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Typhoid Fever and Paratyphoid Fever








National Typhoid and Paratyphoid Fever Surveillance Annual Summary, 2018										Related Pages
										Surveillance
Jurisdictions1 reporting at least one typhoid or paratyphoid fever2,3 case to the NTPFS during 2018 are shown in Figures 1 and 2.
**368** typhoid fever cases were reported by 36 jurisdictions (Figure 1).
**96** paratyphoid fever cases were reported by 22 jurisdictions (Figure 2).1Includes all 50 states and District of Columbia.2Paratyphoid fever is caused by *Salmonella* serotypes Paratyphi A, Paratyphi B, and Paratyphi C. Two distinct pathotypes of Paratyphi B are recognized; one is associated with paratyphoid fever and the other is associated with uncomplicated gastroenteritis. The two pathotypes have distinct virulence characteristics and are differentiated based on the ability to ferment tartrate. The paratyphoidal pathotype is unable to ferment tartrate and is designated serotype Paratyphi B; the nonparatyphoidal pathotype ferments tartrate and is designated serotype Paratyphi B var. L(+) tartrate+. Only those isolates laboratory-confirmed as not able to ferment tartrate are included in the annual summary. Many Paratyphi B reports do not include this information; these reports are therefore excluded from this annual summary.3Three cases of paratyphoid fever caused by *Salmonella* serotype Paratyphi C were reported, and three cases of paratyphoid (unspecified) were 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 2Typhoid fever cases reported to NTPFS, by jurisdiction, 2018 (n = 368)Download Data [XLS – 464 B]Paratyphoid fever cases reported to NTPFS, by jurisdiction, 2018 (n=96)Download Data [XLS – 464 B]Demographic and Clinical Characteristics of Patients
Demographic and clinical characteristics of patients with typhoid fever and paratyphoid fever are shown in Tables 1 and 2.
The median age of patients with typhoid fever was **25 years** (range 0 – 85).
The median age of patients with paratyphoid fever was **27 years** (range 0 – 74).
There was **one death** among patients with typhoid fever. There were no deaths among patients with paratyphoid fever.**Table 1**Demographic and clinical characteristics of patients with typhoid fever reported to NTPFS, 2018 (n =370)
	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 = 367)**
<1
3
<11–4
40
115–14
70
1915–24
70
1925–44
122
3345–64
46
1365+
16
4Female (n = 367)
178
49Food handler (n = 250)
17
7Outbreak-associated (n = 287)
12
4International travel1 (n = 345)
294
85Vaccinated2 (n = 238)
8
3**Specimen source (n = 335)**Blood
295
88Stool
30
9Other
10
3Hospitalizations3 (n = 365)
305
84Deaths (n = 334)
1
<11Travel destinations are shown in Table 3a.2Received typhoid fever vaccination within five years before onset of illness; of the 8 cases in vaccinated persons, vaccine type was not reported.3Median length of hospitalization was five days.**Table 2**Demographic and clinical characteristics of patients with paratyphoid fever reported to NTPFS, 2018 (n = 128)
	Demographic and clinical characteristics of patients with paratyphoid fever reported to NTPFS, 2018 (n = 128)
**Characteristic (number with data available)**
**Number**
**Percent****Age group, years (n = 96)**
<1
1
11–4
8
85–14
16
1715–24
11
1125–44
38
4045–64
17
1865+
5
5Female (n = 95)
47
49Food handler (n = 61)
1
2Outbreak-associated (n = 73)
0
0International travel1 (n = 90)
81
90**Specimen source (n = 86)**Blood
67
78Stool
16
19Other
3
3Hospitalizations2 (n = 94)
65
69Deaths (n = 83)
0
01Travel destinations are shown in Table 3b2Median length of hospitalization was four days.International Travel
Among the 345 typhoid fever patients whose travel histories were reported, **294 (85%)** reported traveling or living outside the United States in the 30 days before illness.
Among the 87 paratyphoid fever patients whose travel histories were reported, **78 (90%)** reported traveling or living outside the United States in the 30 days before illness.
Among patients reporting international travel, **272 (92%)** patients with typhoid fever and **70 (90%)**patients with paratyphoid fever reported travel to a single destination (Tables 3a and 3b).
