title: Population-based surveillance of typhoid fever in Egypt.
abstract: Credible measures of disease incidence are necessary to guide typhoid fever control efforts. In Egypt, incidence estimates have been derived from hospital-based syndromic surveillance, which may not represent the population with typhoid fever. To determine the population-based incidence of typhoid fever in Fayoum Governorate (pop. 2,240,000), we established laboratory-based surveillance at five tiers of health care. Incidence estimates were adjusted for sampling and test sensitivity. Of 1,815 patients evaluated, cultures yielded 90 (5%) Salmonella Typhi isolates. The estimated incidence of typhoid fever was 59/100,000 persons/year. We estimate 71% of typhoid fever patients are managed by primary care providers. Multidrug-resistant (MDR) Salmonella Typhi (resistant to chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole) was isolated from 26 (29%) patients. Population-based surveillance indicates moderate typhoid fever incidence in Fayoum, and a concerning prevalence of MDR typhoid. The majority of patients are evaluated at the primary care level and would not have been detected by hospital-based surveillance.
authors.affiliation: Foodborne and Diarrheal Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. psrikant@itsa.ucsf.edu
authors.forename: Padmini
authors.initials: P
authors.lastname: Srikantiah
authors.forename: Fouad Y
authors.initials: FY
authors.lastname: Girgis
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Luby
authors.forename: Gregory
authors.initials: G
authors.lastname: Jennings
authors.forename: Momtaz Omar
authors.initials: MO
authors.lastname: Wasfy
authors.forename: John A
authors.initials: JA
authors.lastname: Crump
authors.forename: Robert M
authors.initials: RM
authors.lastname: Hoekstra
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Anwer
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Mahoney
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011159:Population Surveillance; D012485:Salmonella typhi / Q000187:drug effects; D014435:Typhoid Fever / Q000453:epidemiology* / Q000382:microbiology