Epidemiology and risk factors for endemic typhoid fever in Uzbekistan.

Journal Article (Journal Article)

BACKGROUND: To investigate the risk factors for infection with endemic typhoid fever in the Samarkand region of Uzbekistan. METHODS: Case-control study of culture-confirmed bloodstream infection with Salmonella Typhi. Patients were compared to age-matched community controls. Salmonella Typhi isolates were tested for antimicrobial susceptibility. RESULTS: We enrolled 97 patients and 192 controls. The median age of patients was 19 years. In a conditional regression model, consumption of unboiled surface water outside the home [adjusted odds ratio (aOR)=3.0, 95% confidence interval (CI)=1.1-8.2], use of antimicrobials in the 2 weeks preceding onset of symptoms (aOR=12.2, 95% CI 4.0-37.0), and being a student (aOR=4.0, 95% CI 1.4-11.3) were independently associated with typhoid fever. Routinely washing vegetables (aOR 0.06, 95% CI 0.02-0.2) and dining at a tea-house (aOR 0.4, 95% CI 0.2-1.0) were associated with protection against illness. Salmonella Typhi resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole was identified in 6 (15%) of 41 isolates tested. CONCLUSIONS: Endemic typhoid fever in Uzbekistan is transmitted by contaminated water. Recent use of antimicrobials also increased risk of infection. Targeted efforts at improving drinking water quality, especially for students and young adults, are likely to decrease transmission of typhoid fever. Measures to decrease the unnecessary use of antimicrobials would be expected to reduce the risk of typhoid fever and decrease the spread of multiple drug-resistant Salmonella Typhi.

Full Text

Duke Authors

Cited Authors

  • Srikantiah, P; Vafokulov, S; Luby, SP; Ishmail, T; Earhart, K; Khodjaev, N; Jennings, G; Crump, JA; Mahoney, FJ

Published Date

  • July 2007

Published In

Volume / Issue

  • 12 / 7

Start / End Page

  • 838 - 847

PubMed ID

  • 17596250

International Standard Serial Number (ISSN)

  • 1360-2276

Digital Object Identifier (DOI)

  • 10.1111/j.1365-3156.2007.01853.x


  • eng

Conference Location

  • England