Skip directly to site content Skip directly to search


Español  Other Languages


Centers for Disease Control and Prevention. CDC twenty four seven. Saving Lives, Protecting People
 Search

		Submit


Typhoid Fever and Paratyphoid Fever








National Typhoid and Paratyphoid Fever Surveillance Annual Summary, 2020						Print
																Related Pages
										Surveillance
Jurisdictions1 reporting at least one case of *Salmonella enterica* serotype Typhi, Paratyphi A, Paratyphi B [tartrate negative], or Paratyphi C,2 to the National Typhoid and Paratyphoid Fever Surveillance system (NTPFS) during 2020 are shown in Figures 1 and 2. The surveillance system case definitions changed in 2019:
**157** *Salmonella* Typhi cases were reported by 26 jurisdictions (Figure 1).
**48** *Salmonella* Paratyphi cases3 were reported by 19 jurisdictions (Figure 2).*Salmonella*Typhi and Paratyphi are bacteria that cause severe and occasionally life-threatening bacteremic illness known as typhoid fever and paratyphoid fever, respectively. This report summarizes all cases of bacterial infection, including those that may be asymptomatic or have atypical clinical presentation.1Includes all 50 states and District of Columbia.2Two pathotypes of Paratyphi B are recognized, differentiated by the ability to ferment tartrate. The pathotype designated serotype Paratyphi B is unable to ferment tartrate; it causes paratyphoid fever. The other pathotype is designated Paratyphi B var. L(+) tartrate+; it can ferment tartrate and causes uncomplicated gastroenteritis. Only isolates laboratory-confirmed as not able to ferment tartrate are included in this annual summary. Many reports of Paratyphi B detection do not include this information.3Zero cases of *Salmonella* serotype Paratyphi C and eleven cases of *Salmonella* Paratyphi without a specified serotype reported.On This Page
			SurveillanceDemographic and Clinical CharacteristicsInternational TravelTyphoid Fever VaccineNational Notifiable Diseases Surveillance SystemAntimicrobial ResistanceOutbreaks
		
