Editing Typhoid fever (section)

== Epidemiology ==
{{Main|Epidemiology of typhoid fever}}
[[File:Fievre typhoide.png|thumb|300x300px|Typhoid fever incidence; most common in Asia, Africa, Central and South America<br />{{Legend|#FF0000|Strongly endemic areas}}{{Legend|#E08040|Moderately endemic areas}}]]
In 2000, typhoid fever caused an estimated 21.7 million illnesses and 217,000 deaths.<ref name=Crump2010/> It occurs most often in children and young adults between 5 and 19 years old.<ref name="who">{{cite web |title=Typhoid Fever |publisher=World Health Organization |url=https://www.who.int/vaccine_research/diseases/diarrhoeal/en/index7.html |access-date=2007-08-28 |url-status=dead |archive-url=https://web.archive.org/web/20111102190825/http://www.who.int/vaccine_research/diseases/diarrhoeal/en/index7.html |archive-date=2011-11-02 }}</ref> In 2013, it resulted in about 161,000 deaths – down from 181,000 in 1990.<ref name=GBD204 /> Infants, children, and adolescents in south-central and Southeast Asia have the highest rates of typhoid.<ref name="Crump JA, Luby SP, Mintz ED 2004">{{cite journal | vauthors = Crump JA, Luby SP, Mintz ED | title = The global burden of typhoid fever | journal = Bulletin of the World Health Organization | volume = 82 | issue = 5 | pages = 346–53 | date = May 2004 | pmid = 15298225 | pmc = 2622843 }}</ref> Outbreaks are also often reported in sub-Saharan Africa and Southeast Asia.<ref name="Muyembe-Tamfum JJ, Veyi J, Kaswa M, Lunguya O, Verhaegen J, Boelaert M 2009">{{cite journal | vauthors = Muyembe-Tamfum JJ, Veyi J, Kaswa M, Lunguya O, Verhaegen J, Boelaert M | title = An outbreak of peritonitis caused by multidrug-resistant Salmonella Typhi in Kinshasa, Democratic Republic of Congo | journal = Travel Medicine and Infectious Disease | volume = 7 | issue = 1 | pages = 40–3 | date = January 2009 | pmid = 19174300 | doi = 10.1016/j.tmaid.2008.12.006 }}</ref><ref name="Baddam, Ramani, Narender Kumar, Kwai-Lin Thong, Soo-Tein Ngoi, Cindy Shuan Ju Teh, Kien-Pong Yap, Lay-Ching Chai, Tiruvayipati Suma Avasthi, and Niyaz Ahmed 2012">{{cite journal | vauthors = Baddam R, Kumar N, Thong KL, Ngoi ST, Teh CS, Yap KP, Chai LC, Avasthi TS, Ahmed N | title = Genetic fine structure of a Salmonella enterica serovar Typhi strain associated with the 2005 outbreak of typhoid fever in Kelantan, Malaysia | journal = Journal of Bacteriology | volume = 194 | issue = 13 | pages = 3565–6 | date = July 2012 | pmid = 22689247 | pmc = 3434757 | doi = 10.1128/jb.00581-12 }}</ref><ref name="Yap et al 2012">{{cite journal | vauthors = Yap KP, Teh CS, Baddam R, Chai LC, Kumar N, Avasthi TS, Ahmed N, Thong KL | title = Insights from the genome sequence of a Salmonella enterica serovar Typhi strain associated with a sporadic case of typhoid fever in Malaysia | journal = Journal of Bacteriology | volume = 194 | issue = 18 | pages = 5124–5 | date = September 2012 | pmid = 22933756 | pmc = 3430317 | doi = 10.1128/jb.01062-12 }}</ref> In 2000, more than 90% of morbidity and mortality due to typhoid fever occurred in Asia.<ref>{{Cite web|url=https://www.who.int/bulletin/volumes/86/4/06-039818/en/|archive-url=https://web.archive.org/web/20080714165057/http://www.who.int/bulletin/volumes/86/4/06-039818/en/|url-status=dead|archive-date=July 14, 2008|title = WHO &#124; A study of typhoid fever in five Asian countries: Disease burden and implications for controls}}</ref> In the U.S., about 400 cases occur each year, 75% of which are acquired while traveling internationally.