Abstract
.Typhoid fever is notifiable in South Africa but clinical notification is notoriously poor. South Africa has an estimated annual incidence rate of 0.1 cases per 100,000 population of culture-confirmed typhoid fever, decreased from 17 cases per 100,000 population in the 1980s. This work was undertaken to identify the reasons for this decrease and identify potential weaknesses that may result in an increase of observed cases. Culture-confirmed cases, with additional demographic and clinical data have been collected from selected sentinel sites since 2003. Data on contextual factors (gross domestic product [GDP], sanitation, female education, and childhood diarrhea mortality) were collected. National incidence rates of culture-confirmed typhoid fever have remained constant for the past 13 years, with the exception of an outbreak in 2005: incidence was 0.4 per 100,000 population. Paratyphoid fever remains a rare disease. Antimicrobial susceptibility data suggest resistance to ciprofloxacin and azithromycin is emerging. The South African population increased from 27.5 million in 1980 to 55.0 million in 2015: urbanization increased from 50% to 65%, GDP increased from United States Dollar (USD) $2,910 to USD $6,167, access to sanitation improved from 64.4% to 70.0% in the urban population and 26.4% to 60.5% in rural areas. Female literacy levels improved from 74.8% to 92.6% over the period. Improved socioeconomic circumstances in South Africa have been temporally associated with decreasing incidence rates of typhoid fever over a 35-year period. Ongoing challenges remain including potential for large outbreaks, a large immigrant population, and emerging antimicrobial resistance. Continued active surveillance is mandatory.
Highlights
Recent evidence has shown that South Africa has low endemicity for typhoid fever, with an estimated annual incidence rate of culture-confirmed disease of 0.1 cases per 100,00050 years ago, there was a very different pattern of disease, and in parts of the country, typhoid fever was highly endemic, with an estimated blood culture positivity rate of 500 per 100,000.4 typhoid fever and outbreaks in particular remain a problem on the Southern African subcontinent, with outbreaks having been reported from Zimbabwe, Zambia, and Malawi.[5,6,7,8]The current national surveillance system for typhoid and paratyphoid fever in South Africa relies on two methods
The South African population increased from 27.5 million in 1980 to 55.0 million in 2015: urbanization increased from 50% to 65%, gross domestic product (GDP) increased from United States Dollar (USD) $2,910 to USD $6,167, access to sanitation improved from 64.4% to 70.0% in the urban population and 26.4% to 60.5% in rural areas
Typhoid fever and outbreaks in particular remain a problem on the Southern African subcontinent, with outbreaks having been reported from Zimbabwe, Zambia, and Malawi.[5,6,7,8]
Summary
Recent evidence has shown that South Africa has low endemicity for typhoid fever, with an estimated annual incidence rate of culture-confirmed disease of 0.1 cases per 100,00050 years ago, there was a very different pattern of disease, and in parts of the country, typhoid fever was highly endemic, with an estimated blood culture positivity rate of 500 per 100,000.4 typhoid fever and outbreaks in particular remain a problem on the Southern African subcontinent, with outbreaks having been reported from Zimbabwe, Zambia, and Malawi.[5,6,7,8]The current national surveillance system for typhoid and paratyphoid fever in South Africa relies on two methods. Recent evidence has shown that South Africa has low endemicity for typhoid fever, with an estimated annual incidence rate of culture-confirmed disease of 0.1 cases per 100,000. 50 years ago, there was a very different pattern of disease, and in parts of the country, typhoid fever was highly endemic, with an estimated blood culture positivity rate of 500 per 100,000.4. Typhoid fever and outbreaks in particular remain a problem on the Southern African subcontinent, with outbreaks having been reported from Zimbabwe, Zambia, and Malawi.[5,6,7,8]. The current national surveillance system for typhoid and paratyphoid fever in South Africa relies on two methods. In addition to confirming each culture-positive case of typhoid fever, this latter system collects information on clinical presentation, antimicrobial susceptibility patterns, and molecular epidemiology of Salmonella enterica serotype Typhi (Salmonella Typhi)[10] and Salmonella Paratyphi A, Salmonella Paratyphi B, and Salmonella Paratyphi C (Salmonella Paratyphi) isolates.[11]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
