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Credible measures of disease incidence are necessary to guide typhoid fever control efforts. In Egypt, incidence estimates have been derived from hospital-based syndromic surveillance, which may not represent the population with typhoid fever. To determine the population-based incidence of typhoid fever in Fayoum Governorate (pop. 2,240,000), we established laboratory-based surveillance at five tiers of health care. Incidence estimates were adjusted for sampling and test sensitivity. Of 1,815 patients evaluated, cultures yielded 90 (5%) Salmonella Typhi isolates. The estimated incidence of typhoid fever was 59/100,000 persons/year. We estimate 71% of typhoid fever patients are managed by primary care providers. Multidrug-resistant (MDR) Salmonella Typhi (resistant to chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole) was isolated from 26 (29%) patients. Population-based surveillance indicates moderate typhoid fever incidence in Fayoum, and a concerning prevalence of MDR typhoid. The majority of patients are evaluated at the primary care level and would not have been detected by hospital-based surveillance.
Received November 28, 2004. Accepted for publication February 21, 2005.
Acknowledgments: We are indebted to the residents of Fayoum Governorate for their cooperation, to the Fayoum Governorate Health Directorate for their support, and to the many clinicians in Fayoum for their valuable assistance with this project.
Financial support: This work was supported by the Global Emerging Infections Surveillance System, United States Department of Defense, and the US Agency for International Development.
* Address correspondence to Padmini Srikantiah, 995 Potrero Ave, Box 0874, Building 80, Ward 84, San Francisco General Hospital, San Francisco, CA 94143-0874. E-mail: psrikant{at}itsa.ucsf.edu
Authors’ addresses: Padmini Srikantiah, 995 Potrero Ave, Box 0874, Building 80, Ward 84, San Francisco General Hospital, San Francisco, CA 94143-0874, Telephone: 415-476-4082, ext. 137, Fax: 415-476-6953, E-mail: psrikant{at}itsa.ucsf.edu. Fouad Y. Youssef, Head, Field Investigation Unit, Disease Surveillance Program, U.S. Naval Medical Research Unit 3, Extension of Ramsis Street, Cairo, Egypt, Telephone: 011-202-342-1375, Fax: 011-202-342-0186, E-mail: yousseff{at}namru3.org. Stephen P. Luby, Head, Programme on Infectious Diseases and Vaccine Sciences, ICDDRB, Centre for Health and Population Research, Mohakali, Dhaka 1212, GPO 128, Bangladesh, Telephone: 880-2-9881761, Fax: 880-2-882-3963, U.S. fax: 1-309-214-3745, E-mail: sluby{at}icddrb.org. Gregory Jennings, Disease Surveillance Program, U.S. Naval Medical Research Unit 3, Extension of Ramsis Street, Cairo, Egypt, Telephone: 011-202-342-1375, Fax: 011-202-342-0186, E-mail: jenningsg{at}namru3.org. Momtaz Omar Wasfy, Head, Lab Unit Disease Surveillance Program, U.S. Naval Medical Research Unit 3, Extension of Ramsis Street, Cairo, Egypt, Telephone 011-202 342 1375/6, Fax: 011-202 342 0186, E-mail: wafsym{at}namru3.org. John A. Crump, Foodborne and Diarrheal Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS A38, Atlanta, GA 30333, Telephone: +1-404-639-2206, Fax: +1-404-639-2205, E-mail: jcrump{at}cdc.gov. Robert M. Hoekstra, Biostatistics and Information Management Branch, National Center for Infectious Diseases, Centers For Disease Control and Prevention, Mailstop C09, 1600 Clifton Road, NE, Atlanta, GA 30333, Telephone: 404-639-4712, Fax: 404-639-0070, E-mail: mhoekstra{at}cdc.gov. Mahmoud Anwer, Health Directorate, Fayoum City, Fayoum, Egypt, Telephone: 011-20-084-345932, Fax: 011-20-084-345934. Frank J. Mahoney, Medical Officer, VPI Eastern Mediterranean Regional Office, WHO, PSC 452, Box 146, FPO AE 09835, Telephone: 011-202-276-5287, Fax: 011-202-276-5414, E-mail: mahoneyf{at}emro.who.int.
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