National Typhoid and Paratyphoid Fever Surveillance Annual Summary, 2016

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 Columbia
²Paratyphoid 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

Surveillance
Demographic and Clinical Characteristics of Patients
International Travel
Typhoid Fever Vaccine
National Notifiable Diseases Surveillance System
Antimicrobial Resistance
Outbreaks

Read an overview of the National Typhoid and Paratyphoid Fever Surveillance (NTPFS) system [PDF – 2 pages]

Figure 1 Figure 2

Typhoid fever cases reported to NTPFS, by jurisdiction, 2016 (n = 349)

CDC data visualization screenshot taken on archive date

NTPFS Typhoid Fever Cases Reported in 2016_figure1.csv

Cases reported in Washington, D.C.: 0 (not shown on figure)

Paratyphoid fever cases reported to NTPFS, by jurisdiction, 2016 (n=80)

NTPFS Typhoid Fever Cases Reported in 2016_figure1.csv

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.

Reported demographic and clinical characteristics of patients with typhoid fever
Characteristic (number with data available)	Number	Percent
Age group, years (n = 349) <1	2	<1
1–4	28	8
5–24	79	23
15–24	68	19
25–44	120	34
45–64	47	13
65+	5	1
Female (n = 347)	161	46
Food handler (n = 267)	9	3
Outbreak-associated (n = 288)	12	4
International travel¹ (n = 342)	299	87
Vaccinated² (n = 231)	13	6
Specimen source (n = 343)
Blood	304	89
Stool	35	10
Other	4	1
Hospitalizations³ (n = 347)	288	83
Deaths (n = 322)	1	<1

¹Travel destinations are shown in Table 3a
²Received 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.

Reported demographic and clinical characteristics of patients with paratyphoid fever
Characteristic (number with data available)	Number	Percent
Age group, years (n = 80) <1	0	0
1–4	5	6
5–14	14	18
15–24	14	18
25–44	34	43
45–64	12	15
65+	1	1
Female (n = 78)	34	44
Food handler (n = 50)	2	4
Outbreak-associated (n = 68)	5	7
International travel¹ (n = 76)	72	95
Specimen source (n = 79)
Blood	74	94
Stool	3	4
Other	2	3
Hospitalizations² (n = 80)	58	73
Deaths (n = 79)	0	0

¹Travel destinations are shown in Table 3b
²Median 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

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

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 Vaccine

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.

Antimicrobial 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 ceftriaxone

Among 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 ceftriaxone

Data 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.

References

CDC. 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 Citation

Centers 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, 2021

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