title: An outbreak of Salmonella Paratyphi A in a boarding school: a community-acquired enteric fever and carriage investigation.
abstract: Salmonella Paratyphi A (SPA) is rapidly becoming a common cause of enteric fever in South East Asia. A large outbreak of SPA occurred in a boarding middle school in China in 2004. There were 394 suspected cases; 95·5% were students. The highest incidence was in the youngest children (7th grade). Forty-four of 151 (29%) blood cultures and 4/54 (7·4%) rectal swabs were positive for SPA; three were from kitchen workers. The geometric mean levels of serum IgG anti-lipopolysaccharide (anti-LPS) from patients was higher than from healthy individuals [35·25 vs. 5·20 ELISA units (EU), P<0·001]. A kitchen worker with a positive rectal swab, negative blood culture and a high level of serum IgG anti-LPS (529·65 EU), was identified as a possible SPA carrier. No SPA was isolated from water or food samples. A survey of students' habits indicated drinking unboiled water as being the main reason for contracting the disease. Hand washing was the second most important factor. A food handler with possible SPA carriage could also have been a risk factor. Attention to maintaining a safe water supply, enhancing food-handler hygiene and proper hand washing can help to prevent similar outbreaks in the future.
authors.affiliation: Guangxi Center for Disease Control and Prevention, Nanning, Guangxi, China.
authors.forename: H H
authors.initials: HH
authors.lastname: Yang
authors.forename: J
authors.initials: J
authors.lastname: Gong
authors.forename: J
authors.initials: J
authors.lastname: Zhang
authors.forename: M L
authors.initials: ML
authors.lastname: Wang
authors.forename: J
authors.initials: J
authors.lastname: Yang
authors.forename: G Z
authors.initials: GZ
authors.lastname: Wu
authors.forename: W L
authors.initials: WL
authors.lastname: Quan
authors.forename: H M
authors.initials: HM
authors.lastname: Gong
authors.forename: S C
authors.initials: SC
authors.lastname: Szu
mesh_terms: D000293:Adolescent; D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood; D001208:Asia; D001210:Asia, Southeastern; D001769:Blood / Q000382:microbiology; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D002681:China / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D004797:Enzyme-Linked Immunosorbent Assay; D005247:Feeding Behavior; D005260:Female; D006235:Hand Disinfection; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008070:Lipopolysaccharides / Q000276:immunology; D008297:Male; D008875:Middle Aged; D010284:Paratyphoid Fever / Q000453:epidemiology* / Q000382:microbiology; D012007:Rectum / Q000382:microbiology; D012482:Salmonella paratyphi A / Q000302:isolation & purification*; D012574:Schools
chemical_list: D000907:Antibodies, Bacterial; D007074:Immunoglobulin G; D008070:Lipopolysaccharides
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