A massive epidemic of multidrug-resistant typhoid fever in Tajikistan associated with consumption of municipal water

Jonathan H. Mermin, Rodrigo Villar, Joe Carpenter, Les Roberts, Aliev Samaridden, Larissa Gasanova, Svetlana Lomakina, Cheryl Bopp, Lori Hutwagner, Paul Mead, Bruce Ross, Eric D. Mintz

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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.

Original languageEnglish (US)
Pages (from-to)1416-1422
Number of pages7
JournalJournal of Infectious Diseases
Volume179
Issue number6
DOIs
Publication statusPublished - 1999
Externally publishedYes

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ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Immunology

Cite this

Mermin, J. H., Villar, R., Carpenter, J., Roberts, L., Samaridden, A., Gasanova, L., ... Mintz, E. D. (1999). A massive epidemic of multidrug-resistant typhoid fever in Tajikistan associated with consumption of municipal water. Journal of Infectious Diseases, 179(6), 1416-1422. https://doi.org/10.1086/314766