title: Epidemiology and risk factors for endemic typhoid fever in Uzbekistan.
abstract: BACKGROUND
  To investigate the risk factors for infection with endemic typhoid fever in the Samarkand region of Uzbekistan.
  
  
  METHODS
  Case-control study of culture-confirmed bloodstream infection with Salmonella Typhi. Patients were compared to age-matched community controls. Salmonella Typhi isolates were tested for antimicrobial susceptibility.
  
  
  RESULTS
  We enrolled 97 patients and 192 controls. The median age of patients was 19 years. In a conditional regression model, consumption of unboiled surface water outside the home [adjusted odds ratio (aOR)=3.0, 95% confidence interval (CI)=1.1-8.2], use of antimicrobials in the 2 weeks preceding onset of symptoms (aOR=12.2, 95% CI 4.0-37.0), and being a student (aOR=4.0, 95% CI 1.4-11.3) were independently associated with typhoid fever. Routinely washing vegetables (aOR 0.06, 95% CI 0.02-0.2) and dining at a tea-house (aOR 0.4, 95% CI 0.2-1.0) were associated with protection against illness. Salmonella Typhi resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole was identified in 6 (15%) of 41 isolates tested.
  
  
  CONCLUSIONS
  Endemic typhoid fever in Uzbekistan is transmitted by contaminated water. Recent use of antimicrobials also increased risk of infection. Targeted efforts at improving drinking water quality, especially for students and young adults, are likely to decrease transmission of typhoid fever. Measures to decrease the unnecessary use of antimicrobials would be expected to reduce the risk of typhoid fever and decrease the spread of multiple drug-resistant Salmonella Typhi.
authors.affiliation: Foodborne and Diarrheal Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. psrikantiah@php.ucsf.edu
authors.forename: Padmini
authors.initials: P
authors.lastname: Srikantiah
authors.forename: Sagdullo
authors.initials: S
authors.lastname: Vafokulov
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Luby
authors.forename: Tharwat
authors.initials: T
authors.lastname: Ishmail
authors.forename: Kenneth
authors.initials: K
authors.lastname: Earhart
authors.forename: Ne'mat
authors.initials: N
authors.lastname: Khodjaev
authors.forename: Gregory
authors.initials: G
authors.lastname: Jennings
authors.forename: John A
authors.initials: JA
authors.lastname: Crump
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Mahoney
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004326:Drinking; D024881:Drug Resistance, Bacterial; D019353:Endemic Diseases / Q000517:prevention & control; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D005511:Food Handling / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D012307:Risk Factors; D012485:Salmonella typhi / Q000187:drug effects; D014435:Typhoid Fever / Q000453:epidemiology* / Q000517:prevention & control; D014610:Uzbekistan / Q000453:epidemiology; D014881:Water Supply
chemical_list: D000900:Anti-Bacterial Agents