title: East London experience with enteric fever 2007-2012.
abstract: OBJECTIVE
  The clinical presentation and epidemiology for patients with enteric fever at two hospitals in East London during 2007-2012 is described with the aim to identify preventive opportunities and to reduce the cost of treatment.
  
  
  METHODS
  A retrospective analysis of case notes from patients admitted with enteric fever during 2007 to 2012 with a microbiologically confirmed diagnosis was undertaken. Details on clinical presentation, travel history, demographic data, laboratory parameters, treatment, patient outcome and vaccination status were collected.
  
  
  RESULTS
  Clinical case notes were available for 98/129 (76%) patients including 69 Salmonella enterica serovar Typhi (S. Typhi) and 29 Salmonella enterica serovar Paratyphi (S. Paratyphi). Thirty-four patients (35%) were discharged from emergency medicine without a diagnosis of enteric fever and then readmitted after positive blood cultures. Seventy-one of the 98 patients (72%) were UK residents who had travelled abroad, 23 (23%) were foreign visitors/new entrants to the UK and four (4%) had not travelled abroad. Enteric fever was not considered in the initial differential diagnosis for 48/98 (49%) cases. The median length of hospital stay was 7 days (range 0-57 days). The total cost of bed days for managing enteric fever was £454,000 in the two hospitals (mean £75,666/year). Median time to clinical resolution was five days (range 1-20). Seven of 98 (7%) patients were readmitted with relapsed or continued infection. Six of the 71 (8%) patients had received typhoid vaccination, 34 (48%) patients had not received vaccination, and for 31 cases (44%) vaccination status was unknown.
  
  
  CONCLUSIONS
  Further interventions regarding education and vaccination of travellers and recognition of the condition by emergency medicine clinicians in travellers to South Asia is required.
authors: Public Health Laboratory London, Public Health England, London, United Kingdom.
authors: Jayshree
authors: J
authors: Dave
authors: Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.
authors: Michael
authors: M
authors: Millar
authors: Public Health Laboratory London, Public Health England, London, United Kingdom.
authors: Horst
authors: H
authors: Maxeiner
authors: Travel and Migrant Health Section, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom.
authors: Joanne
authors: J
authors: Freedman
authors: Public Health Laboratory London, Public Health England, London, United Kingdom.
authors: Rachel
authors: R
authors: Meade
authors: Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.
authors: Caryn
authors: C
authors: Rosmarin
authors: Public Health Laboratory London, Public Health England, London, United Kingdom.
authors: Matthew
authors: M
authors: Jordan
authors: Statistics, Modelling and Economics Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom.
authors: Nick
authors: N
authors: Andrews
authors: Public Health Laboratory London, Public Health England, London, United Kingdom.
authors: Richard
authors: R
authors: Holliman
authors: Centre of Immunology and Infectious Disease, Blizard Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom.
authors: Armine
authors: A
authors: Sefton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003710:Demography; D005260:Female; D006761:Hospitals; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012482:Salmonella paratyphi A / Q000302:isolation & purification; D012485:Salmonella typhi / Q000302:isolation & purification; D014195:Travel; D014435:Typhoid Fever / Q000191:economics / Q000453:epidemiology* / Q000382:microbiology; D014611:Vaccination; D055815:Young Adult
chemical_list: D015415:Biomarkers