Objective: To analyze the incidence trend and epidemiological characteristics of typhoid fever and paratyphoid fever in China from 2004 to 2020, understand the high-incidence population and hotspot areas, and provide evidences to develop more targeted prevention and control measures. Methods: The descriptive epidemiological method and spatial analysis method were applied to analyze the epidemiological characteristics of typhoid fever and paratyphoid fever in China during this period by using the surveillance data collected from the National Notifiable Infectious Disease Reporting System of Chinese Center for Disease Control and Prevention. Results: A total of 202 991 cases of typhoid fever were reported in China from 2004 to 2020. More cases occurred in men than in women (sex ratio: 1.18∶1). Most cases were reported in adults aged 20-59 years (53.60%). The incidence rate of typhoid fever decreased from 2.54/100 000 in 2004 to 0.38/100 000 in 2020. The highest incidence rate was reported in young children aged <3 years after 2011, ranging from 1.13/100 000 to 2.78/100 000, and during this period the proportion of cases in this age group increased from 3.48% to 15.59%. The proportion of the cases in the elderly aged ≥60 years increased from 6.46% in 2004 to 19.34% in 2020. The hotspot areas existed in Yunnan, Guizhou, Guangxi and Sichuan Provinces and expanded to Guangdong, Hunan, Jiangxi, and Fujian Provinces. A total of 86 226 paratyphoid fever cases were reported from 2004 to 2020, the male to female ratio of the cases was 1.21∶1. Most cases were reported in adults aged 20-59 years (59.80%). The incidence rate of paratyphoid fever decreased from 1.26/100 000 in 2004 to 0.12/100 000 in 2020. The highest incidence rate of paratyphoid fever was in young children aged <3 years after 2007, ranging from 0.57/100 000 to 1.19/100 000, and during this period the proportion of the cases in this age group increased from 1.48% to 30.92%. The proportion of the cases in the elderly aged ≥60 years increased from 4.52% in 2004 to 22.28% in 2020. The hotspot areas expanded to the east, including Guangdong, Hunan and Jiangxi Provinces, from Yunnan, Guizhou, Sichuan, and Guangxi Provinces. Conclusions: The results showed a low level of incidence of typhoid fever and paratyphoid fever in China with a trend of decreasing per year. The hotspots were mainly in the of Yunnan, Guizhou, Guangxi and Sichuan Provinces, with an expanding trend to eastern China. It is necessary to strengthen the typhoid fever and paratyphoid fever prevention and control in southwestern China, among young children aged <3 years and the elderly aged ≥60 years.
Adult ; Aged ; Child, Preschool ; Female ; Humans ; Male ; China/epidemiology* ; Paratyphoid Fever/epidemiology* ; Sex Ratio ; Typhoid Fever/epidemiology* ; Young Adult ; Middle Aged

Objective: To understand the epidemiological and molecular characteristics of typhoid and paratyphoid in China from 2009 to 2013, and provide evidence for the prevention and control of typhoid and paratyphoid, the development and improvement of surveillance strategies. Methods: Epidemiological analysis was conducted on the incidence data of typhoid and paratyphoid, and related public health emergencies in China during 2009-2013. Pathogen isolation and culture, serologic test were conducted for the typhoid and paratyphoid cases from 13 national surveillance sites. The isolates were subjected to antimicrobial susceptibility testing. Pulsed-field gel electrophoresis (PFGE) was performed for the molecular typing of these isolates. Results: The average incidence of typhoid and paratyphoid in China during this period was 1.03/100 000. The reported case number and incidence decreased with year. The provinces reporting high case numbers were Yunnan, Guizhou, Guangxi, Hunan, Zhejiang, Guangdong and Xinjiang. The incidence of age group 0-4 years was highest. The proportion of farmers and children outside child care settings showed an increasing tendency over time. The annual incidence peak was during July-August. Twenty five outbreaks occurred during 2009-2013. The results of pathogen isolation and culture showed that the positive rate was 3.00% (940/31 322), among the positive isolates, the proportion of Salmonella paratyphi A accounted for higher proportion (68.19%, 641/940) compared with Salmonella typhi (31.60%, 297/940). The drug resistances of Salmonella typhi and Salmonella paratyphi varied, but their resistances to nalidixic acid were highest (50.22% and 85.33%) respectively. A certain amount of Salmonella typhi isolates showed the resistance to the 3rd generation cephalosporins. PFGE analysis showed divergent patterns of Salmonella typhi compared with limited patterns of Salmonella paratyphi A. Conclusion: The epidemic level of typhoid and paratyphoid in China was relatively low, but the outbreak occurred occasionally. It is necessary to enhance the laboratory-based surveillance, particularly the capability of etiological diagnosis, outbreak investigation, response and antibiotic resistance monitoring, and conduct risk factor investigation in provinces with high incidences in recent years.
Child ; Child, Preschool ; China/epidemiology* ; Disease Outbreaks ; Drug Resistance, Bacterial/genetics* ; Electrophoresis, Gel, Pulsed-Field ; Epidemics ; Farmers ; Humans ; Incidence ; Infant ; Molecular Typing ; Paratyphoid Fever/microbiology* ; Population Surveillance ; Salmonella paratyphi A/isolation & purification* ; Salmonella typhi/isolation & purification* ; Typhoid Fever/microbiology*

