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PubMed1985

Case-control study to identify risk factors for paediatric endemic typhoid fever in Santiago, Chile.

Typhoid fever is an important endemic health problem in Santiago, Chile. Its incidence has more than doubled in recent years, during which access to potable water and sewage disposal in the home became almost universal in the city. A matched case-control study was carried out to identify risk factors and vehicles of transmission of paediatric typhoid fever; 81 children in the 3-14-years age group with typhoid fever were compared with controls, matched with respect to age, sex, and neighbourhood. It was found that case children more frequently bought lunch at school and shared food with classmates. Also, case children more often consumed flavoured ices bought outside the home; none of 41 other food items considered in the study was associated with a higher risk of typhoid fever. Only two food handlers for cases and one for controls were positive for Salmonella typhi, indicating that persons preparing food solely for their own family were not the main source of S. typhi infection. Rather, the risk factors identified in this study are consistent with the hypothesis that paediatric endemic typhoid fever in Santiago is largely spread by consumption of food-stuffs that are prepared outside the individual's home and are shared with or sold to children.

Adolescent↗
PubMed1984

[Prevention of the chronic persistence of typhoid microbes in rabbits with thymostimulin].

Typhoid infection was reproduced by introducing the infective agent into the bone marrow of noninbred rabbits. After the injection of thymostimulin on the first day of infection the release of typhoid bacilli continued for 1-3 weeks; when thymostimulin was injected on day 20, the release of typhoid bacilli stopped in two weeks. In the control group the release of typhoid bacilli continued during the whole term of observation. The injection of thymostimulin at an early period after infection was thus found to prevent the development of chronic typhoid infection with the elimination of the infective agent from the body of rabbits.

Adjuvants, Immunologic↗
PubMed1981

The Widal test in the diagnosis of typhoid fever in the transvaal.

We analysed the results of the Widal test in the northern and eastern Transvaal in relation to bacteriologically confirmed cases of typhoid fever, patients suspected of having the disease, febrile patients without typhoid fever and healthy individuals. Titres of 1:200 or greater for either H or O agglutinins were recorded for 75,2% of patients with bacteriologically proven typhoid fever, 4,6% of healthy subjects residing in an endemic area and 7,5% of patients presenting with non-thyroid fevers. Age, sex and region were found to affect the percentage of positive tests recorded. Despite these failings, the Widal test was found to be of value in the diagnosis of typhoid fever. The concept of a diagnostic titre was considered unreliable, but considered in conjunction with the clinical picture, O or H agglutinin titres of 1:200 or more may be regarded as strong presumptive evidence of typhoid fever.

Adolescent↗
PubMed1981

Antibody response to the lipopolysaccharide and protein antigens of Salmonella typhi during typhoid infection. II. Measurement of intestinal antibodies by radioimmunoassay.

Antibodies to the lipopolysaccharide (LPS) and protein antigens of S. typhi in secretions of small intestine obtained from 12 typhoid patients, four typhoid carriers and 16 non-typhoid control subjects were measured by a solid-phase radioimmunoassay technique. Intestinal secretions obtained from typhoid patients as a group had significantly higher anti-LPS and anti-protein antibodies than those from the control group. These antibodies were both IgM and IgA classes. There was no correlation between the IgM or IgA antibody levels in serum and those in the intestinal secretions. In the intestinal secretions obtained from typhoid carriers, on the other hand, only IgA-class antibodies to the LPS and protein antigens of S. typhi were present at high levels.

Adolescent↗
PubMedDate not supplied

[A dynamic model for analyzing and predicting the epidemic process in typhoid fever].

The results of calculations and theoretical considerations on processes of the spread of typhoid fever, made with the use of a new mathematical model which is based on the model proposed by B. Cvjetanović, further developed and improved. In this new model the latest phenomenology of the description of the processes of the spread of typhoid fever in the heterogeneous susceptible layer of the human population was used. A computer program for the new mathematical model of typhoid fever has been realized on a IBM PC/AT-386, which makes it possible to carry out prognostic analytical studies of the dynamics of the spread of typhoid fever at endemic territories. This program has been used for making calculations in connection with the analysis and prognostication of typhoid fever morbidity and mortality processes in St.-Petersburg.

