title: Restaurant-associated outbreak of Salmonella typhi in Nauru: an epidemiological and cost analysis.
abstract: 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.
authors.affiliation: Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Olsen
authors.forename: B
authors.initials: B
authors.lastname: Kafoa
authors.forename: N S
authors.initials: NS
authors.lastname: Win
authors.forename: M
authors.initials: M
authors.lastname: Jose
authors.forename: W
authors.initials: W
authors.lastname: Bibb
authors.forename: S
authors.initials: S
authors.lastname: Luby
authors.forename: G
authors.initials: G
authors.lastname: Waidubu
authors.forename: M
authors.initials: M
authors.lastname: O'Leary
authors.forename: E
authors.initials: E
authors.lastname: Mintz
mesh_terms: 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