<ref>{{cite journal | vauthors = Matano LM, Morris HG, Wood BM, Meredith TC, Walker S | title = Accelerating the discovery of antibacterial compounds using pathway-directed whole cell screening | journal = Bioorganic & Medicinal Chemistry | volume = 24 | issue = 24 | pages = 6307–6314 | date = December 2016 | pmid = 27594549 | pmc = 5180449 | doi = 10.1016/j.bmc.2016.08.003 }}</ref><ref>{{cite web | title = Typhoid Fever | url = http://www.floridahealth.gov/diseases-and-conditions/disease-reporting-and-management/disease-reporting-and-surveillance/_documents/gsi-typhoid-fever.pdf | work = Florida Department of Health | date = December 23, 2013 }}</ref>

Before the antibiotic era, the [[case fatality rate]] of typhoid fever was 10–20%. Today, with prompt treatment, it is less than 1%,<ref>[[David L. Heymann|Heymann, David L.]], ed. (2008), ''[[Control of Communicable Diseases Manual]]'', [[Washington, D.C.]]: [[American Public Health Association]], pg 665. {{ISBN|978-0-87553-189-2}}.</ref> but 3–5% of people who are infected develop a chronic infection in the gall bladder.<ref name="Levine et al 1982">{{cite journal | vauthors = Levine MM, Black RE, Lanata C | title = Precise estimation of the numbers of chronic carriers of Salmonella typhi in Santiago, Chile, an endemic area | journal = The Journal of Infectious Diseases | volume = 146 | issue = 6 | pages = 724–6 | date = December 1982 | pmid = 7142746 | doi = 10.1093/infdis/146.6.724 }}</ref> Since ''S. enterica'' subsp. enterica serovar Typhi is human-restricted, these chronic carriers become the crucial reservoir, which can persist for decades for further spread of the disease, further complicating its identification and treatment.<ref name="G Gonzalez-Escobedo, JM Marshall, JS Gunn 2010">{{cite journal | vauthors = Gonzalez-Escobedo G, Marshall JM, Gunn JS | title = Chronic and acute infection of the gall bladder by Salmonella Typhi: understanding the carrier state | journal = Nature Reviews. Microbiology | volume = 9 | issue = 1 | pages = 9–14 | date = January 2011 | pmid = 21113180 | pmc = 3255095 | doi = 10.1038/nrmicro2490 }}</ref> Lately, the study of ''S. enterica'' subsp. enterica serovar Typhi associated with a large outbreak and a carrier at the genome level provides new insight into the pathogenesis of the pathogen.<ref name="Yap et al 2012-2">{{cite journal | vauthors = Yap KP, Gan HM, Teh CS, Baddam R, Chai LC, Kumar N, Tiruvayipati SA, Ahmed N, Thong KL | title = Genome sequence and comparative pathogenomics analysis of a Salmonella enterica Serovar Typhi strain associated with a typhoid carrier in Malaysia | journal = Journal of Bacteriology | volume = 194 | issue = 21 | pages = 5970–1 | date = November 2012 | pmid = 23045488 | pmc = 3486090 | doi = 10.1128/jb.01416-12 }}</ref><ref name="Yap et al 2014">{{cite journal | vauthors = Yap KP, Gan HM, Teh CS, Chai LC, Thong KL | title = Comparative genomics of closely related Salmonella enterica serovar Typhi strains reveals genome dynamics and the acquisition of novel pathogenic elements | journal = BMC Genomics | volume = 15 | issue = 1 | pages = 1007 | date = November 2014 | pmid = 25412680 | pmc = 4289253 | doi = 10.1186/1471-2164-15-1007 | doi-access = free }}</ref>

