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- Title
A massive epidemic of multidrug-resistant typhoid fever in Tajikistan associated with consumption of municipal water.
- Authors
Mermin, J H; Villar, R; Carpenter, J; Roberts, L; Samaridden, A; Gasanova, L; Lomakina, S; Bopp, C; Hutwagner, L; Mead, P; Ross, B; Mintz, E D
- Abstract
From 1 January through 30 June 1997, 8901 cases of typhoid fever and 95 associated deaths were reported in Dushanbe, Tajikistan. Of 29 Salmonella serotype Typhi isolates tested, 27 (93%) were resistant to ampicillin, chloramphenicol, nalidixic acid, streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole. In a case-control study of 45 patients and 123 controls, Salmonella Typhi infection was associated with drinking unboiled water (matched odds ratio, 7; 95% confidence interval, 3-24; P<.001). Of tap water samples, 97% showed fecal coliform contamination (mean level, 175 cfu/100 mL). Samples taken from water treatment plants revealed that fecal coliform contamination occurred both before and after treatment. Lack of chlorination, equipment failure, and back-siphonage in the water distribution system led to contamination of drinking water. After chlorination and coagulation were begun at the treatment plants and a water conservation campaign was initiated to improve water pressure, the incidence of typhoid fever declined dramatically.
- Publication
The Journal of infectious diseases, 1999, Vol 179, Issue 6, p1416
- ISSN
0022-1899
- Publication type
Journal Article
- DOI
10.1086/314766