Journal of Community Health
Volume 20, Issue 6, 1995, Pages 451-458

Typhoid fever in the park: Epidemiology of an outbreak at a cultural interface (Article)

Coté T.R.* , Convery H. , Robinson D. , Ries A. , Barrett T. , Frank L. , Furlong W. , Horan J. , Dwyer D.
  • a Division of Field Epidemiology, Center for Disease Control, Atlanta, GA, United States, Division of Epidemiology and Disease Control, Maryland Department of Health and Mental Hygiene, Baltimore, MD, United States
  • b Communicable Disease Division, Montgomery County Health Department, Silver Spring, MD, United States
  • c Preventive Medicine Residency Program, John Hopkins School of Hygiene and Public Health, Baltimore, MD, United States
  • d Division of Bacterial and Mycotic Diseases, Center for Disease Control, Atlanta, GA, United States
  • e Division of Bacterial and Mycotic Diseases, Center for Disease Control, Atlanta, GA, United States
  • f Communicable Disease Division, Montgomery County Health Department, Silver Spring, MD, United States
  • g Division of Field Epidemiology, Center for Disease Control, Atlanta, GA, United States
  • h Division of Field Epidemiology, Center for Disease Control, Atlanta, GA, United States
  • i Division of Epidemiology and Disease Control, Maryland Department of Health and Mental Hygiene, Baltimore, MD, United States

Abstract

The number of reported outbreaks of typhoid fever in the United States has recently increased. Only six were reported from 1980-1989, but seven outbreaks were reported in 1990. In August 1990, health officials in Montgomery County, Maryland, were notified of two cases of typhoid fever among persons who had attended both a family picnic attended by 60 persons and a Latin Food Festival attended by 100,000 people. We obtained interviews, blood and stool cultures, and Vi serologies from attendees at and food handlers for the picnic. We defined cases as culture-confirmed or probable. Of the 60 picnic attendees, 24 (40%) had cases, of which 16 were culture confirmed. Those who ate potato salad were at increased risk of disease (17/32 vs. 6/28, relative risk [RR]=2.5,95% confidence interval [CI] 1.1-5.4). Picnic attendees who also attended the Latin Food Festival were not at significantly greater risk of disease than those who did not, (11/22 vs. 13/38, RR=1.5, CI=0.8-2.7) and we found no evidence of disease among other festival attendees. The potato salad was prepared with intensive handling and without adequate temperature control by a recent immigrant from El Salvador who was asymptomatic, did not attend the picnic, had Salmonella typhi (S. typhi) in her stool, and had elevated Vi antibodies, strongly suggestive of the carrier state. Outbreaks of typhoid fever are a threat for cosmopolitan communities. While currently available control measures are unlikely to prevent all outbreaks, thorough investigation can identify previously unrecognized carriers. © 1995 Human Sciences Press, Inc.

Author Keywords

[No Keywords available]

Index Keywords

thermoregulation food contamination immigrant Salmonella typhi risk Population Surveillance human risk assessment typhoid fever interview United States feces culture blood culture Adolescent male female Infant Child, Preschool Disease Outbreaks Article epidemic food handling major clinical study adult bacterium antibody Emigration and Immigration Maryland Carrier State Holidays Middle Age Salmonella Food Poisoning El Salvador Child
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-0028875801&doi=10.1007%2fBF02277062&partnerID=40&md5=36434a1bb974cc5b2c55fdea10014f29
DOI: 10.1007/BF02277062
ISSN: 00945145
Cited by: 20
Original Language: English