Clinical Updates
19 March 2008
Enteric fever in England, Wales, and Northern Ireland
The Health Protection Agency (HPA) has published a report detailing the findings from a one year pilot study of enhanced surveillance of typhoid and paratyphoid fever (enteric fever) in England, Wales, and Northern Ireland (EWNI). The study was conducted as part of the HPA collaboration with NaTHNaC.
The enhanced surveillance was prompted by an annual increase of six percent in cases of enteric fever in EWNI between 1996 and 2006 [1], and the failure of routine surveillance to effectively capture information such as country of birth, ethnicity, reason for travel, and typhoid vaccination status. These factors are essential for identifying risk groups and targeting preventive action.
During the study period (1 May 2006 to 30 April 2007), 457 cases of enteric fever occurred and 406 surveillance forms were returned (203 typhoid, 198 paratyphoid A, and five paratyphoid B). Only 7% of cases were not associated with travel. The most common reason for travel from the UK was to visit friends and relatives (VFR) (86%, 252/294). Eighty-seven percent of VFR travellers (219/252) were of Indian, Pakistani, or Bangladeshi ethnicity, and the highest risk rate was in those travelling to Bangladesh (29 cases per 100,000 visits). VFR travellers were also the least likely to have sought pre-travel health advice or to have received typhoid vaccination.
More than two-thirds of all cases had isolates of Salmonella Typhi and Salmonella Paratyphi A that exhibited reduced susceptibility to ciprofloxacin, representing an increase since 2001. Cases acquired in India and Bangladesh had the highest proportion of such isolates.
Summary
This pilot of enhanced surveillance of enteric fever identified those most at risk of infection. This information can be used to target preventive action. It is recommended that awareness needs to be raised in at-risk communities and with their health practitioners. In particular, VFR travellers need to take preventive measures against enteric fever when travelling to endemic areas that would include food and water hygiene and vaccination.
The full report is available to download from the HPA website at http://www.hpa.org.uk/infections/topics_az/typhoid/Enhanced/
Advice on the risk of typhoid for specific destinations can be found on the NaTHNaC Country Information Page.
References
1. Health Protection Agency (HPA). Pilot of enhanced enteric fever surveillance in England, Wales, and Northern Ireland: 1 May 2006 – 30 April 2007. London; HPA: 2008. Available at http://www.hpa.org.uk/infections/topics_az/typhoid/Enhanced/
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