INTRODUCTIONEnteric fever is a multisystemic infection which largely affects children. This study aimed to analyse the epidemiology, clinical presentation, treatment and outcome of paediatric enteric fever in Singapore.

MATERIALS AND METHODSA retrospective review of children diagnosed with enteric fever in a tertiary paediatric hospital in Singapore was conducted from January 2006 to January 2012. Patients with positive blood cultures for Salmonella typhi or paratyphi were identified from the microbiology laboratory information system. Data was extracted from their case records.

RESULTSOf 50 enteric fever cases, 86% were due to Salmonella typhi, with 16.3% being multidrug resistant (MDR) strains. Sixty-two percent of S. typhi isolates were of decreased ciprofloxacin susceptibility (DCS). Five cases were both MDR and DCS. The remaining 14% were Salmonella paratyphi A. There were only 3 indigenous cases. Ninety-four percent had travelled to typhoid-endemic countries, 70.2% to the Indian subcontinent and the rest to Indonesia and Malaysia. All patients infected with MDR strains had travelled to the Indian subcontinent. Anaemia was a significant finding in children with typhoid, as compared to paratyphoid fever (P = 0.04). Although all children were previously well, 14% suffered severe complications including shock, pericardial effusion and enterocolitis. None had typhoid vaccination prior to their travel to developing countries.

CONCLUSIONEnteric fever is largely an imported disease in Singapore and has contributed to significant morbidity in children. The use of typhoid vaccine, as well as education on food and water hygiene to children travelling to developing countries, needs to be emphasised.

Adolescent ; Anemia ; epidemiology ; Anti-Bacterial Agents ; therapeutic use ; Child ; Child, Preschool ; Drinking Water ; Drug Resistance, Multiple, Bacterial ; physiology ; Enterocolitis ; epidemiology ; Female ; Food Contamination ; Health Education ; Hospitals, Pediatric ; Humans ; India ; Indonesia ; Infant ; Malaysia ; Male ; Paratyphoid Fever ; drug therapy ; epidemiology ; microbiology ; Pericardial Effusion ; epidemiology ; Retrospective Studies ; Salmonella paratyphi A ; physiology ; Salmonella typhi ; physiology ; Shock ; epidemiology ; Singapore ; epidemiology ; Tertiary Care Centers ; Travel ; Typhoid Fever ; drug therapy ; epidemiology ; microbiology ; prevention & control ; Typhoid-Paratyphoid Vaccines ; therapeutic use

OBJECTIVEThis study was to evaluate the effects of prevention and control regarding programs on typhoid fever and paratyphoid fever, in Guizhou province, from 2007 to 2012, to provide evidence for the improvement of related programs.

METHODSData on typhoid fever and paratyphoid including information on epidemics, individual, cases, measures for prevention and control programs taken and relative government documents were collected and analyzed in Guizhou province, from 2007 to 2012. Information related to the average annual incidence, nature of outbreaks, time span before confirmed diagnosis was made, unit which carried the case report, proportion of laboratory confirmed diagnosed cases and case-management were compared between 2007-2009 and 2010-2012 descriptively while chi-square test with Excel and EpiInfo software were used for data analysis.

