Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America; Epidemic Intelligence Service Officer, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
PLoS Negl Trop Dis. 2014 Mar 6;8(3):e2726. doi: 10.1371/journal.pntd.0002726. eCollection 2014 Mar.
Salmonella enterica serovar Typhi is transmitted by fecally contaminated food and water and causes approximately 22 million typhoid fever infections worldwide each year. Most cases occur in developing countries, where approximately 4% of patients develop intestinal perforation (IP). In Kasese District, Uganda, a typhoid fever outbreak notable for a high IP rate began in 2008. We report that this outbreak continued through 2011, when it spread to the neighboring district of Bundibugyo.
METHODOLOGY/PRINCIPAL FINDINGS: A suspected typhoid fever case was defined as IP or symptoms of fever, abdominal pain, and ≥1 of the following: gastrointestinal disruptions, body weakness, joint pain, headache, clinically suspected IP, or non-responsiveness to antimalarial medications. Cases were identified retrospectively via medical record reviews and prospectively through laboratory-enhanced case finding. Among Kasese residents, 709 cases were identified from August 1, 2009-December 31, 2011; of these, 149 were identified during the prospective period beginning November 1, 2011. Among Bundibugyo residents, 333 cases were identified from January 1-December 31, 2011, including 128 cases identified during the prospective period beginning October 28, 2011. IP was reported for 507 (82%) and 59 (20%) of Kasese and Bundibugyo cases, respectively. Blood and stool cultures performed for 154 patients during the prospective period yielded isolates from 24 (16%) patients. Three pulsed-field gel electrophoresis pattern combinations, including one observed in a Kasese isolate in 2009, were shared among Kasese and Bundibugyo isolates. Antimicrobial susceptibility was assessed for 18 isolates; among these 15 (83%) were multidrug-resistant (MDR), compared to 5% of 2009 isolates.
CONCLUSIONS/SIGNIFICANCE: Molecular and epidemiological evidence suggest that during a prolonged outbreak, typhoid spread from Kasese to Bundibugyo. MDR strains became prevalent. Lasting interventions, such as typhoid vaccination and improvements in drinking water infrastructure, should be considered to minimize the risk of prolonged outbreaks in the future.
肠道沙门氏菌血清型 Typhi 通过粪便污染的食物和水传播，每年导致全世界约 2200 万例伤寒感染。大多数病例发生在发展中国家，其中约 4%的患者发生肠穿孔（IP）。在乌干达卡塞塞区，2008 年爆发了一起以高 IP 率为特征的伤寒疫情。我们报告称，这场疫情一直持续到 2011 年，并蔓延到邻近的本迪布焦区。
方法/主要发现：疑似伤寒病例的定义为 IP 或发热、腹痛以及以下 1 种或多种症状：胃肠道紊乱、身体虚弱、关节痛、头痛、临床疑似 IP 或对抗疟药物无反应。病例通过病历回顾和实验室增强病例发现进行回顾性和前瞻性识别。在卡塞塞居民中，2009 年 8 月 1 日至 2011 年 12 月 31 日期间共发现 709 例病例；其中，2011 年 11 月 1 日开始的前瞻性阶段发现了 149 例。在本迪布焦居民中，2011 年 1 月 1 日至 12 月 31 日期间共发现 333 例病例，其中 2011 年 10 月 28 日开始的前瞻性阶段发现了 128 例。卡塞塞和本迪布焦的病例中分别有 507 例（82%）和 59 例（20%）报告了 IP。前瞻性阶段对 154 名患者进行了血液和粪便培养，从 24 名（16%）患者中分离出了分离株。三个脉冲场凝胶电泳模式组合，包括 2009 年在卡塞塞分离株中观察到的一个组合，在卡塞塞和本迪布焦分离株中均有共享。对 18 株分离株进行了药敏试验；其中 15 株（83%）为多重耐药（MDR），而 2009 年分离株的耐药率为 5%。
结论/意义：分子和流行病学证据表明，在一次长时间的疫情中，伤寒从卡塞塞传播到本迪布焦。MDR 菌株变得普遍存在。应考虑实施持久的干预措施，如伤寒疫苗接种和改善饮用水基础设施，以尽量减少未来长时间疫情爆发的风险。