Convalescence↗
PubMed1975

Trimethoprim-sulfamethoxazole in the treatment of gastrointestinal infections, including enteric fever and typhoid carriers.

Forty-three patients suffering from typhoid fever, 11 from paratyphoid fever, six from bacillary dysentery caused by Shigella flexneri, and nine carriers of Salmonella typhi or S. paratyphi B, have been treated with trimethoprim-sulfamethoxazole compound. Fifty-one of the 54 patients who had typhoid fever or paratyphoid fever responded satisfactorily to treatment. Two patients with typhoid fever failed to respond and one died. In the patients with bacillary dysentery acute symptoms subsided rapidly within 24 hours of starting trimethoprim-sulfamethoxazole. Seven of the nine typhoid or paratyphoid carriers have been followed up after treatment and only one remains a fecal excretor of S. typhi. Five patients in the series developed a skin rash during therapy, one a macrocytic anemia and one reversible neutropenia. It is concluded that trimethoprim-sulfamethoxazole is an effective agent for the treatment of enteric fever, severe bacillary dysentery and typhoid carriers.

Administration, Oral↗
PubMed1996

Adjuvant effect of DEAE-dextran and tetanus toxoid on whole cell heat inactivated phenol preserved typhoid vaccine.

Active mouse protection test (AMPT) and enzyme linked immunosorbent assay (ELISA) were used to determine the immunogenicity of whole cell typhoid vaccine when administered in conjunction with either tetanus toxoid (TT) or DEAE-Dextran (DD). Immunization of mice with whole cell typhoid vaccine showed enhanced potency either when administered in conjunction with TT or DD and values were statistically significant (p < 0.05) in comparison to conventional or standard typhoid vaccines. For ELISA, the mice were immunized with 2 different schedules, one in which a single dose of 0.25 ml subcutaneously (s/c) was administered and in another two doses of 0.25 ml each s/c, 14 days apart. In case of single dose schedule of immunization D vaccine (Whole cell typhoid + 5 mg/ml DD) showed significant increase of immune response (3.201 log10) as compared to plain vaccine (2.550 log10). Two dose schedule further increased the titres to 3.856 log10. DD adjuvanted vaccine showed higher potency by AMPT as compared to the TT adjuvanted vaccine or plain vaccine. The present study clearly demonstrates that a single dose of 0.25 ml which is equivalent to half of the conventionally used single human dose of typhoid vaccine adjuvanted with DD can significantly improve the immunogenicity of the vaccine.

Adjuvants, Immunologic↗
PubMed1997

[Typhoid fever in Chile 1977-1990: an emergent disease].

The emergence of old and new communicable diseases is becoming an important public health problem in industrialized and developing countries worldwide. Chile experienced, at the end of the seventies and during the eighties, epidemics of several emergent communicable infectious diseases whose relevance as public health problems had steadily decreased in the previous 25 years. The most striking of these epidemics was a severe outbreak of typhoid fever that lasted at least 10 years. The majority of the cases occurred in the urban setting of Santiago. Several investigators suggested, in light of apparently good sanitation statistics, that factors responsible for this outbreak of typhoid were an increase in the number of chronic carriers of Salmonella typhi, the lack of microbiological food controls and the consumption of vegetables irrigated with waste water contaminated with S typhi. However, there is a dearth of epidemiological information and field work confirming the role of these factors in this typhoid outbreak. Moreover, the sudden, massive and urban characteristics of this epidemic, coupled to contemporary information regarding shortcomings on the preparation of drinking water and on decreased availability of drinking water to the population in Santiago regardless of good sanitation statistics, suggest that this outbreak may have been partially waterborne. The beginning of this typhoid outbreak also coincided with increased rain fall, with rapidly deteriorating economic and social conditions manifested in high rates of unemployment, and with decreased government investment on social services, including sanitation and health. All these factors are known to influence the epidemiology of typhoid and other emergent diseases worldwide.

Chile↗
PubMed1995

The role of the laboratory in the diagnosis and management of typhoid fever.

