Restaurant-associated outbreak of Salmonella typhi in Nauru: an epidemiological and cost analysis.
Typhoid fever is endemic in the South Pacific. We investigated an outbreak in Nauru. Through interviews and medical records, we identified 50 persons with onset between 1 October 1998 and 10 May 1999, of fever lasting > or = 3 days and one other symptom. Salmonella Typhi was isolated from 19 (38%) cases. Thirty-two (64%) patients were school-aged children, and 17 (34%) were in four households. Case-control studies of (a) culture-confirmed cases and age- and neighbourhood-matched controls; and (b) household index cases and randomly selected age-matched controls implicated two restaurants: Restaurant M (matched OR [MOR] = 11, 95% confidence interval [CI] = 1.3-96) and Restaurant I (MOR = 5.8, 95% CI = 1.2-29). Food-handlers at both restaurants had elevated anti-Vi antibody titres indicative of carrier state. The annual incidence was 5.0/1000 persons. Outbreak-associated costs were $46,000. Routine or emergency immunization campaigns targeting school-aged children may help prevent or control outbreaks of typhoid fever in endemic disease areas.
Olsen
S J
SJ
Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Kafoa
B
B
Win
N S
NS
Jose
M
M
Bibb
W
W
Luby
S
S
Waidubu
G
G
O'Leary
M
M
Mintz
E
E
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000191:economics*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008849:Micronesia / Q000453:epidemiology; D012147:Restaurants; D012485:Salmonella typhi / Q000302:isolation & purification*; D012621:Seasons; D017678:Sex Distribution; D014435:Typhoid Fever / Q000453:epidemiology* / Q000635:transmission