Read an overview of theNational Typhoid and Paratyphoid Fever Surveillance (NTPFS) system [PDF – 2 pages]Figure 1Figure 2*Salmonella* Typhi cases reported to NTPFS by jurisdiction, 2020 (n = 157)Download Data [XLS – 464 B]*Salmonella* Paratyphi cases reported to NTPFS by jurisdiction, 2020 (n = 48)Download Data [XLS – 464 B]Demographic and Clinical Characteristics of Patients
Demographic and clinical characteristics of patients with *Salmonella* Typhi and Paratyphi infections are shown in Tables 1 and 2.
The median age of patients with *Salmonella* Typhi infections was **26 years** (range 0 – 85)
The median age of patients with *Salmonella* Paratyphi infections was **24 years** (range 2 – 73)
There were **no deaths** among patients with *Salmonella* Typhi or Paratyphi infections.**Table 1**Demographic and clinical characteristics of patients with *Salmonella* Typhi infections reported to NTPFS, 2020 (n = 157)
	Demographic and clinical characteristics of patients with typhoid fever reported to NTPFS, 2018 (n =370)
**Characteristic (number with data available)**
**Number**
**Percent****Age group, years (n = 154)**
<1
1
<11–4
23
155–14
28
1815–24
19
1225–44
47
3145–64
28
1865+
8
5Female (n = 156)
74
47Food handler (n = 98)
4
4Outbreak-associated (n = 128)
3
2International travel1 (n = 149)
113
76Vaccinated2 (n = 92)
6
7**Specimen source (n = 145)**Blood
124
86Stool
19
13Other
2
1Hospitalizations3 (n = 154)
126
82Deaths (n = 141)
0
01 Travel destinations are shown in Table 3a.2 Received typhoid fever vaccination within five years before onset of illness; of the six cases in vaccinated persons, four received only the Vi capsular polysaccharide vaccine (ViCPS). Vaccine type was not reported for the other two cases.3 Median length of hospitalization was six days.**Table 2**Demographic and clinical characteristics of patients with *Salmonella* Paratyphi infections reported to NTPFS, 2020 (n = 48)
	Demographic and clinical characteristics of patients with paratyphoid fever reported to NTPFS, 2018 (n = 128)
**Characteristic (number with data)**
**Number**
**Percent****Age group, years (n = 47)**
<1
0
01–4
3
65–14
4
915–24
12
2525–44
20
4345–64
2
465+
6
13Female (n = 48)
27
56Food handler (n = 27)
1
4Outbreak-associated (n = 37)
0
0International travel1 (n = 46)
35
76**Specimen source (n = 44)**Blood
35
80Stool
6
14Other
3
7Hospitalizations2 (n = 48)
37
71Deaths (n = 43)
0
01 Travel destinations are shown in Table 3b2 Median length of hospitalization was four days.International Travel
Among the 149 patients with *Salmonella* Typhi infections whose travel histories were reported, **113** **(76%)** reported traveling or living outside the United States in the 30 days before illness.
Among the 46 patients with *Salmonella* Paratyphi infections whose travel histories were reported, **35 (76%)** reported traveling or living outside the United States in the 30 days before illness.
Among patients reporting international travel, **99 (66%)** patients with *Salmonella* Typhi infections and **33 (94%)** patients with *Salmonella* Paratyphi infections reported travel to a single destination (Tables 3a and 3b). More than 75% of patient with either pathogen reported travel to India or Pakistan.
**54 (48%)** patients with *Salmonella*Typhi infection and **16 (64%)** patients with *Salmonella* Paratyphi infection reported visiting friends or relatives, which was the most commonly reported reason for international travel.**Table 3a**Travel destinations for patients with *Salmonella* Typhi infections who reported a single destination country, n = 99, NTPFS, 2020
	Travel destinations for patients with typhoid fever who reported a single destination country, NTPFS, 2018
**Travel Destination**
**No. (%)**India
51 (52)Pakistan
27 (27)Mexico
7 (7)Bangladesh
5 (5)El Salvador
4 (4)Other1
5 (5)1 Phillipines (2), Ghana (1), Nigeria (1), Thailand (1)**Table 3b**Travel destinations for patients with *Salmonella* Paratyphi infections who reported a single destination country, n = 33, NTPFS, 2020
	Travel destinations for patients with paratyphoid fever who reported a single destination country, NTPFS, 2018
**Travel Destination**
**No. (%)**India
19 (58)Pakistan
9 (27)Cambodia
2 (6)Burma
2 (6)Bangladesh
1 (3)Typhoid Fever VaccineFigure 3. Percentage of patients with *Salmonella* Typhi infections (n = 92) who reported receiving a typhoid fever vaccine in the five years before illness, NTPFS, by year, 2016–20201
	Download Data [XLS – 67 B]1 Figure excludes patients whose typhoid vaccination status was unknown or not reported (n = 65).National Notifiable Diseases Surveillance System
The National Notifiable Diseases Surveillance System (NNDSS) collects and compiles reports of nationally notifiable infectious diseases, including *Salmonella* Typhi and Paratyphi cases. NNDSS reports can be found at www.cdc.gov/nndss/data-statistics.
The figure below presents a comparison of *Salmonella* Typhi case reports submitted to NTPFS and NNDSS in the past five years. Reports submitted to NNDSS, but not NTPFS, can include clinically compatible cases that are epidemiologically linked to a confirmed case but are not laboratory-confirmed.
Comparisons for *Salmonella* Paratyphi are not provided because, although it was nationally notifiable, NNDSS does not report subtyping information for this condition.Figure 4. Number of *Salmonella* Typhi cases reported to the National Notifiable Diseases Surveillance System (NNDSS) and to the National Typhoid and Paratyphoid Fever Surveillance (NTPFS), by year, 2016–2020
	Download Data [XLS – 91 B]1 NNDSS data from some reporting areas may be incomplete due to the coronavirus disease 2019 (COVID-19) pandemic or due to post-reconciliation data updates that could not be confirmed or included in the final data set (NNDSS, 2020)Antimicrobial Resistance
The National Antimicrobial Resistance Monitoring System (NARMS) monitors antimicrobial resistance among enteric bacteria (including *Salmonella enterica* serotypes Typhi and Paratyphi A, Paratyphi B, and Paratyphi C) from humans. Among Typhi, decreased susceptibility to ciprofloxacin (DSC) (minimum inhibitory concentration ≥0.12 μg/mL) has been associated with fluoroquinolone treatment failure. Multidrug-resistance (MDR) is defined as resistance to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole.
Among *Salmonella* Typhi isolates during 2020:
**86%** had DSC
**25%** were MDR
**26.2%** were resistant to three or more classes of antibiotics
**19.4%** were resistant to ceftriaxoneAmong *Salmonella* Paratyphi A isolates during 2020:
**99%** had DSC
No isolates were MDR
No isolates were resistant to three or more classes of antibiotics
No isolates were resistant to ceftriaxoneData on resistance are available in NARMS Now, an interactive tool containing antibiotic resistance data from bacteria isolated from humans.
Outbreaks
The Foodborne Disease Outbreak Surveillance System (FDOSS) collects reports of foodborne disease outbreaks from local, state, tribal, and territorial public health agencies. The most recently published annual reports are available at www.cdc.gov/fdoss/annual-reports.
The Waterborne Disease and Outbreak Surveillance System (WBDOSS) collects reports of waterborne disease outbreaks associated with drinking and recreational water from local, state, tribal, and territorial public health agencies. Reports are available at www.cdc.gov/healthywater/surveillance/surveillance-reports.html.
In 2020, there were **no outbreaks** of typhoid fever or paratyphoid fever.ReferencesCDC. National Antimicrobial Resistance Monitoring System (NARMS) Now: Human Data. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. https://wwwn.cdc.gov/narmsnow. Accessed 5/1/2023.
Recommended CitationCenters for Disease Control and Prevention (CDC). National Typhoid and Paratyphoid Fever Surveillance Annual Report, 2020. Atlanta, Georgia: US Department of Health and Human Services, CDC, 2023Top of Page
							
