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Epidemiology and Infection logoLink to Epidemiology and Infection
. 1993 Feb;110(1):63–70. doi: 10.1017/s0950268800050688

Epidemiology of typhoid fever in Singapore.

F S Yew 1, K T Goh 1, Y S Lim 1
PMCID: PMC2271965  PMID: 8432324

Abstract

A total of 1452 cases of typhoid fever was notified in Singapore from 1980-9. The morbidity rates of indigenous cases showed a steady decline from 5.9 per 100,000 population in 1980 to 1.2 per 100,000 population in 1989. The mean case fatality was 0.8%. Children, adolescents and young adults were most susceptible to typhoid fever. There was no significant difference in morbidity rates between the major ethnic groups. The vast majority of indigenous cases were sporadic while outbreaks accounted for almost one third of them. Food was the main vehicle of transmission. The commonest indigenous phage types were B1, D1 and A. Antimicrobial resistance was infrequently seen. The proportion of imported cases rose from 32% in 1980 to 72% in 1989. Almost half (48.5%) of all imported cases were local residents who contracted typhoid fever while travelling in endemic countries. As imported cases assume greater importance in the epidemiology of typhoid fever in Singapore, further drop in typhoid fever incidence would require reduction of travel-related cases through greater awareness of food hygiene and effective vaccination.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ANDERSON E. S., WILLIAMS R. E. Bacteriophage typing of enteric pathogens and staphylococci and its use in epidemiology. J Clin Pathol. 1956 May;9(2):94–127. doi: 10.1136/jcp.9.2.94. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Acharya I. L., Lowe C. U., Thapa R., Gurubacharya V. L., Shrestha M. B., Cadoz M., Schulz D., Armand J., Bryla D. A., Trollfors B. Prevention of typhoid fever in Nepal with the Vi capsular polysaccharide of Salmonella typhi. A preliminary report. N Engl J Med. 1987 Oct 29;317(18):1101–1104. doi: 10.1056/NEJM198710293171801. [DOI] [PubMed] [Google Scholar]
  3. Bauer A. W., Kirby W. M., Sherris J. C., Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol. 1966 Apr;45(4):493–496. [PubMed] [Google Scholar]
  4. Brown J. D., Duong Hong M. o., Rhoades E. R. Chloramphenicol-resistant Salmonella typhi in Saigon. JAMA. 1975 Jan 13;231(2):162–166. [PubMed] [Google Scholar]
  5. COLQUHOUN J., WEETCH R. S. Resistance to chloramphenicol developing during treatment of typhoid fever. Lancet. 1950 Nov 25;2(6639):621–623. doi: 10.1016/s0140-6736(50)91585-6. [DOI] [PubMed] [Google Scholar]
  6. Chau P. Y., Tsang R. S. Vi serology in screening of typhoid carriers: improved specificity by detection of Vi antibodies by counterimmunoelectrophoresis. J Hyg (Lond) 1982 Oct;89(2):261–267. doi: 10.1017/s0022172400070790. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Cvjetanovic B. Control of enteric fever. Singapore Med J. 1976 Mar;17(1):38–39. [PubMed] [Google Scholar]
  8. Engleberg N. C., Barrett T. J., Fisher H., Porter B., Hurtado E., Hughes J. M. Identification of a carrier by using Vi enzyme-linked immunosorbent assay serology in an outbreak of typhoid fever on an Indian reservation. J Clin Microbiol. 1983 Dec;18(6):1320–1322. doi: 10.1128/jcm.18.6.1320-1322.1983. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Gilman R. H., Islam S., Rabbani H., Ghosh H. Identification of gallbladder typhoid carriers by a string device. Lancet. 1979 Apr 14;1(8120):795–796. doi: 10.1016/s0140-6736(79)91316-3. [DOI] [PubMed] [Google Scholar]
