A study of typhoid fever in five Asian countries: disease burden and implications for controls.
OBJECTIVE
To inform policy-makers about introduction of preventive interventions against typhoid, including vaccination.


METHODS
A population-based prospective surveillance design was used. Study sites where typhoid was considered a problem by local authorities were established in China, India, Indonesia, Pakistan and Viet Nam. Standardized clinical, laboratory, and surveillance methods were used to investigate cases of fever of >or= 3 days' duration for a one-year period. A total of 441,435 persons were under surveillance, 159,856 of whom were aged 5-15 years.


RESULTS
A total of 21,874 episodes of fever were detected. Salmonella typhi was isolated from 475 (2%) blood cultures, 57% (273/475) of which were from 5-15 year-olds. The annual typhoid incidence (per 100,000 person years) among this age group varied from 24.2 and 29.3 in sites in Viet Nam and China, respectively, to 180.3 in the site in Indonesia; and to 412.9 and 493.5 in sites in Pakistan and India, respectively. Altogether, 23% (96/413) of isolates were multidrug resistant (chloramphenicol, ampicillin and trimethoprim-sulfamethoxazole).


CONCLUSIONS
The incidence of typhoid varied substantially between sites, being high in India and Pakistan, intermediate in Indonesia, and low in China and Viet Nam. These findings highlight the considerable, but geographically heterogeneous, burden of typhoid fever in endemic areas of Asia, and underscore the importance of evidence on disease burden in making policy decisions about interventions to control this disease.
Ochiai
R Leon
RL
International Vaccine Institute, Seoul, Republic of Korea. rlochiai@ivi.int
Acosta
Camilo J
CJ
Danovaro-Holliday
M Carolina
MC
Baiqing
Dong
D
Bhattacharya
Sujit K
SK
Agtini
Magdarina D
MD
Bhutta
Zulfiqar A
ZA
Canh
Do Gia
DG
Ali
Mohammad
M
Shin
Seonghye
S
Wain
John
J
Page
Anne-Laure
AL
Albert
M John
MJ
Farrar
Jeremy
J
Abu-Elyazeed
Remon
R
Pang
Tikki
T
Galindo
Claudia M
CM
von Seidlein
Lorenz
L
Clemens
John D
JD
D000293:Adolescent; D000328:Adult; D001208:Asia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D019353:Endemic Diseases; D006801:Humans; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D012485:Salmonella typhi / Q000187:drug effects / Q000302:isolation & purification*; D014435:Typhoid Fever / Q000097:blood / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control