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Risk factors for typhoid and paratyphoid fever in Jakarta, Indonesia.
JAMA. 2004 Jun 02; 291(21):2607-15.JAMA

Abstract

CONTEXT

The proportion of paratyphoid fever cases to typhoid fever cases may change due to urbanization and increased dependency on food purchased from street vendors. For containment of paratyphoid a different strategy may be needed than for typhoid, because risk factors for disease may not coincide and current typhoid vaccines do not protect against paratyphoid fever.

OBJECTIVE

To determine risk factors for typhoid and paratyphoid fever in an endemic area.

DESIGN, SETTING, AND PARTICIPANTS

Community-based case-control study conducted from June 2001 to February 2003 in hospitals and outpatient health centers in Jatinegara district, Jakarta, Indonesia. Enrolled participants were 1019 consecutive patients with fever lasting 3 or more days, from which 69 blood culture-confirmed typhoid cases, 24 confirmed paratyphoid cases, and 289 control patients with fever but without Salmonella bacteremia were interviewed, plus 378 randomly selected community controls.

MAIN OUTCOME MEASURES

Blood culture-confirmed typhoid or paratyphoid fever; risk factors for both diseases.

RESULTS

In 1019 fever patients we identified 88 (9%) Salmonella typhi and 26 (3%) Salmonella paratyphi A infections. Paratyphoid fever among cases was independently associated with consumption of food from street vendors (comparison with community controls: odds ratio [OR], 3.34; 95% confidence interval [CI], 1.41-7.91; with fever controls: OR, 5.17; 95% CI, 2.12-12.60) and flooding (comparison with community controls: OR, 4.52; 95% CI, 1.90-10.73; with fever controls: OR, 3.25; 95% CI, 1.31-8.02). By contrast, independent risk factors for typhoid fever using the community control group were mostly related to the household, ie, to recent typhoid fever in the household (OR, 2.38; 95% CI, 1.03-5.48); no use of soap for handwashing (OR, 1.91; 95% CI, 1.06-3.46); sharing food from the same plate (OR, 1.93; 95% CI, 1.10-3.37), and no toilet in the household (OR, 2.20; 95% CI, 1.06-4.55). Also, typhoid fever was associated with young age in years (OR, 0.96; 95% CI, 0.94-0.98). In comparison with fever controls, risk factors for typhoid fever were use of ice cubes (OR, 2.27; 95% CI, 1.31-3.93) and female sex (OR, 1.79; 95% CI, 1.04-3.06). Fecal contamination of drinking water was not associated with typhoid or paratyphoid fever. We did not detect fecal carriers among food handlers in the households.

CONCLUSIONS

In Jakarta, typhoid and paratyphoid fever are associated with distinct routes of transmission, with the risk factors for disease either mainly within the household (typhoid) or outside the household (paratyphoid).

Authors+Show Affiliations

Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15173152

Citation

Vollaard, Albert M., et al. "Risk Factors for Typhoid and Paratyphoid Fever in Jakarta, Indonesia." JAMA, vol. 291, no. 21, 2004, pp. 2607-15.
Vollaard AM, Ali S, van Asten HA, et al. Risk factors for typhoid and paratyphoid fever in Jakarta, Indonesia. JAMA. 2004;291(21):2607-15.
Vollaard, A. M., Ali, S., van Asten, H. A., Widjaja, S., Visser, L. G., Surjadi, C., & van Dissel, J. T. (2004). Risk factors for typhoid and paratyphoid fever in Jakarta, Indonesia. JAMA, 291(21), 2607-15.
Vollaard AM, et al. Risk Factors for Typhoid and Paratyphoid Fever in Jakarta, Indonesia. JAMA. 2004 Jun 2;291(21):2607-15. PubMed PMID: 15173152.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors for typhoid and paratyphoid fever in Jakarta, Indonesia. AU - Vollaard,Albert M, AU - Ali,Soegianto, AU - van Asten,Henri A G H, AU - Widjaja,Suwandhi, AU - Visser,Leo G, AU - Surjadi,Charles, AU - van Dissel,Jaap T, PY - 2004/6/3/pubmed PY - 2004/6/21/medline PY - 2004/6/3/entrez SP - 2607 EP - 15 JF - JAMA JO - JAMA VL - 291 IS - 21 N2 - CONTEXT: The proportion of paratyphoid fever cases to typhoid fever cases may change due to urbanization and increased dependency on food purchased from street vendors. For containment of paratyphoid a different strategy may be needed than for typhoid, because risk factors for disease may not coincide and current typhoid vaccines do not protect against paratyphoid fever. OBJECTIVE: To determine risk factors for typhoid and paratyphoid fever in an endemic area. DESIGN, SETTING, AND PARTICIPANTS: Community-based case-control study conducted from June 2001 to February 2003 in hospitals and outpatient health centers in Jatinegara district, Jakarta, Indonesia. Enrolled participants were 1019 consecutive patients with fever lasting 3 or more days, from which 69 blood culture-confirmed typhoid cases, 24 confirmed paratyphoid cases, and 289 control patients with fever but without Salmonella bacteremia were interviewed, plus 378 randomly selected community controls. MAIN OUTCOME MEASURES: Blood culture-confirmed typhoid or paratyphoid fever; risk factors for both diseases. RESULTS: In 1019 fever patients we identified 88 (9%) Salmonella typhi and 26 (3%) Salmonella paratyphi A infections. Paratyphoid fever among cases was independently associated with consumption of food from street vendors (comparison with community controls: odds ratio [OR], 3.34; 95% confidence interval [CI], 1.41-7.91; with fever controls: OR, 5.17; 95% CI, 2.12-12.60) and flooding (comparison with community controls: OR, 4.52; 95% CI, 1.90-10.73; with fever controls: OR, 3.25; 95% CI, 1.31-8.02). By contrast, independent risk factors for typhoid fever using the community control group were mostly related to the household, ie, to recent typhoid fever in the household (OR, 2.38; 95% CI, 1.03-5.48); no use of soap for handwashing (OR, 1.91; 95% CI, 1.06-3.46); sharing food from the same plate (OR, 1.93; 95% CI, 1.10-3.37), and no toilet in the household (OR, 2.20; 95% CI, 1.06-4.55). Also, typhoid fever was associated with young age in years (OR, 0.96; 95% CI, 0.94-0.98). In comparison with fever controls, risk factors for typhoid fever were use of ice cubes (OR, 2.27; 95% CI, 1.31-3.93) and female sex (OR, 1.79; 95% CI, 1.04-3.06). Fecal contamination of drinking water was not associated with typhoid or paratyphoid fever. We did not detect fecal carriers among food handlers in the households. CONCLUSIONS: In Jakarta, typhoid and paratyphoid fever are associated with distinct routes of transmission, with the risk factors for disease either mainly within the household (typhoid) or outside the household (paratyphoid). SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/15173152/Risk_factors_for_typhoid_and_paratyphoid_fever_in_Jakarta_Indonesia_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.291.21.2607 DB - PRIME DP - Unbound Medicine ER -