The proportion of paratyphoid fever cases to typhoid fever cases may
change due to urbanization and increased dependency on food purchased from
street vendors. For containment of paratyphoid a different strategy may be
needed than for typhoid, because risk factors for disease may not coincide
and current typhoid vaccines do not protect against paratyphoid fever.
To determine risk factors for typhoid and paratyphoid fever in an endemic
Design, Setting, and Participants
Community-based case-control study conducted from June 2001 to February
2003 in hospitals and outpatient health centers in Jatinegara district, Jakarta,
Indonesia. Enrolled participants were 1019 consecutive patients with fever
lasting 3 or more days, from which 69 blood culture–confirmed typhoid
cases, 24 confirmed paratyphoid cases, and 289 control patients with fever
but without Salmonella bacteremia were interviewed,
plus 378 randomly selected community controls.
Main Outcome Measures
Blood culture–confirmed typhoid or paratyphoid fever; risk factors
for both diseases.
In 1019 fever patients we identified 88 (9%) Salmonella
typhi and 26 (3%) Salmonella paratyphi A infections.
Paratyphoid fever among cases was independently associated with consumption
of food from street vendors (comparison with community controls: odds ratio
[OR], 3.34; 95% confidence interval [CI], 1.41-7.91; with fever controls:
OR, 5.17; 95% CI, 2.12-12.60) and flooding (comparison with community controls:
OR, 4.52; 95% CI, 1.90-10.73; with fever controls: OR, 3.25; 95% CI, 1.31-8.02).
By contrast, independent risk factors for typhoid fever using the community
control group were mostly related to the household, ie, to recent typhoid
fever in the household (OR, 2.38; 95% CI, 1.03-5.48); no use of soap for handwashing
(OR, 1.91; 95% CI, 1.06-3.46); sharing food from the same plate (OR, 1.93;
95% CI, 1.10-3.37), and no toilet in the household (OR, 2.20; 95% CI, 1.06-4.55).
Also, typhoid fever was associated with young age in years (OR, 0.96; 95%
CI, 0.94-0.98). In comparison with fever controls, risk factors for typhoid
fever were use of ice cubes (OR, 2.27; 95% CI, 1.31-3.93) and female sex (OR,
1.79; 95% CI, 1.04-3.06). Fecal contamination of drinking water was not associated
with typhoid or paratyphoid fever. We did not detect fecal carriers among
food handlers in the households.
In Jakarta, typhoid and paratyphoid fever are associated with distinct
routes of transmission, with the risk factors for disease either mainly within
the household (typhoid) or outside the household (paratyphoid).