Chattanooga-Hamilton County Epidemiology Department

Gram-negative bacilli Humans only reservoir Contaminated food/water or person to person Incubation 7-14 days (range 3-60) Fever, abd. pain, malaise ( diarrhea, rash, hepato/splenomegaly) Potentially fatal Image courtesy of the Centers for Disease Control and Prevention

Worldwide incidence highest in: South & East Asia Africa Central & South America 22 million cases with 200,000 deaths per year ~ 1% of adults may become chronic carriers

Source: PHLIS Surveillance Data, 2006

15 cases – MSR 5, CHR 5, NDR 2, MCR 1, SER 1, SUL 1 Median age 23, female 8, male 7 10 cases associated with foreign travel 14 cases hospitalized, 0 deaths

3 cases April 28 – June 3 Children ages 2-6 Fever, abdominal pain, h/a, diarrhea (2) No recent travel history Worked with 6 household contacts, 20 school contacts

y/o child with fever, abdominal pain, diarrhea 4-20 appendectomy 4-23 stool specimen collected 4-28 salmonella + stool 5-5 serotype S. typhi + No obvious exposures identified

y/o child with fever, abdominal pain, vomiting, diarrhea 5-16 blood culture + S. typhi 5-16 to 5-19 hospitalized and treated No obvious exposures No connection to case A??

y/o child with fever, chills, headache sibling of case A 5-29 stool + salmonella 6-3 serotype S. typhi

Initial interviews did not reveal a connection 5-26 home visits with interpreter to Case A & Case B Mothers of the cases are sisters No illness except in sibling 3 adults in each household, deny recent travel All agreed to submit clinical specimens

Case C attended kindergarten while ill 18 of 20 school contacts were interviewed for illness All received a certified letter by mail 1 child evaluated for febrile illness

Media avoidance on a Friday afternoon was unsuccessful!

PFGE pattern of the cases revealed a rare serotype not seen since adult contacts tested negative for salmonella in stool and negative IgM in blood 2 adult males tested + for antibody to S. typhi Vi antigen Carriers were treated to eradicate S. typhi No contacts in high risk occupations

Consider chronic carrier in cases with no travel hx or association with others who have traveled Epi links are hard to find initially Utilizing interpreter with similar culture may yield better results Although no recent travel was identified, most foreign born are not vaccinated prior to travel Providers do not normally include typhoid in differential diagnosis if no travel identified