TY - JOUR
T1 - Typhoid fever in children
T2 - some epidemiological considerations from Karachi, Pakistan
AU - Siddiqui, Fahad Javaid
AU - Rabbani, Fauziah
AU - Hasan, Rumina
AU - Nizami, Syed Qamaruddin
AU - Bhutta, Zulfiqar Ahmed
PY - 2006/5
Y1 - 2006/5
N2 - Background: The morbidity of typhoid fever is highest in Asia with 93% of global episodes occurring in this region. Southeast Asia has an estimated incidence of 110 cases/100 000 population, which is the third highest incidence rate for any region. Pakistan falls into this region. There is also a considerable seasonal variation of typhoid fever, carrying significant public health importance. Children are worst affected. Population-based data from Pakistan are scarce. Methods: From June 1999 to December 2001 a fortnightly surveillance system was established in two squatter settlements in Karachi, Pakistan, with two study centers, each staffed by a doctor and five community health workers. Cases of continuous high-grade fever for three or more days were referred to these centers and screened clinically. Blood culture and Typhidot® tests were done. Results: One-third of the 4198 cases with febrile episodes of three or more days detected in the community were screened at the centers; 341 were clinically suspected of having typhoid fever. Forty-nine were positive by culture whereas 161 were positive by serology. Ten cases were multi-drug resistant. Incidence of culture-proven typhoid was estimated to be 170 (95% CI: 120, 220)/100 000 population, whereas serology-based incidence was 710 (95% CI: 620, 810)/100 000 population. Peak incidence was noted in October followed by May and June. Conclusion: Passive surveillance, even when augmented by household visits, misses a significant portion of suspected cases. Morbidity of typhoid is quite high in Pakistan and needs public health intervention. Hot months have higher incidence of typhoid. Healthcare behavior studies will help to develop a better surveillance system.
AB - Background: The morbidity of typhoid fever is highest in Asia with 93% of global episodes occurring in this region. Southeast Asia has an estimated incidence of 110 cases/100 000 population, which is the third highest incidence rate for any region. Pakistan falls into this region. There is also a considerable seasonal variation of typhoid fever, carrying significant public health importance. Children are worst affected. Population-based data from Pakistan are scarce. Methods: From June 1999 to December 2001 a fortnightly surveillance system was established in two squatter settlements in Karachi, Pakistan, with two study centers, each staffed by a doctor and five community health workers. Cases of continuous high-grade fever for three or more days were referred to these centers and screened clinically. Blood culture and Typhidot® tests were done. Results: One-third of the 4198 cases with febrile episodes of three or more days detected in the community were screened at the centers; 341 were clinically suspected of having typhoid fever. Forty-nine were positive by culture whereas 161 were positive by serology. Ten cases were multi-drug resistant. Incidence of culture-proven typhoid was estimated to be 170 (95% CI: 120, 220)/100 000 population, whereas serology-based incidence was 710 (95% CI: 620, 810)/100 000 population. Peak incidence was noted in October followed by May and June. Conclusion: Passive surveillance, even when augmented by household visits, misses a significant portion of suspected cases. Morbidity of typhoid is quite high in Pakistan and needs public health intervention. Hot months have higher incidence of typhoid. Healthcare behavior studies will help to develop a better surveillance system.
KW - Epidemiology
KW - Incidence
KW - Pakistan
KW - Slums
KW - Typhoid
UR - http://www.scopus.com/inward/record.url?scp=33646081037&partnerID=8YFLogxK
U2 - 10.1016/j.ijid.2005.03.010
DO - 10.1016/j.ijid.2005.03.010
M3 - Article
C2 - 16431148
AN - SCOPUS:33646081037
SN - 1201-9712
VL - 10
SP - 215
EP - 222
JO - International Journal of Infectious Diseases
JF - International Journal of Infectious Diseases
IS - 3
ER -