Bulletin of the World Health Organization

A study of typhoid fever in five Asian countries: disease burden and implications for controls

R Leon Ochiai, Camilo J Acosta, M Carolina Danovaro-Holliday, Dong Baiqing, Sujit K Bhattacharya, Magdarina D Agtini, Zulfiqar A Bhutta, Do Gia Canh, Mohammad Ali, Seonghye Shin, John Wain, Anne-Laure Page, M John Albert, Jeremy Farrar, Remon Abu-Elyazeed, Tikki Pang, Claudia M Galindo, Lorenz von Seidlein, John D Clemens, the Domi Typhoid Study Group

Volume 86, Number 4, April 2008, 260-268

Table 1. Characteristics and incidence of typhoid fever from the study sites

Site Hechi, China Kolkata, India North Jakarta, Indonesia Karachi, Pakistan Hue, Viet Nam Total P-valuea
Site setting Urban / rural Urban slums Urban slums Urban slums Urban – –
Total population from the study census [year of census] 112 889[2001] 56 946[2003] 160 261[2002] 101 937[2001, 2003]b 281 781[2002] 713 814 –
Surveillance period 1 Aug 2001 to 31 Jul 2002 1 Nov 2003 to 30 Oct 2004 1 Aug 2002 to 31 Jul 2003 1 Aug 2002 to 31 Jul 2004c 1 Jun 2002 to 30 Jun 2003 – –
Surveillance target population(age in years)
 5–60
 All ages
 All ages
 2–15
 5–18
 –
 –
Target population (persons)dBy age 97 928 56 946 160 261 41 845 84 455 441 435 –
0–1 years NA 1 121 3 506 NA NA 4 627 –
2–4 years NA 2 940 9 418 10 118 NA 22 476 –
5–15 years 17 084 12 767 32 164 31 727 66 114 159 856 –
≥ 16 years 80 844 40 118 115 173 NA 18 341 254 476 –
Mean age of target population (years)
 31.2
 28.6
 26.7
 8.5
 12.1
 23.4
 <  0.0001
Febrile episodes analysedBy age 1 215 4 378 4 867 7 736 3 678 21 874 –
0–1 years NA 156 1 103 NA NA 1 259 –
2–4 years NA 354 509 2 455 NA 3 318 –
5–15 years 391 1 211 989 5 281 3 461 11 333 –
≥ 16 years 824 2 657 2 266 NA 217 5 964 –
Mean age of febrile cases (years)
 27.4
 24.9
 17.3
 7.4
 10.4
 14.7
 –
Incidence of febrile episode (per 1000/year)By age 12.4 76.9 30.4 184.9 43.6 49.6 <  0.0001
0–1 years NA 139.2 314.6 NA NA 272.1 <  0.0001
2–4 years NA 120.4 54.1 242.6 NA 147.6 <  0.0001
5–15 years 22.9 94.9 30.8 166.5 52.4 70.9 <  0.0001
≥ 16 years
 10.2
 66.2
 19.7
 NA
 11.8
 23.4
 <  0.0001
Febrile episodes with blood culture takenBy age 1 215 4 342 3 954 7 415 3 611 20 537 –
0–1 years NA 145 404 NA NA 549 –
2–4 years NA 344 397 2 293 NA 3 034 –
5–15 years 391 1 201 945 5 122 3 400 11 059 –
≥ 16 years 824 2 652 2 208 NA 211 5 895 –
Mean age of febrile episodes with blood cultures taken (years)
 27.4
 25.0
 20.5
 7.5
 10.4
 15.4
 –
Typhoid casesBy age 15 122 131 189 18 475 –
0–1 years NA 1 0 NA NA 1 –
2–4 years NA 10 14 58 NA 82 –
5–15 years 5 63 58 131 16 273 –
≥ 16 years 10 48 59 NA 2 119 –
Mean age of typhoid cases (years)
 24.9
 15.5
 16.6
 7.0
 11.3
 12.5
 –
Typhoid Incidence(per 100 000/year)By age 15.3 214.2 81.7 451.7 21.3 107.6 <  0.0001
0–1 years NA 89.2 0.0 NA NA 21.6 0.0777
2–4 years NA 340.1 148.7 573.2 NA 364.8 <  0.0001
5–15 years 29.3 493.5 180.3 412.9 24.2 170.8 <  0.0001
≥ 16 years
 12.4
 119.7
 51.2
 NA
 10.9
 46.8
 <  0.0001
Typhoid prevalence(per 1000 febrile episodes with blood cultures taken)By age 12.3 28.1 33.1 25.5 5.0 23.1 <  0.0001
0–1 years NA 6.9 0.0 NA NA 1.8 0.0986
2–4 years NA 29.1 35.3 25.3 NA 27.0 0.5432
5–15 years 12.8 52.5 61.4 25.6 4.7 24.7 <  0.0001
≥ 16 years 12.1 18.1 26.7 NA 9.5 20.2 0.0243

NA, not available.a P-value for the five site comparison, estimated with 4 degrees of freedom.b Surveillance conducted from 1 Aug 2002 to 31Jul 2003 in Hijrat and Sultanabad, and from 1 Aug 2003 to 31 Jul 2004 in Bilal Colony.c Baseline censuses were conducted in Hijrat and Sultanabad in 2001, and in Bilal Colony in 2003.d For Hue, Viet Nam, the age is up to 18 years; for Hechi, China, the age is up to 60 years.