RESULTSIn the period of 2007-2009, a total of 5 978 typhoid fever and paratyphoid fever cases were reported in Guizhou province with the average yearly incidence as 5.29/100 000. In the period of 2010-2012, 2 765 cases were reported with the average yearly incidence as 2.57/100 000. When compared to the former, data from the latter period showed that the average yearly incidence had declined 51.31% in all the prefectures. There were still some outbreaks appeared but the total number of cases involved reduced 87.50%. The time span before the confirmation of diagnosis became shorter but the difference was not statistically significant (χ² = 0.08, P = 0.99). Number of cases reported by hospitals at county or above had 11.51% of increase while those cases reported at the township hospitals or below decreased for 61.47% . The proportion of laboratory diagnosed cases increased 23.63%. Rates of timeliness on cards being filled in, input and audited showed increase of 8.44%, 6.76% and 2.40% respectively.

CONCLUSIONSuccessful measures for prevention and control on typhoid fever and paratyphoid fever had been remarkably taken in Guizhou province, but the potential risk of outbreaks still existed in some areas, suggesting that health education and surveillance programs including laboratory diagnosis, should be strengthened.

China ; epidemiology ; Communicable Disease Control ; methods ; Humans ; Paratyphoid Fever ; epidemiology ; prevention & control ; Typhoid Fever ; epidemiology ; prevention & control

OBJECTIVETo analysis the etiological and epidemiological characteristics of the reported infectious diarrhea (other than cholera, dysentery, typhoid and paratyphoid) cases in China in 2011.

METHODSA total of 836 591 reported infectious diarrhea cases were collected from "China Information System for Disease Prevention and Control" since first week to fifty-second weeks in 2011, 59 929 out of which were laboratory-confirmed. The information of thirty public health emergencies relevant with infectious diarrhea was collected from "Emergency Public Reporting System" between first week and fifty-second weeks in 2011. The epidemiological characteristics of reported cases, confirmed cases and outbreaks, and the pathogenic spectrum of confirmed cases were then analyzed.

RESULTSIn 2011, 836 591 infectious diarrhea cases (other than cholera, dysentery, typhoid and paratyphoid) were reported, and the incidence rate was 62.39/100 000. More than half patients were children aged under 5 year-old, accounting for 52.13% (436 098/836 591) and the incidence rate was 447.06/100 000 (436 098 cases). Most of the ill children were scattered, accounting for 50.53% (422 752/836 591). Reported cases showed two incidence peaks, with a summer peak from twenty-third weeks to thirty-fifth weeks, accounting for 34.33% (287 231/836 591) and a winter peak from forty-third weeks to fifty-second weeks, accounting for 23.54% (196 939/836 591). Cases distributed all over China, the incidence in Beijing (253.00/100 000 (49 619 cases)), Tianjin (244.34/100 000 (31 614 cases)), Zhejiang (204.42/100 000 (111 257 cases)), Ningxia (132.16/100 000 (9328 cases)) and Guangdong (127.40/100 000 (132 880 cases)) ranked the top five. Among the 30 public health emergencies, 5 outbreaks had lab tested pathogenic results, including 4 were norovirus-induced. Laboratory-confirmed cases accounted for 7.16% (59 929/836 591) of the case reported, including 56 687 viral cases and 3242 bacterial cases. Rotavirus cases took the highest proportion of viral cases, at 97.35% (53 612/55 185); and 97.15% (53 612/55 185) of which were children aged under 5 year-old. 82.42% (45 480/55 185) of the cases distributed in Guangdong and Zhejiang province, with the incidence peak from fiftieth weeks to fifty-first weeks, accounting for 15.42% (8508/55 185) of the whole year cases. The main pathogens of bacterial diarrhea were Salmonella, Vibrio parahaemolyticus and Escherichia coli, accounting for 48.43% (1570/3242), 32.20% (1044/3242) and 8.57% (278/3242) respectively, with the incidence peak from thirty-first weeks to thirty-fifth weeks, accounting for 23.01% (746/3242). Salmonella infection patients were mainly from Shanghai, Guangdong and Zhejiang province (91.59% (1438/1570)), Vibrio parahaemolyticus patients were mainly from Shanghai (80.94% (845/1044)), and Escherichia coli patients were mainly from Guangdong province (84.17% (234/278)). Salmonella patients were concentrated in 0-9 years group, accounting for 42.36% (665/1570), while Vibrio parahaemolyticus patients in 20-39 years group, accounting for 81.99% (856/1044), and Escherichia coli patients in under 1 year old and 20-39 years group, accounting for 63.67% (177/278).

CONCLUSIONIn China, children aged under 5 year-old should be the priority population in surveillance of infectious diarrhea. Rotavirus is the main pathogen causing infectious diarrhea. The lab-testing and case-reporting capabilities differed greatly among areas.

