Abstract
BackgroundTyphoid fever is endemic in Fiji, with high reported annual incidence. We sought to identify the sources and modes of transmission of typhoid fever in Fiji with the aim to inform disease control.Methodology/Principal findingsWe identified and surveyed patients with blood culture-confirmed typhoid fever from January 2014 through January 2017. For each typhoid fever case we matched two controls by age interval, gender, ethnicity, and residential area. Univariable and multivariable analysis were used to evaluate associations between exposures and risk for typhoid fever. We enrolled 175 patients with typhoid fever and 349 controls. Of the cases, the median (range) age was 29 (2–67) years, 86 (49%) were male, and 84 (48%) lived in a rural area. On multivariable analysis, interrupted water availability (odds ratio [OR] = 2.17; 95% confidence interval [CI] 1.18–4.00), drinking surface water in the last 2 weeks (OR = 3.61; 95% CI 1.44–9.06), eating unwashed produce (OR = 2.69; 95% CI 1.48–4.91), and having an unimproved or damaged sanitation facility (OR = 4.30; 95% CI 1.14–16.21) were significantly associated with typhoid fever. Frequent handwashing after defecating (OR = 0.57; 95% CI 0.35–0.93) and using soap for handwashing (OR = 0.61; 95% CI 0.37–0.95) were independently associated with a lower odds of typhoid fever.ConclusionsPoor sanitation facilities appear to be a major source of Salmonella Typhi in Fiji, with transmission by drinking contaminated surface water and consuming unwashed produce. Improved sanitation facilities and protection of surface water sources and produce from contamination by human feces are likely to contribute to typhoid control in Fiji.
Highlights
Typhoid fever remains a substantial cause of morbidity and mortality in many low- and middle-income countries, with an estimated 17.8 million new episodes annually [1]
Poor sanitation facilities appear to be a major source of Salmonella Typhi in Fiji, with transmission by drinking contaminated surface water and consuming unwashed produce
Improved sanitation facilities and protection of surface water sources and produce from contamination by human feces are likely to contribute to typhoid control in Fiji
Summary
Typhoid fever remains a substantial cause of morbidity and mortality in many low- and middle-income countries, with an estimated 17.8 million new episodes annually [1]. Pacific island nations including Fiji [4], Nauru [5], and Papua New Guinea [6] report high case counts of typhoid fever and frequent large outbreaks of the disease. Despite this apparent high incidence, studies to investigate sources and modes of transmission of typhoid fever in the Pacific, where unique socio-demographic, behavioral, and environmental conditions may exist, have been rare [4, 7]. We sought to identify the sources and modes of transmission of typhoid fever in Fiji with the aim to inform disease control
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