title: A massive epidemic of multidrug-resistant typhoid fever in Tajikistan associated with consumption of municipal water.
abstract: From 1 January through 30 June 1997, 8901 cases of typhoid fever and 95 associated deaths were reported in Dushanbe, Tajikistan. Of 29 Salmonella serotype Typhi isolates tested, 27 (93%) were resistant to ampicillin, chloramphenicol, nalidixic acid, streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole. In a case-control study of 45 patients and 123 controls, Salmonella Typhi infection was associated with drinking unboiled water (matched odds ratio, 7; 95% confidence interval, 3-24; P<.001). Of tap water samples, 97% showed fecal coliform contamination (mean level, 175 cfu/100 mL). Samples taken from water treatment plants revealed that fecal coliform contamination occurred both before and after treatment. Lack of chlorination, equipment failure, and back-siphonage in the water distribution system led to contamination of drinking water. After chlorination and coagulation were begun at the treatment plants and a water conservation campaign was initiated to improve water pressure, the incidence of typhoid fever declined dramatically.
authors.affiliation: Foodborne and Diarrheal Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. jmermin@dhs.ca.gov
authors.forename: J H
authors.initials: JH
authors.lastname: Mermin
authors.forename: R
authors.initials: R
authors.lastname: Villar
authors.forename: J
authors.initials: J
authors.lastname: Carpenter
authors.forename: L
authors.initials: L
authors.lastname: Roberts
authors.forename: A
authors.initials: A
authors.lastname: Samaridden
authors.forename: L
authors.initials: L
authors.lastname: Gasanova
authors.forename: S
authors.initials: S
authors.lastname: Lomakina
authors.forename: C
authors.initials: C
authors.lastname: Bopp
authors.forename: L
authors.initials: L
authors.lastname: Hutwagner
authors.forename: P
authors.initials: P
authors.lastname: Mead
authors.forename: B
authors.initials: B
authors.lastname: Ross
authors.forename: E D
authors.initials: ED
authors.lastname: Mintz
mesh_terms: D016022:Case-Control Studies; D004196:Disease Outbreaks; D004326:Drinking; D018432:Drug Resistance, Multiple; D005243:Feces / Q000382:microbiology; D005618:Fresh Water / Q000382:microbiology; D005843:Geography; D011159:Population Surveillance; D012307:Risk Factors; D012485:Salmonella typhi / Q000187:drug effects*; D012621:Seasons; D013620:Tajikistan / Q000453:epidemiology; D014435:Typhoid Fever / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D014505:Urban Population; D014881:Water Supply