title: Enteric fever in the Pacific: a regional retrospective study from Auckland, New Zealand.
abstract: BACKGROUND
  There are limited clinical data on enteric fever in the Pacific and New Zealand (NZ) compared with the Indian subcontinent (ISC) and South-East Asia (SEA). Our objective was to describe enteric fever in Auckland - a large Pacific city, focusing on disease acquired in these regions.
  
  
  METHODS
  We reviewed enteric fever cases hospitalised in Auckland from January 2005 to December 2010.
  
  
  RESULTS
  Microbiologically confirmed EF was identified in 162 patients. Travel regions: Pacific, 40 cases (25%) (Samoa, 38; Fiji, two), ISC, 72 (44%), SEA, seven (4%), other, three (2%), no travel, 40 (25%). Enteric fever rates for Auckland resident travellers were: India 50.3/100 000; Samoa 19.7/100 000.All Pacific cases were Salmonella Typhi. Of local isolates (without travel history), 38 were S. Typhi (36 fully susceptible, one multi-drug resistant (MDR) + nalidixic acid resistant (NAR), one unknown) and two S. Paratyphi (both NAR). Of non-Pacific travel, 56/82 (69%) isolates were S. Typhi, the remainder S. Paratyphi (15 isolates were fully susceptible, only 1% were MDR). Significant associations of serotype and antibiotic resistance with different travel regions and similarity of phage types (local and Pacific) were observed. Headache, vomiting and acute kidney injuries were more frequent with Pacific travel, while abdominal distension and cholecystitis with local disease. Shorter duration of treatment in the Pacific group was seen despite length of stay in hospital not being reduced. Local cases were associated with longer hospital admissions.
  
  
  CONCLUSIONS
  One half of cases in Auckland are acquired either from Pacific or locally. Similarities mean that disease acquired locally is likely of Pacific origin.
authors.affiliation: Infectious Diseases Department, Middlemore Hospital, Auckland, New Zealand; Infectious Diseases Department, Auckland City Hospital, Auckland, New Zealand.
authors.forename: R J
authors.initials: RJ
authors.lastname: Lane
authors.forename: D
authors.initials: D
authors.lastname: Holland
authors.forename: S
authors.initials: S
authors.lastname: McBride
authors.forename: S
authors.initials: S
authors.lastname: Perera
authors.forename: I
authors.initials: I
authors.lastname: Zeng
authors.forename: M
authors.initials: M
authors.lastname: Wilson
authors.forename: K
authors.initials: K
authors.lastname: Read
authors.forename: T
authors.initials: T
authors.lastname: Jelleyman
authors.forename: R J H
authors.initials: RJ
authors.lastname: Ingram
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004196:Disease Outbreaks; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D010139:Pacific Islands / Q000453:epidemiology; D012189:Retrospective Studies; D012482:Salmonella paratyphi A / Q000302:isolation & purification*; D012485:Salmonella typhi / Q000302:isolation & purification*; D012720:Severity of Illness Index; D017678:Sex Distribution; D014435:Typhoid Fever / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D014505:Urban Population; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Auckland; Pacific Region; enteric fever; paratyphoid; salmonella; typhoid