BACKGROUND: The morbidity of typhoid fever is highest in Asia with 93% of global episodes occurring in this region. Southeast Asia has an estimated incidence of 110 cases/100,000 population, which is the third highest incidence rate for any region. Pakistan falls into this region. There is also a considerable seasonal variation of typhoid fever, carrying significant public health importance. Children are worst affected. Population-based data from Pakistan are scarce. METHODS: From June 1999 to December 2001 a fortnightly surveillance system was established in two squatter settlements in Karachi, Pakistan, with two study centers, each staffed by a doctor and five community health workers. Cases of continuous high-grade fever for three or more days were referred to these centers and screened clinically. Blood culture and Typhidot tests were done. RESULTS: One-third of the 4198 cases with febrile episodes of three or more days detected in the community were screened at the centers; 341 were clinically suspected of having typhoid fever. Forty-nine were positive by culture whereas 161 were positive by serology. Ten cases were multi-drug resistant. Incidence of culture-proven typhoid was estimated to be 170 (95% CI: 120, 220)/100,000 population, whereas serology-based incidence was 710 (95% CI: 620, 810)/100,000 population. Peak incidence was noted in October followed by May and June. CONCLUSION: Passive surveillance, even when augmented by household visits, misses a significant portion of suspected cases. Morbidity of typhoid is quite high in Pakistan and needs public health intervention. Hot months have higher incidence of typhoid. Healthcare behavior studies will help to develop a better surveillance system.
BACKGROUND: The morbidity of typhoid fever is highest in Asia with 93% of global episodes occurring in this region. Southeast Asia has an estimated incidence of 110 cases/100,000 population, which is the third highest incidence rate for any region. Pakistan falls into this region. There is also a considerable seasonal variation of typhoid fever, carrying significant public health importance. Children are worst affected. Population-based data from Pakistan are scarce. METHODS: From June 1999 to December 2001 a fortnightly surveillance system was established in two squatter settlements in Karachi, Pakistan, with two study centers, each staffed by a doctor and five community health workers. Cases of continuous high-grade fever for three or more days were referred to these centers and screened clinically. Blood culture and Typhidot tests were done. RESULTS: One-third of the 4198 cases with febrile episodes of three or more days detected in the community were screened at the centers; 341 were clinically suspected of having typhoid fever. Forty-nine were positive by culture whereas 161 were positive by serology. Ten cases were multi-drug resistant. Incidence of culture-proven typhoid was estimated to be 170 (95% CI: 120, 220)/100,000 population, whereas serology-based incidence was 710 (95% CI: 620, 810)/100,000 population. Peak incidence was noted in October followed by May and June. CONCLUSION: Passive surveillance, even when augmented by household visits, misses a significant portion of suspected cases. Morbidity of typhoid is quite high in Pakistan and needs public health intervention. Hot months have higher incidence of typhoid. Healthcare behavior studies will help to develop a better surveillance system.
Authors: Kathryn E Holt; Stephen Baker; Sabina Dongol; Buddha Basnyat; Neelam Adhikari; Stephen Thorson; Anoop S Pulickal; Yajun Song; Julian Parkhill; Jeremy J Farrar; David R Murdoch; Dominic F Kelly; Andrew J Pollard; Gordon Dougan Journal: BMC Infect Dis Date: 2010-05-31 Impact factor: 3.090
Authors: Abhilasha Karkey; Amit Arjyal; Katherine L Anders; Maciej F Boni; Sabina Dongol; Samir Koirala; Phan Vu Tra My; Tran Vu Thieu Nga; Archie C A Clements; Kathryn E Holt; Pham Thanh Duy; Jeremy N Day; James I Campbell; Gordon Dougan; Christiane Dolecek; Jeremy Farrar; Buddha Basnyat; Stephen Baker Journal: PLoS One Date: 2010-11-15 Impact factor: 3.240
Authors: R Leon Ochiai; Camilo J Acosta; M Carolina Danovaro-Holliday; Dong Baiqing; Sujit K Bhattacharya; Magdarina D Agtini; Zulfiqar A Bhutta; Do Gia Canh; Mohammad Ali; Seonghye Shin; John Wain; Anne-Laure Page; M John Albert; Jeremy Farrar; Remon Abu-Elyazeed; Tikki Pang; Claudia M Galindo; Lorenz von Seidlein; John D Clemens Journal: Bull World Health Organ Date: 2008-04 Impact factor: 9.408