Internationally-Acquired Acute Typhoid Fever Cases
Reported in Maryland from 1989 to 2001
Leslie Edwards, MHS,
Maryland Department of Health and Mental Hygiene
Division of Outbreak Investigation
Background: Tropical diseases are of increasing
concern as international travel from the United States has increased
in recent years. In the United States, there are approximately 400
cases of typhoid fever per year, and at least 70% of these cases
are acquired during travel abroad.
Methods: Exposure information, including travel
history, hospitalization, and occupation, was reviewed for all persons
with lab-confirmed Salmonella typhi infection reported
to the Maryland Department of Health and Mental Hygiene from 1989
to 2001.
Results: From 1989 to 2001, there were 145 laboratory-confirmed
cases of acute typhoid fever reported in Maryland; an average of
11.2 cases per year. Of the 144 persons where age was given, the
median age was 21 years (range: 11 months – 61 years). Of
these cases, 101 (69.7%) were hospitalized and none died as a result
of S. typhi infection. In 1990, 24 cases were domestically
acquired and were linked to an S. typhi chronic carrier
who prepared food for a holiday party. Excluding these outbreak-related
cases, international travel during the 30 days prior to the onset
of illness was noted for 81 of 145 cases (55.8%). Areas visited
include: the Indian subcontinent (41 cases, [51%]), Southeast Asia
(14 cases, 17.3%), Africa (13 cases, 16%), Central and South America
(11 cases, 13.6%), and Europe (1 case, 1.2%).] Three cases (2.1%)
occurred in food handlers who had traveled internationally at least
30 days prior to the onset of symptoms.
Conclusion: S. typhi infection in Maryland
is clearly associated with foreign travel. Emergency department
physicians seeing patients with acute diarrhea should consider typhoid
fever in their differential diagnosis, particularly if the patient
traveled to the Indian Subcontinent in the month prior to illness.
It is also important to collect information about the occupation
of confirmed or suspect typhoid fever cases because cases that work
in certain occupations, such as food-handling and patient care,
could transmit Salmonella typhi to the public.
Maryland Department of
Health & Mental Hygiene — Epidemiology & Disease Control
Program |
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