In typhoid-endemic areas the results obtained from the laboratory are important in confirming the clinical diagnosis of typhoid and may also contribute to decisions made on the management and treatment of typhoid cases. Isolation of Salmonella typhi remains the gold standard, with culture from bone marrow aspirate or a combination of specimens from other body sites resulting in the greatest sensitivity. Antibody detection techniques may still provide valuable information, but only if the results are interpreted in the context of the background antibody levels in the local population. None of the available antigen detection techniques have been consistently demonstrated to be of diagnostic value and a recently developed polymerase chain reaction (PCR) for the detection of Salmonella typhi has yet to undergo a full-scale clinical evaluation. The initial identification of chronic typhoid carriers relies upon the detection of elevated Vi capsular antibody levels, but seeking out chronic carriers will be of limited value in controlling the spread of typhoid in areas where transmission is principally mediated by convalescent excretors. Whilst resistance of Salmonella typhi to antibiotics has emerged as an increasing problem in some areas of the world, it is still uncommon in isolates from Papua New Guinea. However, monitoring of antibiotic susceptibility patterns will ensure that signs of developing resistance are detected early and that the appropriate action is taken.

Antibodies, Bacterial↗
PubMedDate not supplied

Spontaneous non-typhoidal Salmonella peritonitis in patients with serious underlying disorders.

Non-typhoidal Salmonella is a rare cause of spontaneous bacterial peritonitis (SBP). Non-typhoidal Salmonella SBP has been reported in patients with relatively normal ascitic fluid protein levels. Five patients with non-typhoidal Salmonella SBP and a review of the literature are reported. These patients had chronic underlying disorders, such as malignancy, or other conditions causing immunosuppression. In previous reports, an ascitic fluid protein level above 1.5 g/dl was present in six patients, and under 1.5 g/dl in two. In the present report, ascitic fluid protein is above 2.5 g/dl in three patients and under 1.5 g/dl in one. Immunosuppression and the virulence of the organism seem to play a major role in non-typhoidal Salmonella SBP. Physicians should be alert to the possibility of non-typhoidal Salmonella infection in patients with SBP and normal protein levels in ascitic fluid.

Adult↗
PubMed2006

Incidence and prognosis of non-typhoid Salmonella bacteraemia in Denmark: a 10-year county-based follow-up study.

The aim of this study was to examine the incidence and prognosis of non-typhoid Salmonella bacteraemia in a well-defined population in which complete follow-up investigations had been performed. All patients with non-typhoid Salmonella bacteraemia from 1994 through 2003 in North Jutland County, Denmark, were eligible for the study. Annual incidence rates were calculated for 10-year age groups. The North Jutland County Bacteraemia Database (inclusion of subjects), medical hospital records, the Prescription Registry (redemption of prescription drugs), and the Central Population Registry (deaths) were used as data sources. The outcomes were mortality within 30 and 180 days of the first non-typhoid-Salmonella-positive blood sample. Cox proportional-hazards regression analysis was performed, first with age and comorbidity as evidenced by Charlson index scores, and second with selected clinical and laboratory prognostic variables potentially related to non-typhoid Salmonella bacteraemia per se. A total of 111 non-typhoid Salmonella bacteraemia patients were included in the study. The incidence rate (mean 2.3/100,000 person-years) increased steadily from 1.9/100,000 person-years in the 40-49-year age group to 14.6/100,000 person-years in those >90 years. Twelve (11%) and 24 (22%) patients died within 30 and 180 days, respectively. Cox regression analyses showed that increasing age and, to a higher degree, increasing levels of comorbidity were independently associated with an unfavourable outcome, whereas none of the clinical or laboratory variables studied were strong independent prognostic factors. In conclusion, the presence of comorbid diseases and old age were independently associated with mortality, whereas clinical and laboratory variables were less important.

Adolescent↗
PubMed2006

Severity of infection and seasonal variation of non-typhoid Salmonella occurrence in humans.

