Burden of typhoid and paratyphoid fever in a densely populated urban community, Dhaka, Bangladesh.
BACKGROUND
We conducted blood culture surveillance to estimate the incidence of typhoid and paratyphoid fever among urban slum residents in Dhaka, Bangladesh.


METHODS
Between January 7, 2003 and January 6, 2004, participants were visited weekly to detect febrile illnesses. Blood cultures were obtained at the clinic from patients with fever (≥38°C). Salmonella isolates were assayed for antimicrobial susceptibility.


RESULTS
Forty Salmonella Typhi and eight Salmonella Paratyphi A were isolated from 961 blood cultures. The incidence of typhoid fever was 2.0 episodes/1000 person-years, with a higher incidence in children aged<5 years (10.5/1000 person-years) than in older persons (0.9/1000 person-years) (relative risk=12, 95% confidence interval (CI) 6.3-22.6). The incidence of paratyphoid fever was 0.4/1000 person-years without variation by age group. Sixteen S. Typhi isolates were multidrug-resistant (MDR). All S. Paratyphi isolates were pan-susceptible. The duration of fever among patients with an MDR S. Typhi infection was longer than among patients with non-MDR S. Typhi (16±8 vs. 11±4 days, p=0.02) and S. Paratyphi (10±2 days, p=0.04) infections.


CONCLUSIONS
Typhoid fever is more common than paratyphoid fever in the urban Bangladeshi slum; children<5 years old have the highest incidence. Multidrug resistance is common in S. Typhi isolates and is associated with prolonged illness. Strategies for typhoid fever prevention in children aged<5 years in Bangladesh, including immunization, are needed.
Naheed
Aliya
A
International Centre for Diarrhoeal Disease Research, 68 Shaheed Tajuddin Sharani, Mohakhali, Dhaka, Bangladesh. anaheed@icddrb.org
Ram
Pavani K
PK
Brooks
W Abdullah
WA
Hossain
M Anowar
MA
Parsons
Michele B
MB
Talukder
Kaisar Ali
KA
Mintz
Eric
E
Luby
Stephen
S
Breiman
Robert F
RF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010284:Paratyphoid Fever / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D011159:Population Surveillance; D011204:Poverty Areas; D012482:Salmonella paratyphi A / Q000187:drug effects / Q000302:isolation & purification; D012485:Salmonella typhi / Q000187:drug effects / Q000302:isolation & purification; D014435:Typhoid Fever / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D014505:Urban Population; D055815:Young Adult