National Typhoid and Paratyphoid Fever Surveillance Annual Summary, 2017

Surveillance

Jurisdictions¹ reporting at least one typhoid or paratyphoid fever^2,3 case to the NTPFS during 2017 are shown in Figures 1 and 2.

402 typhoid fever cases were reported by 39 jurisdictions (Figure 1).
63 paratyphoid fever cases were reported by 21 jurisdictions; 62 were caused by Salmonella serotype Paratyphi A, 1 by Paratyphi C (Figure 2).

¹Includes all 50 states and District of Columbia.
²Paratyphoid fever is caused by Salmonella serotypes Paratyphi A, Paratyphi B, and Paratyphi C. Two distinct pathotypes of Paratyphi B are recognized; one is associated with paratyphoid fever and the other is associated with uncomplicated gastroenteritis. The two pathotypes have distinct virulence characteristics and are differentiated based on the ability to ferment tartrate. The paratyphoidal pathotype is unable to ferment tartrate and is designated serotype Paratyphi B; the nonparatyphoidal pathotype ferments tartrate and is designated serotype Paratyphi B var. L(+) tartrate+. Only those isolates laboratory-confirmed as not able to ferment tartrate are included in the annual summary. Many Paratyphi B reports do not include this information; these reports are therefore excluded from this annual summary.
³One case of paratyphoid fever caused by Salmonella serotype Paratyphi C was reported.

On This Page

Surveillance
Demographic and Clinical Characteristics
International Travel
Typhoid Fever Vaccine
National Notifiable Diseases Surveillance System
Antimicrobial Resistance
Outbreaks

Read an overview of the National Typhoid and Paratyphoid Fever Surveillance (NTPFS) system [PDF – 2 pages]

Figure 1
Figure 2

Typhoid fever cases reported to NTPFS, by jurisdiction, 2017 (n = 402)

Download Data [XLS – 463 B]

Paratyphoid fever cases reported to NTPFS, by jurisdiction, 2017 (n=63)

Download Data [XLS – 463 B]

Demographic and Clinical Characteristics of Patients

Demographic and clinical characteristics of patients with typhoid fever and paratyphoid fever are shown in Tables 1 and 2.

The median age of patients with typhoid fever was 25 years (range 0 – 87 years).
The median age of patients with paratyphoid fever was 27 years (range 2 – 76 years).
There were two deaths among patients with typhoid fever. There was one death among patients with paratyphoid fever.

Table 1

Demographic and clinical characteristics of patients with typhoid fever reported to NTPFS, 2017 (n =402)
Characteristic (number with data available)	Number	Percent
Age group, years (n = 401) <1	2	<1
1–4	48	12
5–14	96	23
15–24	54	13
25–44	133	33
45–64	57	14
65+	15	4
Female (n = 401)	174	43
Food handler (n = 287)	6	2
Outbreak-associated (n = 330)	23	7
International travel¹ (n = 398)	339	85
Vaccinated² (n = 264)	11	4
Specimen source (n = 396)
Blood	327	83
Stool	60	15
Other	9	2
Hospitalizations³ (n = 399)	326	82
Deaths (n = 373)	2	<1

¹Travel destinations are shown in Table 3a.
²Received typhoid fever vaccination within five years before illness began. Of the 11 cases in vaccinated persons, one received only the Vi capsular polysaccharide vaccine (ViCPS); vaccine type was not reported for the other ten.
³Median length of hospitalization was five days.

Table 2

Reported demographic and clinical characteristics of patients with paratyphoid fever
Characteristic (number with data available)	Number	Percent
Age group, years (n = 63) <1	0	0
1–4	3	5
5–14	16	25
15–24	11	17
25–44	21	33
45–64	7	11
65+	5	8
Female (n = 63)	29	46
Food handler (n = 36)	0	0
Outbreak-associated (n = 51)	3	6
International travel¹ (n = 58)	54	93
Specimen source (n = 62)
Blood	53	85
Stool	5	8
Other	4	6
Hospitalizations² (n = 63)	50	79
Deaths (n = 56)	1	2

¹Travel destinations are shown in Table 3b.
²Median length of hospitalization was five days.

