title: Informing the public health management of typhoid and paratyphoid: the Australian context.
abstract: OBJECTIVE
  To examine outcomes of public health management of notified enteric fever cases in South-East Queensland over the past five years.
  
  
  METHODS
  Notification records of typhoid and paratyphoid infection in South-East Queensland 2008-2012 (inclusive) were reviewed to determine likelihood of cases and contacts adhering to present or previous recommendations for faecal clearance/screening, duration of infectiousness of cases and extent of local transmission to contacts.
  
  
  RESULTS
  Sixty-nine of 85 cases and 218 of 265 contacts submitted at least one faecal specimen. Cases were 2.7 (95%CI 1.2-6.0) and contacts were 4.4 (95%CI 3.0-6.4) times more likely to complete recommended faecal clearance/screening under previous compared to present guidelines (requiring more specimens). In ten cases with positive post-treatment specimens, last recorded infectiousness was 19 days to six months after notification. The documented rate of local transmission of infection was 18/1,000 contacts submitting at least one faecal specimen (95%CI 6-48/1,000).
  
  
  CONCLUSIONS
  Local transmission risk of enteric fever in South-East Queensland is low, although small numbers of cases may have prolonged bacilli excretion post-treatment. More complex clearance/screening regimens are associated with decreased compliance.
  
  
  CONCLUSIONS
  Pursuing extensive faecal clearance/screening regimens is unlikely to be effective in terms of public health management of enteric fever in South-East Queensland. We suggest a unified national approach focussing on cases/contacts at high risk of disease transmission.
authors.affiliation: Metro North Public Health Unit, Metro North Hospital and Health Service, Queensland.|MHIQ and School of Medicine, Griffith University, Queensland.
authors.forename: Megan K
authors.initials: MK
authors.lastname: Young
authors.affiliation: Metro South Public Health Unit, Metro South Hospital and Health Service, Queensland.
authors.forename: Vicki
authors.initials: V
authors.lastname: Slinko
authors.affiliation: Metro North Public Health Unit, Metro North Hospital and Health Service, Queensland.
authors.forename: James
authors.initials: J
authors.lastname: Smith
authors.affiliation: Communicable Diseases Unit, Queensland Health.
authors.forename: Heidi
authors.initials: H
authors.lastname: Carroll
authors.affiliation: Communicable Diseases Unit, Queensland Health.
authors.forename: Sonya
authors.initials: S
authors.lastname: Bennett
authors.affiliation: QML Pathology, Queensland.
authors.forename: Sally
authors.initials: S
authors.lastname: Appleton
authors.affiliation: Metro South Public Health Unit, Metro South Hospital and Health Service, Queensland.
authors.forename: Brad J
authors.initials: BJ
authors.lastname: McCall
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D016358:Contact Tracing / Q000379:methods / Q000706:statistics & numerical data*; D018563:Disease Notification / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D010284:Paratyphoid Fever / Q000453:epidemiology* / Q000517:prevention & control; D011634:Public Health; D011635:Public Health Administration; D011793:Queensland / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D014435:Typhoid Fever / Q000453:epidemiology* / Q000517:prevention & control; D055815:Young Adult
keywords: enteric fever; paratyphoid; public health management; typhoid