					
							Last Reviewed:  August 28, 2023						Source: 	Centers for Disease Control and Prevention
, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
, Division of Foodborne, Waterborne, and Environmental Diseases (DFWED)
					Facebook
        Twitter
        LinkedIn
        Syndicate homeTyphoid Fever and Paratyphoid Fever
Questions & Answers
Prevention
Symptoms & Treatment
Vaccination
For Healthcare Professionals
Surveillance
Resources & Publications


About CDC
					Contact Us
					800-232-4636
 Facebook Twitter Instagram LinkedIn Youtube Pinterest Snapchat
 CONTACT CDC
				Contact Us
							Call 800-232-4636
							Email Us
			ABOUT CDC
				About CDC
							Jobs
							Funding
			POLICIES
				Accessibility
							External Links
							Privacy
							Policies
							No Fear Act
							FOIA
							OIG
							Nondiscrimination
							Vulnerability Disclosure Policy
			CONNECT WITH US
				Facebook
								Twitter
								Instagram
								LinkedIn
							Youtube
								Pinterest
								Snapchat
								Email
			LANGUAGES
				Español
							繁體中文
							Tiếng Việt
							한국어
							Tagalog
							Русский
							العربية
							Kreyòl Ayisyen
							Français
							Polski
							Português
							Italiano
							Deutsch
							日本語
							فارسی
							English


U.S. Department of Health & Human Services
			Accessibility
			External Links
			Privacy
			Policies
			No Fear Act
			FOIA
			Nondiscrimination
			OIG
			Vulnerability Disclosure Policy
			USA.gov


Exit Notification / Disclaimer Policy Close
 Links with this icon  indicate that you are leaving the CDC website. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
				Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
				You will be subject to the destination website's privacy policy when you follow the link.
				CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Website Disclaimers
 Cancel Continue