were abnormal in all patients. The most common abdominal manifestations on CT were the presence of mesenteric lymphadenopathy and splenomegaly (75%). Other features were circumferential small bowel wall thickening (58.3%) and free intraperitoneal fluid (50%). Three patients were found to have complications; one with bleeding from terminal ileal ulceration, another with an ileal perforation and the third with renal abscess formation.</p><p><b>CONCLUSION</b>CT is useful in evaluating enteric fever in patients with severe forms of presentation, a longer clinical course or less specific symptoms. Although the imaging features overlap with other abdominal infections, when combined with clinical features, travel history to endemic areas and presence of transaminitis, the diagnosis of enteric fever should be considered. CT in particular, is useful for the detection of complications such as perforation, bleeding and abscess formation.</p>

Occurrence & antibiogram of Salmonella Typhi & S. Paratyphi A isolated from Rourkela, Orissa.

Background & objectives: Almost round-the-year occurrence of Salmonella Typhi and Salmonella Paratyphi A has been noticed in Rourkela since last 13 and five years respectively. The incidence of infection along with the antibiogram of these two serotypes in this area were carried out. Methods: The study was carried out at Ispat General Hospital, Rourkela, India, between January 2005 and December 2008 with 5340 blood samples collected from patients with suspected enteric fever and pyrexia of unknown origin. Isolation, identification and antibiogram of the causative organisms were performed according to standard bacteriological procedures. Results: A total of 298 Salmonella isolates showed an overall per cent positivity of 5.58. Multidrug resistance was found in 11.96 per cent and 15.62 per cent isolates of S. Typhi and S. Paratyphi A respectively. Less than 2 per cent isolates of Salmonella showed resistance to ciprofloxacin. A resistance of 3.0 to 6.25 per cent against third generation cephalosporins was observed among the salmonella isolates. Interpretation & conclusion: A round-the-year occurrence of Salmonella spp. in Rourkela might have been due to the presence of a considerable number of carriers in the locality, poor sanitation in nearby slum areas, and inadequate and contaminated community water supply at times. Higher degree of susceptibility among S. Typhi isolates against various antibiotics was encouraging, but increasing trend of resistance observed among S. Paratyphi A isolates was a matter of concern.

Yields from blood cultures of patients with suspected paratyphoid fever A

The yield and speed of detection of Salmonella enterica serotype Paratyphi A from the blood of patients with suspected paratyphoid fever A in 13 500 paired aerobic and anaerobic bottles (AEB, ANB) that were each filled with 5 ml of blood by the BacT/ALERT 3D system were compared, and the blood bacterial counts of 1 000 probable patients were estimated by pour plate method. A total of 4 060 isolates were recovered, of these, 3 149 were recovered from both AEB and ANB, 461 from the AEB only, and 450 from the ANB only. The estimating median bacterial count in blood from 400 patients was 0.5 CFU/ml. The research findings demonstrate that the blood volume drawn is an important factor determining the yields from blood cultures. Growth of significantly more isolates was detected earlier in AEB.