In industrialized nations, water sanitation and food handling improvements have reduced the number of typhoid cases.<ref>{{cite journal | vauthors = Crump JA, Sjölund-Karlsson M, Gordon MA, Parry CM | title = Epidemiology, Clinical Presentation, Laboratory Diagnosis, Antimicrobial Resistance, and Antimicrobial Management of Invasive Salmonella Infections | journal = Clinical Microbiology Reviews | volume = 28 | issue = 4 | pages = 901–37 | date = October 2015 | pmid = 26180063 | pmc = 4503790 | doi = 10.1128/CMR.00002-15 }}</ref> Third world nations have the highest rates. People in these areas often lack access to clean water, proper sanitation systems, and proper healthcare facilities. In these areas, such access to basic public-health needs is not expected in the near future.<ref>{{cite journal | vauthors = Khan MI, Pach A, Khan GM, Bajracharya D, Sahastrabuddhe S, Bhutta W, Tahir R, Soofi S, Thapa CB, Joshi N, Puri MK, Shrestha P, Upreti SR, Clemens JD, Bhutta Z, Ochiai RL | title = Typhoid vaccine introduction: An evidence-based pilot implementation project in Nepal and Pakistan | journal = Vaccine | volume = 33 | pages = C62-7 | date = June 2015 | issue = Suppl 3 | pmid = 25937612 | doi = 10.1016/j.vaccine.2015.03.087 }}</ref>

In 2004–2005, an outbreak in the [[Democratic Republic of Congo]] resulted in more than 42,000 cases and 214 deaths.<ref name="who" /> Since November 2016, [[Pakistan]] has had an outbreak of extensively [[drug-resistant]] (XDR) typhoid fever.<ref>{{cite news |title=Extensively Drug-Resistant Typhoid Fever in Pakistan |url=https://wwwnc.cdc.gov/travel/notices/watch/xdr-typhoid-fever-pakistan |work=Centers for Disease Control and Prevention |date=30 September 2019}}</ref>

In Europe, a report based on data for 2017 retrieved from The European Surveillance System (TESSy) on the distribution of confirmed typhoid and [[paratyphoid fever]] cases found that 22 EU/EEA countries reported a total of 1,098 cases, 90.9% of which were travel-related, mainly acquired during travel to [[South Asia]].<ref>{{cite web |url=https://www.ecdc.europa.eu/sites/default/files/documents/AER_for_2017_typhoid_and_paratyphoid_fevers.pdf |title=Typhoid and paratyphoid fevers: Annual Epidemiological Report for 2017 |publisher=European Centre for Disease Prevention and Control |date=October 2020 |access-date=20 July 2021 }}</ref>
===Outbreaks===
[[File:TyphoidOutbreaksMap.pdf|thumb|312x312px|Map of Typhoid Fever Outbreaks 1989–2018<ref name=":11">{{cite journal | vauthors = Appiah GD, Chung A, Bentsi-Enchill AD, Kim S, Crump JA, Mogasale V, Pellegrino R, Slayton RB, Mintz ED | title = Typhoid Outbreaks, 1989–2018: Implications for Prevention and Control | journal = The American Journal of Tropical Medicine and Hygiene | volume = 102 | issue = 6 | pages = 1296–1305 | date = June 2020 | pmid = 32228795 | pmc = 7253085 | doi = 10.4269/ajtmh.19-0624 }}</ref>]]
* [[Plague of Athens]] (suspected)<ref name=":10" />
* [[Cocoliztli epidemics]] (suspected)<ref name="Krause 2018">{{cite journal|last1=Vågene|first1=Åshild|display-authors=etal|title=Salmonella enterica genomes from victims of a major sixteenth-century epidemic in Mexico|journal=Nature Ecology & Evolution|url=https://www.biorxiv.org/content/10.1101/106740v2.full|date=2018|volume=2|issue=3|pages=520–528|doi=10.1038/s41559-017-0446-6|pmid=29335577|bibcode=2018NatEE...2..520V |s2cid=3358440}}</ref>
* "Burning Fever" outbreak among [[Native Americans in the United States|indigenous Americans]]. Between 1607 and 1624, 85% of the population at the [[James River]] died from a typhoid epidemic. The [[World Health Organization]] estimates the death toll was over 6,000 during this time.<ref>{{Cite web|title=Disease & Death in Early America: Tully Area Historical Society|url=https://tullyhistoricalsociety.org/tahs/medical.php#epidemics|access-date=2021-06-29|website=tullyhistoricalsociety.org}}</ref>
