title: Comparisons of predictors for typhoid and paratyphoid fever in Kolkata, India.
abstract: BACKGROUND
  Exposure of the individual to contaminated food or water correlates closely with the risk for enteric fever. Since public health interventions such as water improvement or vaccination campaigns are implemented for groups of individuals we were interested whether risk factors not only for the individual but for households, neighbourhoods and larger areas can be recognised?
  
  
  METHODS
  We conducted a large enteric fever surveillance study and analyzed factors which correlate with enteric fever on an individual level and factors associated with high and low risk areas with enteric fever incidence. Individual level data were linked to a population based geographic information systems. Individual and household level variables were fitted in Generalized Estimating Equations (GEE) with the logit link function to take into account the likelihood that household factors correlated within household members.
  
  
  RESULTS
  Over a 12-month period 80 typhoid fever cases and 47 paratyphoid fever cases were detected among 56,946 residents in two bustees (slums) of Kolkata, India. The incidence of paratyphoid fever was lower (0.8/1000/year), and the mean age of paratyphoid patients was older (17.1 years) than for typhoid fever (incidence 1.4/1000/year, mean age 14.7 years). Residents in areas with a high risk for typhoid fever had lower literacy rates and economic status, bigger household size, and resided closer to waterbodies and study treatment centers than residents in low risk areas.
  
  
  CONCLUSIONS
  There was a close correlation between the characteristics detected based on individual cases and characteristics associated with high incidence areas. Because the comparison of risk factors of populations living in high versus low risk areas is statistically very powerful this methodology holds promise to detect risk factors associated with diseases using geographic information systems.
authors.affiliation: 1National Institute of Cholera and Enteric Diseases, Kolkata, India. dipikasur@hotmail.com
authors.forename: Dipika
authors.initials: D
authors.lastname: Sur
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ali
authors.forename: Lorenz
authors.initials: L
authors.lastname: von Seidlein
authors.forename: Byomkesh
authors.initials: B
authors.lastname: Manna
authors.forename: Jacqueline L
authors.initials: JL
authors.lastname: Deen
authors.forename: Camilo J
authors.initials: CJ
authors.lastname: Acosta
authors.forename: John D
authors.initials: JD
authors.lastname: Clemens
authors.forename: Sujit K
authors.initials: SK
authors.lastname: Bhattacharya
mesh_terms: D000293:Adolescent; D002648:Child; D005191:Family Characteristics; D005260:Female; D040362:Geographic Information Systems; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D010284:Paratyphoid Fever / Q000453:epidemiology* / Q000635:transmission; D011159:Population Surveillance / Q000379:methods; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors; D012482:Salmonella paratyphi A / Q000302:isolation & purification; D012485:Salmonella typhi / Q000302:isolation & purification; D012499:Sanitation / Q000592:standards; D012923:Social Class; D014435:Typhoid Fever / Q000453:epidemiology* / Q000635:transmission; D014871:Water Microbiology