Non-typhoid Salmonella infections may present as severe gastroenteritis necessitating hospitalization and some patients become septic with bacteraemia. We hypothesized that the seasonal variation of non-typhoid Salmonella occurrence in humans diminishes with increased severity of infection. We examined the seasonal variation of non-typhoid Salmonella infections in three patient groups with differing severity of infection: outpatients treated for gastroenteritis (n=1490); in-patients treated for gastroenteritis (n=492); and in-patients treated for bacteraemia (n=113). The study was population-based and included all non-typhoid Salmonella patients in a Danish county from 1994 to 2003. A periodic regression model was used to compute the peak-to-trough ratio for the three patient groups. The peak-to-trough ratios were 4.3 [95% confidence interval (CI) 3.6-5.0] for outpatients with gastroenteritis, 3.2 (95% CI 2.4-4.2) for in-patients with gastroenteritis, and 1.6 (95% CI 1.0-2.8) for in-patients with bacteraemia. We conclude that the role of seasonal variation diminishes with increased severity of non-typhoid Salmonella infection.

Adolescent↗
PubMed1985

Inefficacy of the commercial live oral Ty 21a vaccine in the prevention of typhoid fever.

The efficacy of the live oral typhoid fever vaccine Ty 21a marketed in Switzerland in 1981 was investigated. Forty-seven Swiss travellers to Third World countries contracted typhoid fever in 1982 and 1983; 20 (43%) of these persons had been vaccinated with Ty 21a. The incidence of typhoid fever in vaccinees was 1.1 per 10,000 doses of Ty 21a vaccine sold, which was similar to the incidence of 0.9 per 10,000 doses for the ineffective killed Ty 2 vaccine. Comparison of the incidence of vaccination in patients with typhoid fever in 1983 and in healthy travellers to India revealed vaccination efficacy rates which were not significantly different from zero. It is suggested that Ty 21a vaccine in the form marketed in Switzerland in 1981-1983 is not sufficiently potent or heat-stable, so that the doses of viable bacteria ingested were too low.

Administration, Oral↗
PubMed2004

A randomized, open-label study of the immunogenicity and reactogenicity of three lots of a combined typhoid fever/hepatitis A vaccine in healthy adults.

BACKGROUND: Travelers are often advised to receive both the typhoid fever and hepatitis A virus (HAV) vaccines, particularly when going to areas where the 2 diseases are endemic. Thus, combined administration of these vaccines could make immunization more acceptable by reducing the number of injections needed. OBJECTIVE: This study compared the safety profiles and immunogenicity of 3 batches of a combined typhoid fever/HAV vaccine administered using a dual-chamber bypass syringe. METHODS: This randomized, open-label study was conducted at 2 university-based travel clinics in Germany and Austria. Subjects received a single IM injection from 1 of 3 batches of the combined vaccine. Blood samples were drawn immediately before and 28 days after vaccination to evaluate the response to the 2 antigens by assessing geometric mean titers (GMTs) and rates of seroconversion and seroprotection. Subjects recorded all adverse events (AEs) occurring during the study period in a diary. RESULTS: Six hundred ten healthy adults were enrolled in the study. Twenty-eight days after vaccination, 90.6% of the study population had protective typhoid Vi antibody titers (> or = 1 microg/mL) and 100% had protective HAV antibody titers (> or = 20 mIU/mL). Seroconversion rates and GMTs were not significantly different between the 3 batches. There were no differences with regard to local or systemic AEs between the 3 batches of vaccine. There were no immediate adverse reactions (within 30 minutes of vaccination) and no serious AEs related to vaccination. Of 609 evaluable subjects (1 was lost to follow-up after the first visit), 555 (91.1%) experienced > or = 1 local reaction within the first 7 days after vaccination, mainly pain at the injection site (550 [90.3%]), but only 26 (4.3%) described this pain as severe. Vaccine-related headache and mild to moderate asthenia were each reported by 54 subjects (8.9%). Symptoms resolved spontaneously in all cases. CONCLUSIONS: The 3 batches of the combined typhoid fever/HAV vaccine administered by dual-chamber bypass syringe were equally well tolerated and effective in healthy adults, and did not differ significantly in terms of GMTs or seroconversion rates.

Adult↗
PubMed2004

Typhoid fever in travelers: who should be targeted for prevention?

