TYPHOID FEVER - USA: (TENNESSEE) CLUSTER

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A ProMED-mail post

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Date: Sat 6 Jun 2009
Source: Chattanooga (TN) Times Free Press [edited]



Local health officials have identified 2 confirmed cases and 1
probable case of typhoid fever, a potentially life-threatening
disease that is common in developing countries.

Cases of typhoid fever in Chattanooga are not unheard of, but those
sickened usually have contracted the disease while traveling
internationally, said Margaret Zylstra, epidemiologist with the
Chattanooga-Hamilton County Health Department. None of the children
sickened locally had been outside Tennessee recently, Ms Zylstra said.

"That is a little bit more unusual, but across the country that does
happen," she said. "We're still currently working on an
investigation" into the source of the infections. All 3 children have
recovered, she said.

On Friday [5 Jun 2009], the local health department sent out an
"epidemiology alert" to local doctors and emergency rooms to be sure
providers are on the lookout for symptoms of typhoid. Any cases
should be reported to the local health department, the release said.

"It is helpful to know that it's out there," Dr Peter Rawlings, a
Chattanooga pediatrician, said. "This is not something that is
usually on our typical radar screen. ... I don't think I've ever seen
it, to be honest with you."

The disease is often seen in developing countries with unsanitary
conditions in which food and water sources can become contaminated
with raw sewage, according to the health department.

[Byline: Emily Bregel]

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[Typhoid fever, the disease caused in humans from infection with
_Salmonella enterica_ subtype Typhi, is the rare form of
salmonellosis that is not a zoonosis. Most cases in the USA and other
areas of the developed world are imported from abroad and secondary
cases do not occur because of adequate sewage systems unlike what
occurs in much of the rest of the world where, usually water-borne,
outbreaks occur regularly. These cases are likely to be linked
epidemiologically related to a single source although that
information is not available.

The classical cluster of _S. typhi_ in the USA occurred related to a
summer house in the (still) wealthy suburb of New York City of Oyster
Bay, Long Island in August 1906. This was the still infamous cluster
associated with Mary Mallon, "Typhoid Mary," an Irish immigrant who
was both a food preparer and a typhoid bacillus carrier. A number of
clusters have been reported in the USA in the 21st century including:

- New York City: In the summer of 2000, an outbreak of endemic
typhoid fever involved 6 people in Queens, NY, and a 7th person in
Manhattan, NY (boroughs of New York City). An investigation by the
New York City Department of Health traced the likely source to an
immigrant employee working at a local restaurant (1).
- Ohio: In August 2000, the Ohio Department of Health reported a
cluster of men with typhoid fever who denied having traveled abroad.
To determine the cause and the extent of the outbreak, an
epidemiological investigation was initiated in which 7 persons in
Ohio, Kentucky, and Indiana with culture-confirmed _S._ Typhi
infection and 2 persons with probable typhoid fever were evaluated;
all were men, and all but one reported having had sex with 1
asymptomatic male carrier (2).
- New York City: 2 cases of _S. typhi_ infections in 2005 were
domestically acquired and linked to a chronic carrier Haitian traveler.

References
----------
1. Yoon J, Segal-Maurer S, Rahal JJ: An outbreak of domestically
acquired typhoid fever in Queens, NY. Arch Intern Med. 2004; 164:
565-7 [abstract available at
].
2. Reller ME, Olsen SJ, Kressel AB, et al: Sexual transmission of
typhoid fever: a multistate outbreak among men who have sex with men.
Clin Infect Dis. 2003; 37: 141-4 [available at
].
3. Nguyen TQ, Reddy V, Sahl S, et al: Importance of travel in
domestically acquired typhoid fever infections: opportunities for
prevention and early detection. J Immigrant Minority Health. 2009;
11: 139-42 [abstract available at
].

The east-central state of Tennessee can be located on the
HealthMap/ProMED-mail interactive map of the USA at
.
Hamilton County in southeast Tennessee can be seen on the map at
. - Mod.LL]

[see also:
1999
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Typhoid fever from imported juice - USA (Florida) 19990222.0236]
...................................ll/mj/dk

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