Child, Preschool ; China ; epidemiology ; Cholera ; epidemiology ; Diarrhea ; epidemiology ; microbiology ; virology ; Dysentery ; epidemiology ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Rotavirus Infections ; epidemiology ; Typhoid Fever ; epidemiology

BACKGROUNDTyphoid/paratyphoid fever (TPF) is endemic in Guizhou. We conducted wavelet analysis and Spearman's rank correlation analysis to explore the impact of meteorological variations on TPF infection in Guizhou, in an attempt to assess the risk factors associated with TPF epidemics.

METHODSWe examined the association between TPF incidence in Guizhou and temperature, precipitation and relative humidity using 24 years of data from 1984 to 2007. Periodicities of TPF incidence and the impact of climate factors on the TPF were detected by Spearman's rank correlation and wavelet analysis,

RESULTSTemperature and precipitation with a 1-month lag were positively correlated with the monthly incidence of TPF. The multiyear incidence pattern of TPF in Guizhou was explicitly periodic. Moreover, the association and driving effect of precipitation on TPF were observed, and the results showed that the incidence of TPF in Guizhou had a closer correlation with precipitation than with temperature.

CONCLUSIONSSafe water supply is the key issue for TPF control in Guizhou. Moreover, climate variation might impact the enteric infections, which may inform policy assessment for TPF control in Guizhou.

China ; epidemiology ; Humans ; Incidence ; Paratyphoid Fever ; epidemiology ; Rain ; Temperature ; Typhoid Fever ; epidemiology

Humans ; Paratyphoid Fever ; epidemiology ; prevention & control ; Public Health Surveillance ; methods ; Typhoid Fever ; epidemiology ; prevention & control

INTRODUCTIONWe studied the epidemiological trends of enteric fevers (typhoid and paratyphoid fever) in Singapore from 1990 to 2009 and carried out a review of the current prevention and control measures.

MATERIALS AND METHODSEpidemiological records of all reported enteric fevers maintained by the Communicable Diseases Division, Ministry of Health from 1990 to 2009 were analysed.

RESULTSA total of 2464 laboratory confirmed cases of enteric fevers (1699 cases of typhoid and 765 cases of paratyphoid) were reported. Of these, 75% were imported, mainly from India and Indonesia. There had been a significant fall in the mean annual incidence rate of indigenous enteric fevers from 4.3 per 100,000 population in 1990 to 0.26 per 100,000 population in 2009 (P <0.005) with a corresponding increase in the proportion of imported cases from 71% between 1990 and 1993 to 92% between 2006 and 2009 (P <0.0005). Imported cases involving foreign contract workers increased significantly from 12.8% between 1990 and 1993 to 40.4% between 2006 and 2009 (P <0.0005).

CONCLUSIONSingapore has experienced a marked decline in the incidence of enteric fevers that is now comparable to that of other developed countries. Continued vigilance and proactive measures that address the changing epidemiology of enteric fevers in Singapore are necessary to sustain the milestone achieved in the past 2 decades.

Adolescent ; Adult ; Child ; Child, Preschool ; Disease Outbreaks ; Epidemiologic Studies ; Female ; Humans ; Incidence ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Paratyphoid Fever ; epidemiology ; prevention & control ; Population Surveillance ; Singapore ; epidemiology ; Typhoid Fever ; epidemiology ; prevention & control ; Young Adult

Studying on typhoid fever in 16417 people of Binh Thanh Trung commune and 16324 ones of Vinh Thanh commune (control commune) after 2 years with the intervention. The results showed that drinking water sterilized by chloramin B increased by 295.58%, drinking boiling water increased by 10.06%; drinking rainny water increased by 464.30%; vegetable washing by safety water increased by 2886.61%, good sanitary latrine increased by 292.30%, close fish pond latrine increased by 46.91%, sinking latrine increased by 195.995%, fish pond latrine open to river reduced by 17.68%, latrine on the river reduced by 29.24%. Typhoid fever reduced by 92% in comparison to before interventrion. Real effect in comparison to control commune was 5.04%
Typhoid Fever ; Therapeutics ; Epidemiology

Morbidity and mortality of typhoid fever in Dong Thap province had reduced gradually in the last 10 years. The number of typhoid fever between 1999 and 2003 was equal to a third cases occurred between 1994 and 1998. There had been 29 of dead cases resulting from typhoid fever for ten years. The highest number of dead cases in 1995 was 6. The death to incidence ratio was 0.076%
epidemiology ; Typhoid Fever ; Fever