Typhoid Outbreaks, 1989-2018: Implications for Prevention and Control
Typhoid fever remains an important public health problem in low- and middle-income countries, with large outbreaks reported from Africa and Asia. Although the WHO recommends typhoid vaccination for control of confirmed outbreaks, there are limited data on the epidemiologic characteristics of outbrea...
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| Published in | The American journal of tropical medicine and hygiene Vol. 102; no. 6; pp. 1296 - 1305 |
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| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Institute of Tropical Medicine
01.06.2020
The American Society of Tropical Medicine and Hygiene |
| Subjects | |
| Online Access | Get full text |
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| Summary: | Typhoid fever remains an important public health problem in low- and middle-income countries, with large outbreaks reported from Africa and Asia. Although the WHO recommends typhoid vaccination for control of confirmed outbreaks, there are limited data on the epidemiologic characteristics of outbreaks to inform vaccine use in outbreak settings. We conducted a literature review for typhoid outbreaks published since 1990. We found 47 publications describing 45,215 cases in outbreaks occurring in 25 countries from 1989 through 2018. Outbreak characteristics varied considerably by WHO region, with median outbreak size ranging from 12 to 1,101 cases, median duration from 23 to 140 days, and median case fatality ratio from 0% to 1%. The largest number of outbreaks occurred in WHO Southeast Asia, 13 (28%), and African regions, 12 (26%). Among 43 outbreaks reporting a mode of disease transmission, 24 (56%) were waterborne, 17 (40%) were foodborne, and two (5%) were by direct contact transmission. Among the 34 outbreaks with antimicrobial resistance data, 11 (32%) reported Typhi non-susceptible to ciprofloxacin, 16 (47%) reported multidrug-resistant (MDR) strains, and one reported extensively drug-resistant strains. Our review showed a longer median duration of outbreaks caused by MDR strains (148 days versus 34 days for susceptible strains), although this difference was not statistically significant. Control strategies focused on water, sanitation, and food safety, with vaccine use described in only six (13%) outbreaks. As typhoid conjugate vaccines become more widely used, their potential role and impact in outbreak control warrant further evaluation. |
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| Bibliography: | Authors’ addresses: Grace D. Appiah, Sunkyung Kim, and Eric D. Mintz, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: ydg3@cdc.gov, wox0@cdc.gov, and edm1@cdc.gov. Alexandria Chung, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom, E-mail: s1508032@sms.ed.ac.uk. Adwoa D. Bentsi-Enchill, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland, E-mail: bentsienchilla@who.int. John A. Crump, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, and Centre for International Health, University of Otago, Dunedin, New Zealand, E-mail: zcn0@cdc.gov. Vittal Mogasale, Policy and Economic Research Department, Development and Delivery Unit, International Vaccine Institute, Seoul, South Korea, E-mail: vmogasale@ivi.int. Rachael Pellegrino, Johns Hopkins University School of Medicine, Baltimore, MD, E-mail: vmogasale@ivi.int. Rachel B. Slayton, Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: via3@cdc.gov. Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the views of the World Health Organization. Financial support: The work reported in this article was supported by a grant from the Bill & Melinda Gates Foundation to the World Health Organization. The study received grants from the Bill & Melinda Gates Foundation to the WHO covering the conduct of this study, and. J. A. C. also reports grants from the Bill & Melinda Gates Foundation during the conduct of the study. Disclosure: A. D. B.-E. is a staff member of the World Health Organization. |
| ISSN: | 0002-9637 1476-1645 |
| DOI: | 10.4269/ajtmh.19-0624 |