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Typhoid Fever and Paratyphoid Fever








National Typhoid and Paratyphoid Fever Surveillance Annual Summary, 2019						Print
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										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 2019 are shown in Figures 1 and 2. The surveillance system case definitions changed in 2019:
**439** *Salmonella* Typhi cases were reported by 37 jurisdictions (Figure 1).
**139** *Salmonella* Paratyphi cases3 were reported by 27 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.3Seven cases of *Salmonella* serotype Paratyphi C and two 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, 2019 (n = **439**)Download Data [XLS – 474 B]*Salmonella* Paratyphi cases reported to NTPFS by jurisdiction, 2019 (n = **139**)Download Data [XLS – 474 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 **24 years** (range 0 – 78)
The median age of patients with *Salmonella* Paratyphi infections was **26 years** (range 1 – 85)
There were **no deaths** among patients among patients with *Salmonella* Typhi or Paratyphi infections**Table 1**Demographic and clinical characteristics of patients with *Salmonella* Typhi infections reported to NTPFS, 2019 (n = 439)
	Demographic and clinical characteristics of patients with typhoid fever reported to NTPFS, 2018 (n =370)
**Characteristic (number with data)**
**Number**
**Percent****Age group, years (n = 438)**
<1
4
<11–4
40
95–14
90
2115–24
91
2125–44
149
3445–64
53
1265+
11
3Female (n = 435)
221
51Food handler (n = 308)
13
4Outbreak-associated (n = 367)
18
5International travel1 (n = 422)
378
90Vaccinated2 (n = 290)
13
4**Specimen source (n = 430)**Blood
360
84Stool
61
14Other
9
2Hospitalizations3 (n = 432)
360
83Deaths (n = 409)
0
01 Travel destinations are shown in Table 3a.2 Received typhoid fever vaccination within five years before onset of illness. Of the 13 cases in vaccinated persons, six received only the Vi capsular polysaccharide vaccine (ViCPS) (injection), and two received only the Ty21a oral capsule vaccine. Vaccine type was not reported for the other five.3 Median length of hospitalization was five days.**Table 2**Demographic and clinical characteristics of patients with *Salmonella* Paratyphi infections reported to NTPFS, 2019 (n = 139)
	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 = 138)**
<1
0
01–4
11
85–14
33
2415–24
22
1625–44
50
3645–64
18
1365+
4
3Female (n = 136)
65
48Food handler (n = 91)
5
5Outbreak-associated (n = 104)
2
2International travel1 (n = 123)
118
96**Specimen source (n = 131)**Blood
110
84Stool
19
15Other
2
2Hospitalizations2 (n = 136)
99
73Deaths (n = 123)
0
01 Travel destinations are shown in Table 3b2 Median length of hospitalization was four days.International Travel
Among the 422 patients with *Salmonella* Typhi infections whose travel histories were reported, **378 (90%)** reported traveling or living outside the United States in the 30 days before illness.
Among the 121 *Salmonella* Paratyphi infections whose travel histories were reported, **116 (96%)** reported traveling or living outside the United States in the 30 days before illness.
Among patients reporting international travel, **335 (89%)**patients with *Salmonella* Typhi infections and **102 (90%)** patients with *Salmonella* Paratyphi infections reported travel to a single destination country (Tables 3a and 3b).
**192 (51%)** patients with *Salmonella*Typhi infection and **63 (54%)** patients with *Salmonella* Paratyphi infection associated with travel 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 international travel to a single destination country, NTPFS, 2019 (n = 335)
	Travel destinations for patients with typhoid fever who reported a single destination country, NTPFS, 2019
**Travel Destination**
**No. (%)**India
145 (43)Pakistan
56 (17)Mexico
50 (15)Bangladesh
24 (7)El Salvador
21 (6)Other1
39 (12)1Guatemala (16), Cambodia (2), Haiti (2), Nepal (2), Philippines (2), Burma (1), Dominican Republic (1), Honduras (1), Indonesia (1), Iraq (1), Jamaica (1), Kenya (1), Myanmar (1), Nicaragua (1), Niger (1), Nigeria (1), Samoa (1), Sierra Leone (1), Tanzania (1), United Arab Emirates (1)**Table 3b**Travel destinations for patients with *Salmonella* Paratyphi infections who reported international travel to a single destination country, NTPFS, 2019 (n = 102)
	Travel destinations for patients with typhoid fever who reported a single destination country, NTPFS, 2019
**Travel Destination**
**No. (%)**India
70 (69)Pakistan
13 (13)Bangladesh
8 (8)Cambodia
4 (4)Senegal
3 (3)Other1
4 (4)1Mexico (1), Nepal (1), Vietnam (1), Unknown (1)Typhoid Fever VaccineFigure 3. Percentage of patients with *Salmonella* Typhi infections who reported receiving a typhoid fever vaccine in the five years before illness, NTPFS, by year, 2015–20191 (n = 290)
	Download Data [XLS – 67 B]1 Figure excludes patients whose typhoid vaccination status was unknown or not reported (n = 149).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 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, it was reported under the case definition for salmonellosis during these years.Figure 4. Number of *Salmonella* Typhi cases reported to the National Notifiable Diseases Surveillance System (NNDSS) and to NTPFS, by year, 2015–2019
	Download Data [XLS – 91 B]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-resistant (MDR) is defined as resistance to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole. Resistance to ceftriaxone is an indicator of extensively drug resistant (XDR) Typhi, an emerging public health concern.
Among *Salmonella* Typhi isolates during 2019:
**75%** had DSC
**15%** were MDR
**16%** were resistant to three or more classes of antibiotics
**9%** were resistant to ceftriaxoneAmong *Salmonella* Paratyphi A isolates during 2019:
**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 www.cdc.gov/healthywater/surveillance/surveillance-reports.html.
There were **two multistate outbreaks** of typhoid fever, resulting in **100** human illnesses. There was one outbreak of paratyphoid fever serotype Paratyphi A, resulting in **24** human illnesses reported in 2019. All outbreaks were linked to international travel.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, 2019. Atlanta, Georgia: US Department of Health and Human Services, CDC, 2023Top of Page
							
					
							Last Reviewed:  December 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)
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