International Travel

Among the 398 typhoid fever patients whose travel histories were reported, 339 (85%) reported traveling or living outside the United States in the 30 days before illness began.
Among the 58 paratyphoid fever patients whose travel histories were reported, 54 (93%) reported traveling or living outside the United States in the 30 days before illness began.
Among patients reporting international travel, 310 (91%) patients with typhoid fever and 51 (94%) patients with paratyphoid fever reported travel to a single destination (Tables 3a and 3b).
Visiting friends or relatives was the most common reason for international travel among patients with typhoid fever (45%) and paratyphoid fever (55%).

Table 3a

Travel destinations for patients with typhoid fever who reported a single destination country, NTPFS, 2017
Travel Destination	No. (%)
India	181 (58)
Pakistan	33 (11)
Bangladesh	32 (10)
Mexico	24 (8)
Haiti	6 (2)
Other¹	34 (11)

¹Nigeria (6), El Salvador (4), Guatemala (3), Burundi (2), Dominican Republic (2), Indonesia (2), Philippines (2), Afghanistan (1), Ghana (1), Iran (1), Iraq (1), Kenya (1), Mali (1), Marshall Islands (1), Morocco (1), Nepal (1), Samoa (1), Tonga (1), Uganda (1), United Arab Emirates (1)

Table 3b

Travel destinations for patients with paratyphoid fever who reported a single destination country, NTPFS, 2017
Travel Destination	No. (%)
India	29 (57)
Pakistan	12 (24)
Bangladesh	6 (12)
Indonesia	1 (2)
Mali	1 (2)
Other¹	2 (4)

¹Nigeria (1), Senegal (1)

Typhoid Fever Vaccine

Download Data [XLS – 67 B]

¹Figure excludes patients whose typhoid vaccination status was unknown or not reported (n=138).

National Notifiable Diseases Surveillance System

The National Notifiable Diseases Surveillance System (NNDSS) collects and compiles reports of nationally notifiable infectious diseases, including typhoid fever. NNDSS reports can be found at www.cdc.gov/nndss/data-statistics.

The figure below presents a comparison of typhoid fever reports submitted to NTPFS and NNDSS in the past five years. Reports submitted to NNDSS can include clinically compatible cases that are epidemiologically linked to a confirmed case but are not laboratory-confirmed.

Comparisons for paratyphoid fever are not provided because, although it was nationally notifiable, it was reported under the case definition for salmonellosis during these years.

Download Data [XLS – 91 B]

Antimicrobial Resistance

The National Antimicrobial Resistance Monitoring System (NARMS) monitors antimicrobial resistance among enteric bacteria, including Salmonella serotypes Typhi and Paratyphi A, Paratyphi B (tartrate negative), and Paratyphi C. Decreased susceptibility to ciprofloxacin (DSC, defined as minimum inhibitory concentration ≥0.12 µg/mL) has been associated with fluoroquinolone treatment failure among patients with Typhi infections in published literature. Multidrug-resistant (MDR) is defined as resistance to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole.

Among Salmonella serotype Typhi isolates obtained from patients during 2017:

73% had DSC
10% were MDR
11% were resistant to three or more classes of antibiotics
No isolates were resistant to ceftriaxone

Among Salmonella serotype Paratyphi A isolates obtained from patients during 2017:

86% had DSC
No isolates were MDR
No isolates were resistant to three or more classes of antibiotics
No isolates were resistant to ceftriaxone

Data are available in NARMS Now, an interactive tool containing antibiotic resistance data from bacteria isolated from humans.

Outbreaks

The Foodborne Disease Outbreak Surveillance System (FDOSS) collects reports of foodborne disease outbreaks from local, state, tribal, and territorial public health agencies. The most recently published annual reports are available at www.cdc.gov/fdoss/annual-reports.

The Waterborne Disease and Outbreak Surveillance System (WBDOSS) collects reports of waterborne disease outbreaks associated with drinking water and recreational water from local, state, tribal, and territorial public health agencies. Reports are available at http://www.cdc.gov/healthywater/surveillance/surveillance-reports.html.

One outbreak of typhoid fever (none of paratyphoid fever) was reported in 2017. The outbreak occurred in Ohio and resulted in 17 laboratory-confirmed and 11 probable cases.

References

CDC. National Antimicrobial Resistance Monitoring System (NARMS) Now: Human Data. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. https://wwwn.cdc.gov/narmsnow. Accessed 9/27/2022.

Recommended Citation

Centers for Disease Control and Prevention (CDC). National Typhoid and Paratyphoid Fever Surveillance Annual Report, 2017. Atlanta, Georgia: US Department of Health and Human Services, CDC, 2022.

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