Visiting friends or relatives was the most common reason for international travel among patients with typhoid fever **(73%)** and paratyphoid fever **(70%).****Table 3a**Travel destinations for patients with typhoid fever who reported a single destination country, NTPFS, 2018
	Travel destinations for patients with typhoid fever who reported a single destination country, NTPFS, 2018
**Travel Destination**
**No. (%)**India
146 (54)Pakistan
37 (14)Bangladesh
30 (11)Mexico
13 (5)El Salvador
10 (4)Other1
34 (13)1Guatemala (8), Nepal (5), Burundi (3), Iraq (3), Haiti (2), Nigeria (2), Uganda (2), Burma (1), Cambodia (1), Dominican Republic (1), Indonesia (1), Laos (1), Mali (1), Marshall Islands (1), Myanmar (1), Samoa (1)**Table 3b**Travel destinations for patients with paratyphoid fever who reported a single destination country, NTPFS, 2018
	Travel destinations for patients with paratyphoid fever who reported a single destination country, NTPFS, 2018
**Travel Destination**
**No. (%)**India
42 (60)Bangladesh
12 (17)Pakistan
8 (11)Cambodia
4 (6)Antigua and Barbuda
1 (1)Other1
3 (4)1Ghana (1), Nepal (1), Qatar (1)Typhoid Fever VaccineFigure 3. Percentage of patients with typhoid fever (n =238) who reported receiving a typhoid fever vaccine in the five years before illness began, NTPFS, by year, 2014–20181
	Download Data [XLS – 67 B]1Figure excludes patients whose typhoid vaccination status was unknown or not reported (n=132).National Notifiable Diseases Surveillance System
The National Notifiable Diseases Surveillance System (NNDSS) collects and compiles reports of nationally notifiable infectious diseases, including typhoid fever. NNDSS reports can be found at www.cdc.gov/nndss/data-statistics.
The figure below presents a comparison of typhoid fever reports submitted to NTPFS and NNDSS in the past five years. Reports submitted to NNDSS can include clinically compatible cases that are epidemiologically linked to a confirmed case but are not laboratory-confirmed.
Comparisons for paratyphoid fever are not provided because, although it was nationally notifiable, it was reported under the case definition for salmonellosis during these years.Figure 4. Number of typhoid fever cases reported to the National Notifiable Diseases Surveillance System (NNDSS) and to the National Typhoid and Paratyphoid Fever Surveillance (NTPFS), by year, 2014–2018
	Download Data [XLS – 91 B]Antimicrobial Resistance
The National Antimicrobial Resistance Monitoring System (NARMS) monitors antimicrobial resistance among enteric bacteria, including *Salmonella* serotypes Typhi and Paratyphi A, Paratyphi B (tartrate negative), and Paratyphi C. Decreased susceptibility to ciprofloxacin (DSC, defined as minimum inhibitory concentration ≥0.12 μg/mL) has been associated with fluoroquinolone treatment failure among patients with Typhi infections in published literature. Multidrug-resistant (MDR) is defined as resistance to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole.
Among *Salmonella* serotype Typhi isolates obtained from patients during 2018:
**84%** had DSC
**9.7%** were MDR
**10.5%** were resistant to three or more classes of antibiotics
**2.7%** were resistant to ceftriaxoneAmong *Salmonella* serotype Paratyphi A isolates obtained from patients during 2018:
**96%** had DSC
No isolates were MDR
No isolates were resistant to three or more classes of antibiotics
No isolates were resistant to ceftriaxoneData 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 water and recreational water from local, state, tribal, and territorial public health agencies. Reports are available at http://www.cdc.gov/healthywater/surveillance/surveillance-reports.html.
There were **no outbreaks** of typhoid fever and no outbreaks of paratyphoid fever reported in 2018.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 10/2/2022.Recommended CitationCenters for Disease Control and Prevention (CDC). National Typhoid and Paratyphoid Fever Surveillance Annual Report, 2018. Atlanta, Georgia: US Department of Health and Human Services, CDC, 2022.Top of Page
							
					
							Last Reviewed:  February 14, 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)
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