title: Considerations regarding mass vaccination against typhoid fever as an adjunct to sanitation and public health measures: potential use in an epidemic in Tajikistan.
abstract: We report on the ongoing epidemic of typhoid fever in Tajikistan that started in 1996. It has involved more than 24,000 cases to date, and is characterized by multiple point sources, overflow of sewage, contaminated municipal water, and person-to-person spread. Of the Salmonella typhi isolates available for testing in western laboratories, more than 90% are multidrug-resistant (MDR). Most recently, 28 (82%) of 34 isolates are resistant to ciprofloxacin, representing the first reported epidemic of quinolone-resistant typhoid fever. In the past, mass immunization during typhoid fever epidemics has been discouraged. A review of this policy is recommended in light of the alarming emergence of quinolone-resistant strains of S. typhi, the availability of improved vaccines, and the ongoing epidemic in Tajikistan. Mass immunization may be a useful measure for the control of prolonged MDR typhoid fever epidemics, as an adjunct to correction of municipal infrastructure and public health intervention.
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: P E
authors.initials: PE
authors.lastname: Tarr
authors.forename: L
authors.initials: L
authors.lastname: Kuppens
authors.forename: T C
authors.initials: TC
authors.lastname: Jones
authors.forename: B
authors.initials: B
authors.lastname: Ivanoff
authors.forename: P G
authors.initials: PG
authors.lastname: Aparin
authors.forename: D L
authors.initials: DL
authors.lastname: Heymann
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D018432:Drug Resistance, Multiple; D006801:Humans; D017589:Immunization Programs; D011634:Public Health; D012485:Salmonella typhi / Q000472:pathogenicity*; D012499:Sanitation; D013620:Tajikistan / Q000453:epidemiology; D014435:Typhoid Fever / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D014436:Typhoid-Paratyphoid Vaccines / Q000627:therapeutic use*; D014871:Water Microbiology; D014944:World Health Organization
chemical_list: D000890:Anti-Infective Agents; D014436:Typhoid-Paratyphoid Vaccines; D002939:Ciprofloxacin