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Typhoid Fever and Paratyphoid Fever


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National Typhoid and Paratyphoid Fever Surveillance Annual Summary, 2016										Related Pages
					Surveillance
Jurisdictions1 reporting at least one typhoid or paratyphoid fever2 case to the NTPFS during 2016 are shown in Figures 1 and 2.
**349** typhoid fever cases were reported by 40 jurisdictions Figure 1
**80** paratyphoid fever cases were reported by 21 jurisdictions; all were caused by *Salmonella* serotype Paratyphi A Figure 2.1Includes all 50 states and District of Columbia2Paratyphoid 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 report. Many Paratyphi B reports do not include this information; these reports are presumed to be of the non-paratyphoidal pathotype and are therefore excluded in this report.On This Page
			SurveillanceDemographic and Clinical Characteristics of PatientsInternational TravelTyphoid Fever VaccineNational Notifiable Diseases Surveillance SystemAntimicrobial ResistanceOutbreaks
		
Read an overview of theNational Typhoid and Paratyphoid Fever Surveillance (NTPFS) system pdf icon[PDF – 2 pages]Figure 1Figure 2Typhoid fever cases reported to NTPFS, by jurisdiction, 2016 (n = 349)

Cases reported in Washington, D.C.: 0 (not shown on figure)Paratyphoid fever cases reported to NTPFS, by jurisdiction, 2016 (n=80)

Cases reported in Washington, D.C.: 0 (not shown on figure)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 **23 years** (range 0 – 80 years)
The median age of patients with paratyphoid fever was **26 years** (range 1 – 74 years)
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, 2016 (n = 349)
	Reported demographic and clinical characteristics of patients with typhoid fever
**Characteristic (number with data available)**
**Number**
**Percent****Age group, years (n = 349)**
<1
2
<11–4
28
85–24
79
2315–24
68
1925–44
120
3445–64
47
1365+
5
1Female (n = 347)
161
46Food handler (n = 267)
9
3Outbreak-associated (n = 288)
12
4International travel1 (n = 342)
299
87Vaccinated2 (n = 231)
13
6**Specimen source (n = 343)**Blood
304
89Stool
35
10Other
4
1Hospitalizations3 (n = 347)
288
83Deaths (n = 322)
1
<11Travel destinations are shown in Table 3a2Received typhoid fever vaccination within five years before illness began; of the 13 cases in vaccinated persons, six received only the Vi capsular polysaccharide vaccine (ViCPS). Vaccine type was not reported for the other seven.3Median length of hospitalization was five days.Table 2. Demographic and clinical characteristics of patients with paratyphoid fever reported to NTPFS, 2016 (n = 80)
	Reported demographic and clinical characteristics of patients with paratyphoid fever
**Characteristic (number with data available)**
**Number**
**Percent****Age group, years (n = 80)**
<1
0
01–4
5
65–14
14
1815–24
14
1825–44
34
4345–64
12
1565+
1
1Female (n = 78)
34
44Food handler (n = 50)
2
4Outbreak-associated (n = 68)
5
7International travel1 (n = 76)
72
95**Specimen source (n = 79)**Blood
74
94Stool
3
4Other
2
3Hospitalizations2 (n = 80)
58
73Deaths (n = 79)
0
01Travel destinations are shown in Table 3b2Median length of hospitalization was five days.International Travel
Among the 342 typhoid fever patients whose travel histories were reported, **299 (87%)** reported traveling or living outside the United States in the 30 days before illness began.
Among the 76 paratyphoid fever patients whose travel histories were reported, **72 (95%)** reported traveling or living outside the United States in the 30 days before illness began.
Among patients reporting international travel, **264 (88%)** patients with typhoid fever and **66 (92%)** 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 **(55%)** and paratyphoid fever**(50%)**.**Table 3a**Travel destinations for patients with typhoid fever who reported a single destination country, NTPFS, 2016
	Reported travel destinations for patients with typhoid fever
**Travel Destination**
**No. (%)**India
155 (59)Pakistan
30 (11)Bangladesh
18 (7)Mexico
10 (4)Haiti
9 (3)Other1
42 (16)1Guatemala (7 patients), El Salvador (5), Nigeria (5), Nepal (3), Dominican Republic (2), Kenya (2), Philippines (2), Tanzania (2), Burma (1), Chad (1), Democratic Republic Of The Congo (1), Ethiopia (1), Ghana (1), Indonesia (1), Jamaica (1), Lebanon (1), Peru (1), Samoa (1), Sri Lanka (1), Sudan (1), United Arab Emirates (1), and Zimbabwe (1)**Table 3b**Travel destinations for patients with paratyphoid fever who reported a single destination country, NTPFS, 2016
	Reported percentage of patients with typhoid fever (n = 231)
**Travel Destination**
**No. (%)**India
45 (68)Pakistan
11 (17)Bangladesh
6 (9)Cambodia
1 (2)Ghana
1 (2)Other1
2 (3)1Nepal (1), Philippines (1)Typhoid Fever VaccineFigure 3. Percentage of patients with typhoid fever (n = 231) who reported receiving a typhoid fever vaccine in the five years before illness began, NTPFS, by year, 2012–20161
	1Figure excludes patients whose typhoid vaccination status was unknown or not reported (n=118).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 NTPFS and to the NNDSS, by year, 2012–2016Antimicrobial 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. Among Typhi, decreased susceptibility to ciprofloxacin (DSC, defined as 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.
Among *Salmonella* serotype Typhi isolated during 2016:
**73.3%** had DSC
**9.6%** were MDR
**12.4%** were resistant to three or more classes of antibiotics
No isolates were resistant to ceftriaxoneAmong *Salmonella* serotype Paratyphi A isolated during 2016:
**94.6%** 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.
**One outbreak** of typhoid fever (none of paratyphoid fever) was reported in 2016. The outbreak occurred in Arizona and resulted in **two illnesses**.ReferencesCDC. National Antimicrobial Resistance Monitoring System (NARMS) Now: Human Data. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. 03/30/2021. https://www.cdc.gov/narmsnow. Accessed 3/30/2021.Recommended CitationCenters for Disease Control and Prevention (CDC). National Typhoid and Paratyphoid Fever Surveillance Annual Report, 2016. Atlanta, Georgia: US Department of Health and Human Services, CDC, 2021Top of Page
							
					
						Page last reviewed:  September 14, 2021					Content source: 	Centers for Disease Control and Prevention
, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
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