Typhoid Fever in the United States

According to the U.S. Centers for Disease Control and Prevention (CDC), about 400 Americans each year acquire typhoid, most of them while traveling in developing countries. Untreated, the illness may last for 3 to 4 weeks. Roughly 5 percent of those who contract the illness become chronic carriers-excreting the typhoid bacteria in their stools for more than a year. Treatment usually consists of antibiotics--either ampicillin, trimethoprim-sulfamethoxazole, or ciprofloxacin. With antibiotic treatment, recovery usually begins within 2 to 3 days, and deaths rarely occur. Untreated, typhoid victims may experience fever for weeks or months. Anywhere from 12 to 30 percent of typhoid victims who do not receive treatment eventually die from such complications of the infection as intestinal perforation. (http://www.cdc.gov/nczved/divisions/dfbmd/diseases/typhoid_fever/additional.html)

The most recent comprehensive analysis available of typhoid fever in the United States found that the cause of most cases of the disease that did not result from travel abroad could not be accounted for. About 19 percent of U.S. typhoid cases were associated with outbreaks among groups of people. The largest such outbreak, involving 47 people, was attributed to orange juice contaminated by a food handler. ("Typhoid Fever in the United States, 1985-1994, Archives of Internal Medicine, March 23, 1998, pp. 633-638.)

Another analysis found that many U.S. typhoid cases involved infection with strains of S. Typhi that were resistant to the antibiotics commonly used to treat them. Of S. typhi samples isolated from 293 patients, 25 percent were resistant to one or more antibiotics, and 17 percent were resistant to 5 or more antibiotics, including ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole. The researchers concluded that ciprofloxacin and ceftriaxone are the most appropriate drugs to treat typhoid. They added that physicians should be on the alert for drug-resistant strains of the bacteria in their typhoid patients. ("Laboratory-Based Surveillance of Salmonella Serotype Typhi Infections in the United States," Journal of the American Medical Association, May 24-31, 2000, pp. 2668-2673. http://jama.ama-assn.org/content/283/20/2668.full External Web Site Policy

In 1988, Feng-Ying (Kimi) Lin, now of NICHD, then of the Maryland Department of Health and Mental Hygiene, in Baltimore, and John Robbins, of NICHD, together with several other researchers, reported a typhoid outbreak that they had traced to a fast-food worker at a restaurant in Silver Spring, MD. All 10 reported cases were associated with the consumption of a shrimp salad served at the restaurant. Although the salad tested negative for typhoid bacteria, a restaurant worker who had handled the salad tested positive for it. The young woman had emigrated from a country where typhoid fever is common and had visited her home country about 2 years before. ("Restaurant-Associated Outbreak of Typhoid Fever in Maryland: Identification of Carrier Facilitated by Measurement of Serum Vi Antibodies." Journal of Clinical Microbiology, June 1988, pp. 1194-1197.)

Before the advent of public sewage systems, typhoid was common in the United States. In 1920, for example, typhoid fever occurred in 100 out of every 100,000 people. By 1920, it had decreased to 33.8 per 100,000 people, and, by 1950, to 1.7 for every 100,000; http://www.cdc.gov/mmwr/PDF/wk/mm4840.pdf (PDF - 290 KB).

Perhaps the most famous outbreaks of tyhpoid fever in the U.S. involved Mary Mallon, a cook in the New York City area in the early 1900s. Most well known as "Typhoid Mary," Mallon was taken into custody in 1907 by local health officials when it was shown that a number of typhoid cases in the area could be traced to kitchens where she worked. She was held for three years on Brother Island in New York's East River and then released on the condition that she never again work as a cook. About 5 years later, officials found that typhoid outbreaks were again traceable to kitchens where Mallon worked. She was then detained on Brother Island until her death in 1938.

The NICHD is part of the National Institutes of Health, the biomedical research arm of the Federal government. The Institute sponsors research on development before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. NICHD publications, as well as information about the Institute, are available from the NICHD website, http://www.nichd.nih.gov, or from the NICHD Information Resource Center, 1-800-370-2943; E-mail NICHDInformationResourceCenter@mail.nih.gov.


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