A massive epidemic of multidrug-resistant typhoid fever in Tajikistan associated with consumption of municipal water.
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.
Mermin
J H
JH
Foodborne and Diarrheal Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. jmermin@dhs.ca.gov
Villar
R
R
Carpenter
J
J
Roberts
L
L
Samaridden
A
A
Gasanova
L
L
Lomakina
S
S
Bopp
C
C
Hutwagner
L
L
Mead
P
P
Ross
B
B
Mintz
E D
ED
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