Schwartz E, Shlim D R, Eaton M, Jenks N, Houston R
Canadian International Water and Energy Consultants Clinic, Kathmandu, Nepal.
Arch Intern Med. 1990 Feb;150(2):349-51.
We studied the incidence of enteric fever among travelers and foreign residents who attended an expatriate clinic in Kathmandu, Nepal, from February 1987 to June 1988. There were 42 cases of enteric fever; 20 were caused by Salmonella typhi and 22 by Salmonella paratyphi A. Among 18 unvaccinated foreigners who had enteric fever, S typhi was isolated from 67%, and S paratyphi A from 33%, a ratio similar to the local Nepalese population. Among 22 vaccinated foreigners, S typhi was isolated from 35%, compared with 65% with S paratyphi A. Nine percent of tourists had received the oral Ty21A typhoid vaccine. However, among seven vaccinated tourists who became infected with S typhi, four (57%) had received the oral vaccine. Typhoid vaccine efficacy for tourists was calculated and showed an overall protective rate of 90% against enteric fever in general, 95% protection against S typhi, and 72% to 75% protection against S paratyphi A. We conclude that typhoid vaccine should be recommended to all travelers to the Indian subcontinent, and since S paratyphi A is the predominant cause of enteric fever among vaccinated travelers, consideration should be given to an effective vaccine against S paratyphi A when that becomes available.
我们研究了1987年2月至1988年6月期间在尼泊尔加德满都一家外籍人员诊所就诊的旅行者和外国居民中伤寒热的发病率。共有42例伤寒热病例；其中20例由伤寒沙门氏菌引起，22例由甲型副伤寒沙门氏菌引起。在18例未接种疫苗而患伤寒热的外国人中，分离出伤寒沙门氏菌的占67%，分离出甲型副伤寒沙门氏菌的占33%，这一比例与当地尼泊尔人群相似。在22例接种疫苗的外国人中，分离出伤寒沙门氏菌的占35%，而分离出甲型副伤寒沙门氏菌的占65%。9%的旅行者接种过口服Ty21A伤寒疫苗。然而，在7例接种疫苗后感染伤寒沙门氏菌的旅行者中，有4例（57%）接种的是口服疫苗。计算得出旅行者伤寒疫苗的效力，总体上对伤寒热的保护率为90%，对伤寒沙门氏菌的保护率为95%，对甲型副伤寒沙门氏菌的保护率为72%至75%。我们得出结论，应向所有前往印度次大陆的旅行者推荐接种伤寒疫苗，而且由于甲型副伤寒沙门氏菌是接种疫苗旅行者中伤寒热的主要病因，一旦有针对甲型副伤寒沙门氏菌的有效疫苗，应考虑使用。
