Nadu, Andhra Pradesh
Uttar Pradesh, Himachal
Pradesh in North India, Assam, Bengal,
Sikkim in East India
Travel to India, Pak, Bangla linked to typhoid fever cases
A study has linked typhoid fever cases in the U.S. to
international travel, especially to India, Pakistan, and
Bangladesh. 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. They say
that typhoid fever is a rare disease in America, with
approximately 300 clinical cases reported each year, and
that improvements in municipal water and sewage treatments
in the country resulted in dramatic declines in the incidence
of and deaths from typhoid fever at the beginning of the
last century. According to them, the majority of the cases
that were seen in the U.S. in the recent past were associated
with foreign travel. "Over the last 20 years, emergence
of S Typhi strains resistant to antimicrobial agents has
complicated treatment of infected patients," they wrote.
They further report: "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." Dr. Michael
F. Lynch, 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: "1,295 (73 percent)
were hospitalised 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."
They even said that the three countries in the Indian
subcontinent accounted for more than two-thirds of all
travel associated cases of typhoid fever-India (47 percent),
Pakistan (10 percent) and Bangladesh (10 percent). The
authors write: "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 study has been published in JAMA.