  10. Goh K. T. Enteric infections in Singapore with special reference to typhoid. Southeast Asian J Trop Med Public Health. 1978 Sep;9(3):433–439. [PubMed] [Google Scholar]
  11. Jegathesan M., Khor S. Y. First isolates of chloramphenicol resistant S. typhi in Malaysia. Med J Malaysia. 1980 Jun;34(4):395–398. [PubMed] [Google Scholar]
  12. Jegathesan M. Phage types of Salmonella typhi isolated in Malaysia over the 10-year period 1970-1979. J Hyg (Lond) 1983 Feb;90(1):91–97. doi: 10.1017/s0022172400063889. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Klugman K. P., Gilbertson I. T., Koornhof H. J., Robbins J. B., Schneerson R., Schulz D., Cadoz M., Armand J. Protective activity of Vi capsular polysaccharide vaccine against typhoid fever. Lancet. 1987 Nov 21;2(8569):1165–1169. doi: 10.1016/s0140-6736(87)91316-x. [DOI] [PubMed] [Google Scholar]
  14. Koh T. S., Goh K. T. Enteric fever surveillance in Singapore. Singapore Med J. 1976 Mar;17(1):32–37. [PubMed] [Google Scholar]
  15. Kontomichalou P. Studies on resistance transfer factors. Pathol Microbiol (Basel) 1967;30(1):71–93. doi: 10.1159/000161646. [DOI] [PubMed] [Google Scholar]
  16. Lam S. Y., Goh K. T. Vi-phage types in Singapore. Singapore Med J. 1978 Mar;19(1):3–7. [PubMed] [Google Scholar]
  17. Lampe R. M., Mansuwan P., Duangmani C. Letter: Chloramphenicol--resistant typhoid. Lancet. 1974 Apr 6;1(7858):623–624. doi: 10.1016/s0140-6736(74)92678-6. [DOI] [PubMed] [Google Scholar]
  18. Lanata C. F., Levine M. M., Ristori C., Black R. E., Jimenez L., Salcedo M., Garcia J., Sotomayor V. Vi serology in detection of chronic Salmonella typhi carriers in an endemic area. Lancet. 1983 Aug 20;2(8347):441–443. doi: 10.1016/s0140-6736(83)90401-4. [DOI] [PubMed] [Google Scholar]
  19. Levine M. M., Black R. E., Lanata C. Precise estimation of the numbers of chronic carriers of Salmonella typhi in Santiago, Chile, an endemic area. J Infect Dis. 1982 Dec;146(6):724–726. doi: 10.1093/infdis/146.6.724. [DOI] [PubMed] [Google Scholar]
  20. Levine M. M., Ferreccio C., Black R. E., Germanier R. Large-scale field trial of Ty21a live oral typhoid vaccine in enteric-coated capsule formulation. Lancet. 1987 May 9;1(8541):1049–1052. doi: 10.1016/s0140-6736(87)90480-6. [DOI] [PubMed] [Google Scholar]
  21. Levine M. M. Modern vaccines. Enteric infections. Lancet. 1990 Apr 21;335(8695):958–961. doi: 10.1016/0140-6736(90)91013-z. [DOI] [PubMed] [Google Scholar]
  22. Lin F. Y., Becke J. M., Groves C., Lim B. P., Israel E., Becker E. F., Helfrich R. M., Swetter D. S., Cramton T., Robbins J. B. Restaurant-associated outbreak of typhoid fever in Maryland: identification of carrier facilitated by measurement of serum Vi antibodies. J Clin Microbiol. 1988 Jun;26(6):1194–1197. doi: 10.1128/jcm.26.6.1194-1197.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Losonsky G. A., Ferreccio C., Kotloff K. L., Kaintuck S., Robbins J. B., Levine M. M. Development and evaluation of an enzyme-linked immunosorbent assay for serum Vi antibodies for detection of chronic Salmonella typhi carriers. J Clin Microbiol. 1987 Dec;25(12):2266–2269. doi: 10.1128/jcm.25.12.2266-2269.1987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. MOORE B., PERRY E. L., CHARD S. T. A survey by the sewage swab method of latent enteric infection in an urban area. J Hyg (Lond) 1952 Jun;50(2):137–156. doi: 10.1017/s0022172400019501. