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Jacques J. Mathieu, MD, MPH; Kelly J. Henning, MD; Eleanor Bell, RN; Thomas R. Frieden, MD, MPH

Arch Intern Med. 1994;154(15):1713-1718.

Abstract
Background
Although typhoid fever incidence decreased in the 1960s and 1970s in New York City and elsewhere, it did not disappear. In this article, trends associated with various modes of transmission of Salmonella typhi in New York City patients are described.

Methods
Typhoid fever surveillance reports from 1980 to 1990 were reviewed for clinical, demographic, and epidemiologic characteristics. Cases of typhoid fever were classified as travel related or domestically acquired.

Results
In all, 479 typhoid cases were identified, of which 67% were travel related. The age groups most frequently affected were children and adolescents. Cases more than doubled in the decade, and the ratio of travelrelated cases to domestically acquired cases increased steadily from 63% to 80%. Travelers to Southeast Asia were at three times higher risk than those visiting South America and eight times higher than those visiting the Caribbean. The case-fatality proportion was 1.5%.

Conclusion
The trends of S typhi infection in New York City followed the trends observed in the United States since 1978, which demonstrates the importance of international travel. Although food and water precautions may be effective for short-term travelers, selective use of oral antityphoid vaccines for New York City travelers to high-risk endemic countries should be encouraged.

(Arch Intern Med. 1994;154:1713-1718)

Author Affiliations
From the Division of Community Medicine, Mount Sinai School of Medicine, New York, NY (Dr Mathieu); Division of Disease Intervention, New York (NY) City Department of Health (Drs Mathieu, Henning, and Frieden and Ms Bell); and Division of Field Epidemiology, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Henning and Frieden).

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