To clarify indications for typhoid vaccination, we reviewed laboratory-confirmed cases of typhoid fever reported to the United States Centers for Disease Control and Prevention between 1994 and 1999. To estimate the risk of adverse events associated with typhoid vaccination, we reviewed reports to the Vaccine Adverse Event Reporting System for the same period. Acute Salmonella enterica serotype Typhi infection was reported for 1393 patients. Of these patients, recent travel was reported by 1027 (74%), only 36 (4%) of whom reported having received a vaccination. Six countries accounted for 76% of travel-associated cases (India [30%], Pakistan [13%], Mexico [12%], Bangladesh [8%], The Philippines [8%], and Haiti [5%]). For 626 travelers who traveled to a single country, the length of stay was <or=1 week for 31 (5%), <or=2 weeks for 100 (16%), <or=3 weeks for 169 (27%), <or=4 weeks for 232 (37%), <or=5 weeks for 338 (54%), and <or=6 weeks for 376 (60%). Reports of serious adverse events due to typhoid vaccination were very rare. Vaccination should be considered even for persons planning short-term travel to high-risk areas.

Adolescent↗
PubMed1991

Protecting travelers from typhoid fever.

Although the incidence of domestically acquired typhoid fever is declining, the proportion of cases resulting from foreign travel has continued to rise. The widely available heat-phenol-inactivated parenteral vaccine has an efficacy of 65% but evokes severe adverse reactions in approximately 25% of recipients. A major advance in the control of typhoid fever was the development of an oral live, attenuated vaccine. Three doses of Ty21a in an enteric coated formulation given over one week provides 69% efficacy for at least four years. A series of four doses confers maximum protection. Increasing the interval between doses does not improve protection. Vaccine should be refrigerated and is currently not recommended for pregnant women, children older than 6 years of age, or immunocompromised patients. With respect to vaccines that are not available in the United States, parenteral purified Vi polysaccharide is considered safe and provides 64% to 72% protection over 21 months. Lastly, the safety and immunogenicity of an auxotrophic (Aro-, Pur-) S typhi recently has been evaluated. Travelers to areas of high risk should be vaccinated but must be cautioned that vaccination is not a substitute for careful selection of food and water. Since typhoid vaccines are not 100% effective, the protection of the vaccine can be overcome by large inocula of S typhi. Physicians caring for world travelers must also keep in mind that other infections, such as plague, typhus, and arboviral fever, may mimic a typhoidal pattern.

Adolescent↗
PubMed2006

Household demand for typhoid fever vaccines in Hue, Vietnam.

The demand function for vaccines against typhoid fever was estimated using stated preference data collected from a random sample of 1065 households in Hue, Vietnam, in 2002. These are the first estimates of private willingness-to-pay (WTP) and demand functions for typhoid vaccines in a developing country. Mean respondent WTP for a single typhoid fever vaccine ranged from USD 2.30 to USD 4.80. Mean household WTP estimates (vaccinating all members of the household) ranged from USD 21 to USD 27. Demand was similar for vaccines with different degrees of effectiveness and intervals of duration. These results suggest a significant potential for private sector provision of typhoid fever vaccines in Hue.

Adult↗
PubMed1982

A controlled field trial of live Salmonella typhi strain Ty 21a oral vaccine against typhoid: three-year results.

A controlled field trial of Salmonella typhi strain Ty 21a oral vaccine against typhoid was carried out in Alexandria, Egypt, from March 1978 to March 1981. A total of 32,388 children was included in the study. The children were divided in two comparable groups, one given three doses of vaccine and the other three doses of placebo. Each dose of vaccine contained 1-8 X 10(9) live Ty 21a bacteria. The population was monitored, and each suspected case of typhoid was investigated bacteriologically and serologically. The effectiveness of the vaccine was assessed by analyzing the number of confirmed cases of typhoid fever in the two groups. The incidence of typhoid fever was 4.9 cases per 10,000 children per year in the control group and 0.2 cases per 10,000 children per year in the vaccine group. The results indicate that, in the dose schedule used, the Ty 21a mutant strain, which is stable and safe, is protective for a period of at least three years.

Administration, Oral↗