Community-Wide Epidemiological Investigation of a Typhoid Outbreak in a Rural Township in Taiwan, Republic of China

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Abstract
King C C (Department of Microbiology, Soochow University, Taipei, Taiwan, Republic of China), Chen C J, You S J, Chuang Y C, Huang H H, Tsai W C. Community-wide epidemiological investigation of a typhoid outbreak in a rural township in Taiwan, Republic of China. International Journal of Epidemiology 1989, 18: 254–260. An outbreak of typhoid fever occurred in Chu-Tung township, Taiwan, with dates of onset from 6 July to 8 August, 1983. Fifty-four cases were hospitalized, of which 52 were laboratory confirmed. A chloramphenicol-resistant strain of Salmonella typhi was isolated from patients' blood samples. A community survey of 2772 people selected from 490 households by stratified systematic cluster sampling, presented an attack rate of 9.4 per 1000 and a case reporting rate of 10%. The attack rate was higher in males than females for persons younger than ten years, but was greater in females than in males aged 40 years and older. The only consistent characteristic of the early outbreak cases was drinking of tapwater (10/10, 100% versus 319/490, 65% of the controls). None of the early cases but 36% (13/36) of the late cases had drunk stream or river water. Households of early cases had better hygienic conditions than those of late cases. Laboratory examination of environmental specimens indicated Escherichia coli contamination of tapwater, well water and all stream foci associated with human activities. The epidemiological data combined with laboratory results suggested that the epidemic might be due to repeated contamination of some common source (such as municipal tapwater) and/or a variety of other vehicles.