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. MURTI B. R., RAJYALAKSHMI K., BHASKARAN C. S. Resistance of Salmonella typhi to chloramphenicol. I. A preliminary report. J Clin Pathol. 1962 Nov;15:544–551. doi: 10.1136/jcp.15.6.544. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. NJOKU-OBI A. N., NJOKU-OBI J. C. RESISTANCE OF SALMONELLA TYPHOSA TO CHLORAMPHENICOL. J Bacteriol. 1965 Aug;90:552–553. doi: 10.1128/jb.90.2.552-553.1965. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Nolan C. M., White P. C., Jr, Feeley J. C., Hambie E. A., Brown S. L., Wong K. H. Vi serology in the detection of typhoid carriers. Lancet. 1981 Mar 14;1(8220 Pt 1):583–585. doi: 10.1016/s0140-6736(81)92033-x. [DOI] [PubMed] [Google Scholar]
  28. Paniker C. K., Vimala K. N. Transferable chloramphenicol resistance in Salmonella typhi. Nature. 1972 Sep 8;239(5367):109–110. doi: 10.1038/239109b0. [DOI] [PubMed] [Google Scholar]
  29. Rice P. A., Baine W. B., Gangarosa E. J. Salmonella typhi infections in the United States, 1967-1972: increasing importance of international travelers. Am J Epidemiol. 1977 Aug;106(2):160–166. doi: 10.1093/oxfordjournals.aje.a112446. [DOI] [PubMed] [Google Scholar]
  30. Ryan C. A., Hargrett-Bean N. T., Blake P. A. Salmonella typhi infections in the United States, 1975-1984: increasing role of foreign travel. Rev Infect Dis. 1989 Jan-Feb;11(1):1–8. doi: 10.1093/clinids/11.1.1. [DOI] [PubMed] [Google Scholar]
  31. Sanborn W. R., Lesmana M., Dennis D. T., Treggonowati R., Kairman Lita I., Suyani Letter: Antibiotic-resistant typhoid in Indonesia. Lancet. 1975 Aug 30;2(7931):408–409. doi: 10.1016/s0140-6736(75)92923-2. [DOI] [PubMed] [Google Scholar]
  32. Sanborn W. R., Vieu J. F., Komalarini S., Sinta, Trenggonowati R., Kadirman I. L., Sumarmo, Aziz A., Sadjimin T., Triwibowo Salmonellosis in Indonesia: phage type distribution of Salmonella typhi. J Hyg (Lond) 1979 Feb;82(1):143–153. doi: 10.1017/s0022172400025560. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Sharp J. C., Heymann C. S. Enteric fever in Scotland, 1967-1974. J Hyg (Lond) 1976 Feb;76(1):83–89. doi: 10.1017/s0022172400054978. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Shinohara N., Tanaka H., Saito T., Deguchi J., Kondo R., Soda K., Suzuki M. Detection of carriers of typhoid bacilli by sewerage-tracing surveillance in Matsuyama City. Jpn J Med Sci Biol. 1981 Dec;34(6):385–392. doi: 10.7883/yoken1952.34.385. [DOI] [PubMed] [Google Scholar]
  35. Somerville P. C., Notelovitz J., Alberts M. Typhoid fever in the Northern Transvaal national states. An approach to an epidemiological quandary. S Afr Med J. 1981 Sep 26;60(13):491–495. [PubMed] [Google Scholar]
  36. Sompolinski D., Ben-Yakov M., Aboud M., Boldur I. Transferable resistance factors with mutator effect in Salmonella typhi. Mutat Res. 1967 Mar-Apr;4(2):119–127. doi: 10.1016/0027-5107(67)90063-2. [DOI] [PubMed] [Google Scholar]
  37. Wahdan M. H., Sérié C., Cerisier Y., Sallam S., Germanier R. A controlled field trial of live Salmonella typhi strain Ty 21a oral vaccine against typhoid: three-year results. J Infect Dis. 1982 Mar;145(3):292–295. doi: 10.1093/infdis/145.3.292. [DOI] [PubMed] [Google Scholar]
  38. Yew F. S., Chew S. K., Goh K. T., Monteiro E. H., Lim Y. S. Typhoid fever in Singapore: a review of 370 cases. J Trop Med Hyg. 1991 Oct;94(5):352–357. [PubMed] [Google Scholar]

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