Date Kashmira A, Newton Anna E, Medalla Felicita, Blackstock Anna, Richardson LaTonia, McCullough Andre, Mintz Eric D, Mahon Barbara E
Epidemic Intelligence Service, Office of Workforce and Career Development Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Clin Infect Dis. 2016 Aug 1;63(3):322-9. doi: 10.1093/cid/ciw232. Epub 2016 Apr 18.
Enteric fever in the United States has been primarily associated with travel and with worrisome changes in global patterns of antimicrobial resistance. We present the first comprehensive report of National Typhoid and Paratyphoid Fever Surveillance System (NTPFS) data for a 5-year period (2008-2012).
We reviewed data on laboratory-confirmed cases reported to NTPFS, and related antimicrobial susceptibility results of Salmonella Typhi and Paratyphi A isolates sent for testing by participating public health laboratories to the Centers for Disease Control and Prevention's National Antimicrobial Resistance Monitoring System laboratory.
During 2008-2012, 2341 enteric fever cases were reported, 80% typhoid and 20% paratyphoid A. The proportion caused by paratyphoid A increased from 16% (2008) to 22% (2012). Foreign travel within 30 days preceding illness onset was reported by 1961 (86%) patients (86% typhoid and 92% paratyphoid A). Travel to southern Asia was common (82% for typhoid, 97% for paratyphoid A). Among 1091 (58%) typhoid and 262 (56%) paratyphoid A isolates tested for antimicrobial susceptibility, the proportion resistant to nalidixic acid (NAL-R) increased from 2008 to 2012 (Typhi, 60% to 68%; Paratyphi A, 91% to 94%). Almost all NAL-R isolates were resistant or showed decreased susceptibility to ciprofloxacin. Resistance to at least ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole (multidrug resistant [MDR]) was limited to Typhi isolates, primarily acquired in southern Asia (13%). Most MDR isolates were also NAL-R.
Enteric fever in the United States is primarily associated with travel to southern Asia, and increasing resistance is adding to treatment challenges. A bivalent typhoid and paratyphoid vaccine is needed.
美国的伤寒热主要与旅行以及全球抗菌药物耐药模式令人担忧的变化有关。我们提供了国家伤寒和副伤寒热监测系统（NTPFS）5年期间（2008 - 2012年）数据的首份综合报告。
我们审查了向NTPFS报告的实验室确诊病例数据，以及参与的公共卫生实验室送往疾病控制和预防中心国家抗菌药物耐药监测系统实验室检测的伤寒沙门氏菌和甲型副伤寒沙门氏菌分离株的相关抗菌药物敏感性结果。
在2008 - 2012年期间，报告了2341例伤寒热病例，其中80%为伤寒，20%为甲型副伤寒。甲型副伤寒所致病例比例从2008年的16%增至2012年的22%。1961例（86%）患者报告在发病前30天内有国外旅行史（伤寒患者中86%，甲型副伤寒患者中92%）。前往南亚旅行很常见（伤寒患者中82%，甲型副伤寒患者中97%）。在1091株（58%）伤寒和262株（56%）甲型副伤寒分离株中进行了抗菌药物敏感性检测，对萘啶酸耐药（NAL - R）的比例从2008年到2012年有所增加（伤寒沙门氏菌，从60%增至68%；甲型副伤寒沙门氏菌，从91%增至94%）。几乎所有NAL - R分离株对环丙沙星耐药或敏感性降低。对至少氨苄西林、氯霉素和甲氧苄啶 - 磺胺甲恶唑耐药（多重耐药[MDR]）仅限于伤寒沙门氏菌分离株，主要在南亚获得（13%）。大多数MDR分离株也是NAL - R。
美国的伤寒热主要与前往南亚旅行有关，耐药性增加给治疗带来了挑战。需要一种二价伤寒和副伤寒疫苗。
