Volume 74, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


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%) 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) 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.


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  1. Crump JA, Luby SP, Mintz ED, 2004. The global burden of typhoid fever. Bull World Health Organ 82 : 346–353. [Google Scholar]
  2. Black RE, Cisneros L, Levine MM, Banfi A, Lobos H, Rodriguez H, 1985. Case-control study to identify risk factors for paediatric endemic typhoid fever in Santiago, Chile. Bull World Health Organ 63 : 899–904. [Google Scholar]
  3. Gasem MH, Dolmans WM, Keuter MM, Djokomoeljanto RR, 2001. Poor food hygiene and housing as risk factors for typhoid fever in Semarang, Indonesia. Trop Med Int Health 6 : 484–490. [Google Scholar]
  4. Luby SP, Faizan MK, Fisher-Hoch SP, Syed A, Mintz ED, Bhutta ZA, McCormick JB, 1998. Risk factors for typhoid fever in an endemic setting, Karachi, Pakistan. Epidemiol Infect 120 : 129–138. [Google Scholar]
  5. Rowe B, Ward LR, Threlfall EJ, 1997. Multidrug-resistant Salmonella Typhi: a worldwide epidemic. Clin Infect Dis 24 : S106–S109. [Google Scholar]
  6. Lin FY, Ho VA, Khiem HB, Trach DD, Bay PV, Thanh TC, Kossaczka Z, Bryla DA, Shiloach J, Robbins JB, Schneerson R, Szu SC, 2001. The efficacy of a Salmonella Typhi Vi conjugate vaccine in two-to-five-year-old children. N Engl J Med 344 : 1263–1269. [Google Scholar]
  7. Archibald LK, Reller LB, 2001. Clinical microbiology in developing countries. Emerg Infect Dis 7 : 302–305. [Google Scholar]
  8. Crump JA, Youssef FG, Luby SP, Wasfy MO, Rangel JM, Taalat M, Oun SA, Mahoney FJ, 2003. Estimating the incidence of typhoid fever and other febrile illnesses in developing countries. Emerg Infect Dis 9 : 539–544. [Google Scholar]
  9. United Nations Development Programme, 2004. Egypt Human Development Report 2003. Available at: http://www.undp.org.eg/publications/ENHDR_2003/P41-63.PDF.
  10. Talaat M, el-Oun S, Kandeel A, Abu-Rabei W, Bodenschatz C, Lohiniva AL, Hallaj Z, Mahoney FJ, 2003. Overview of injection practices in two governorates in Egypt. Trop Med Int Health 8 : 234–241. [Google Scholar]
  11. NCCLS. Performance Standards for Antimicrobial Susceptibility Testing; Eleventh Informational Supplement, 2001. NCCLS document M100-S11.
  12. Gasem MH, Dolmans WMV, Isbandrio BB, Wahyono H, Keuter M, Djokomoeljanto R, 1995. Culture of Salmonella Typhi and Salmonella Paratyphi from blood and bone marrow in suspected typhoid fever. Trop Geogr Med 47 : 164–167. [Google Scholar]
  13. Gilman RH, Terminel M, Levine MM, Hernandez-Mendoza P, Hornick RB, 1975. Relative efficacy of blood, urine, rectal swab, bone-marrow, and rose-spot cultures for recovey of Salmonella Typhi in typhoid fever. Lancet 1 : 1211–1213. [Google Scholar]
  14. Hoffman SL, Punjabi NH, Rockhill RC, Sutomo A, Rivai AR, Pulungsih SP, 1984. Duodenal string-capsule culture compared with bone-marrow, blood, and rectal-swab cultures for diagnosing typhoid and paratyphoid fever. J Infect Dis 149 : 157–161. [Google Scholar]
  15. Lin F-YC, Ho VA, Bay PV, Thuy NTT, Bryla D, Thanh TC, Khiem HB, Trach DD, Robbins JB, 2000. The epidemiology of typhoid fever in the Dong Thap Province, Mekong Delta region of Vietnam. Am J Trop Med Hyg 62 : 644–648. [Google Scholar]
  16. Murdoch DR, Woods CW, Zimmerman MD, Dull PM, Belbase RH, Keenan AJ, Scott RM, Basnyat B, Archibald LK, Reller LB, 2004. The etiology of febrile illness in adults presenting to Patan hospital in Kathmandu, Nepal. Am J Trop Med Hyg 70 : 670–675. [Google Scholar]
  17. Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ, 2002. Typhoid fever. N Engl J Med 347 : 1770–1782. [Google Scholar]
  18. Sinha A, Sazawal S, Kumar R, Sood S, Reddaiah VP, Singh B, Rao M, Naficy A, Clemens JD, Bhan MK, 1999. Typhoid fever in children aged less than 5 years. Lancet 354 : 734–737. [Google Scholar]
  19. Saha SK, Baqui AH, Hanif M, Darmstadt GL, Ruhulamin M, Nagatake T, Santosham M, Black RE, 2001. Typhoid fever in Bangladesh: implications for vaccination policy. Pediatr Infect Dis J 20 : 521–524. [Google Scholar]
  20. Wasfy MO, Frenck R, Ismail TF, Mansour H, Malone JL, Mahoney FJ, 2002. Trends of multiple-drug resistance among Salmonella serotype Typhi isolates during a 14-year period in Egypt. Clin Infect Dis 35 : 1265–1268. [Google Scholar]
  21. O’Brien TF, 1997. The global epidemic nature of antimicrobial resistance and the need to monitor and manage it locally. Clin Infect Dis 24 (Suppl 1): S2–S8. [Google Scholar]
  22. Crump JA, Barrett TJ, Nelson JT, Angulo FJ, 2003. Reevaluating fluoroquinolone breakpoints for Salmonella enterica serotype Typhi and for non-Typhi salmonellae. Clin Infect Dis 37 : 75–81. [Google Scholar]
  23. Bhutta ZA, 1996. Impact of age and drug resistance on mortality in typhoid fever. Arch Dis Child 75 : 214–217. [Google Scholar]
  24. Kabra SK, Madhulika, Talati A, Soni N, Patel S, Modi RR, 2000. Multidrug-resistant typhoid fever. Trop Doct 30 : 195–197. [Google Scholar]
  25. Mishra S, Patwari AK, Anand VK, Pillai PK, Aneja S, Chandra J, Sharma D, 1991. A clinical profile of multidrug resistant typhoid fever. Indian Pediatr 28 : 1171–1174. [Google Scholar]
  26. Rajajee S, Anandi TB, Subha S, Vatsala BR, 1995. Patterns of resistant Salmonella Typhi infection in infants. J Trop Pediatr 41 : 52–54. [Google Scholar]
  27. Butler T, Islam A, Kabir I, Jones PK, 1991. Patterns of morbidity and mortality in typhoid fever dependent on age and gender: review of 552 hospitalized patients with diarrhea. Rev Infect Dis 13 : 85–90. [Google Scholar]
  28. van den Bergh ET, Gasem MH, Keuter M, Dolmans MV, 1999. Outcome in three groups of patients with typhoid fever in Indonesia between 1948 and 1990. Trop Med Int Health 4 : 211–215. [Google Scholar]

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  • Received : 28 Nov 2004
  • Accepted : 21 Feb 2005

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