title: A study of typhoid fever in five Asian countries: disease burden and implications for controls.
abstract: 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.
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea. rlochiai@ivi.int
authors.forename: R Leon
authors.initials: RL
authors.lastname: Ochiai
authors.forename: Camilo J
authors.initials: CJ
authors.lastname: Acosta
authors.forename: M Carolina
authors.initials: MC
authors.lastname: Danovaro-Holliday
authors.forename: Dong
authors.initials: D
authors.lastname: Baiqing
authors.forename: Sujit K
authors.initials: SK
authors.lastname: Bhattacharya
authors.forename: Magdarina D
authors.initials: MD
authors.lastname: Agtini
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
authors.forename: Do Gia
authors.initials: DG
authors.lastname: Canh
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ali
authors.forename: Seonghye
authors.initials: S
authors.lastname: Shin
authors.forename: John
authors.initials: J
authors.lastname: Wain
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Page
authors.forename: M John
authors.initials: MJ
authors.lastname: Albert
authors.forename: Jeremy
authors.initials: J
authors.lastname: Farrar
authors.forename: Remon
authors.initials: R
authors.lastname: Abu-Elyazeed
authors.forename: Tikki
authors.initials: T
authors.lastname: Pang
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Galindo
authors.forename: Lorenz
authors.initials: L
authors.lastname: von Seidlein
authors.forename: John D
authors.initials: JD
authors.lastname: Clemens
mesh_terms: 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