* [[Maidstone]], Kent outbreak in 1897–1898: 1,847 patients were recorded to have typhoid fever. This outbreak is notable because it was the first time a typhoid vaccine was deployed during a civilian outbreak. [[Almroth Wright|Almoth Edward Wright]]'s vaccine was offered to 200 healthcare providers, and of the 84 individuals who received the vaccine, none developed typhoid whereas 4 who had not been vaccinated became ill.<ref name=":1" />
* American army in the [[Spanish–American War|Spanish-American war]]: government records estimate over 21,000 troops had typhoid, resulting in 2,200 deaths.<ref name=":1" />
* In 1902, guests at mayoral banquets in Southampton and Winchester, England became ill and four died, including [[William Stephens (Dean of Winchester)|the Dean of Winchester]], after consuming oysters. The infection was due to oysters sourced from [[Emsworth]], where the oyster beds had been contaminated with raw sewage.<ref name="oyster1">{{cite web|date=10 February 2019|title=Emsworth Oysters|url=http://www.emsworth.org.uk/news/emsworths-oysters-video-now-online|url-status=dead|archive-url=https://web.archive.org/web/20160203191517/http://www.emsworth.org.uk/news/emsworths-oysters-video-now-online|archive-date=3 February 2016|publisher=Emsworth Business Association|df=dmy}}</ref><ref>{{Cite report|url=https://archive.org/stream/b24914812#page/n0/mode/2up|title=Dr. H. Timbrell Bulstrode's report to the Local Government Board upon alleged oyster-borne enteric fever and other illness following the mayoral banquets at Winchester and Southampton, and upon enteric fever occurring simultaneously elsewhere and also ascribed to oysters|publisher=HMSO|location=London|page=1|vauthors=Bulstrode HT|year=1903|df=dmy}}</ref>
* [[Jamaica Plain]] neighborhood, [[Boston]] in 1908 – linked to milk delivery. See the history section, "carriers" for further details.<ref name=":2" />
* Outbreak in upper-class New Yorkers who employed [[Mary Mallon]] – 51 cases and 3 deaths from 1907 to 1915.<ref name=":4" /><ref name=":7" />
* [[Aberdeen]], Scotland, in summer 1964 – traced back to contaminated canned beef sourced from Argentina sold in markets. More than 500 patients were quarantined in the hospital for a minimum of four weeks, and the outbreak was contained without any deaths.<ref>{{Cite news|date=2008-06-26|title=Typhoid left city 'under siege'|language=en-GB|url=http://news.bbc.co.uk/2/hi/uk_news/scotland/7471198.stm|access-date=2021-06-29}}</ref>
* [[Dushanbe]], Tajikistan, in 1996–1997: 10,677 cases reported, 108 deaths.<ref name=":11" />
* [[Kinshasa]], Democratic Republic of the Congo, in 2004: 43,000 cases and over 200 deaths.<ref name=":1" /> A prospective study of specimens collected in the same region between 2007 and 2011 revealed about one-third of samples obtained from patient samples were resistant to multiple antibiotics.<ref>{{cite journal | vauthors = Lunguya O, Lejon V, Phoba MF, Bertrand S, Vanhoof R, Verhaegen J, Smith AM, Keddy KH, Muyembe-Tamfum JJ, Jacobs J | title = Salmonella typhi in the democratic republic of the congo: fluoroquinolone decreased susceptibility on the rise | journal = PLOS Neglected Tropical Diseases | volume = 6 | issue = 11 | pages = e1921 | date = 2012-11-15 | pmid = 23166855 | pmc = 3499407 | doi = 10.1371/journal.pntd.0001921 | veditors = Ryan ET | doi-access = free }}</ref>
* [[Kampala]], Uganda in 2015: 10,230 cases reported.<ref name=":11" />