Typhoid in Tajikistan

These Epidemiologic Case Studies are based on historical events and include epidemiologic methods that were practiced at the time. Given the historical nature of this content, the methods that are referenced on this site may be outdated practices in some settings. As some of the practices are still used, they continue to offer educational value.

Target Audience

This case study was developed for students and public health practitioners interested in learning and practicing specific skills in outbreak investigation, especially outbreaks associated with drinking water. The target audience includes epidemiologists, environmental health specialists, sanitarians, public health nurses, disease investigators, health officers, and physicians.

Learning Objectives

After completing this case study, the student should be able to

  • List health problems common in countries with economic hardships, deteriorating infrastructure, and displaced populations
  • Discuss the steps typically used to develop hypotheses on the source of an infectious disease outbreak
  • Interpret the results of a matched case-control study
  • List activities that should be included in the evaluation of a public water system associated with an outbreak
  • Define surface water and groundwater
  • List the steps in collecting water samples from a point-of-use water tap
  • Describe point-of-use water disinfection and give examples of proven approaches
  • Describe the clinical features, epidemiology, and control of typhoid fever


Successful completion of basic training in infectious disease epidemiology, descriptive epidemiology, study design, measures of association, and outbreak investigation. The student also will benefit from having familiarity with drinking water treatment processes and the evaluation of a water treatment system but probably will rely on others with greater expertise in these areas during a real-life outbreak.






3 to 3.5 hours

Continuing Education

Continuing education credits are not available for completing this case study.

Developed By

Jeanette K. Stehr-Green, MD, developed this case study in collaboration with individuals from the Centers for Disease Control and Prevention:

  • National Center for Zoonotic, Vector-borne, and Enteric Diseases
  • National Center for Environmental Health

Original Investigation Team

The following individuals investigated the original outbreak of typhoid in Tajikistan: Johnathan H. Mermin, MD; Rodrigo Villar, MD; Joe Carpenter, PE; Les Roberts, PhD, MSPH; Aliev Samaridden; Larissa Gasanova; Svetlana Lomakina; Cheryl Bopp, MS; Lori Hutwagner, MS; Paul Mead, MD, MPH; Bruce Ross; and Eric D. Mintz, MD, MPH.