Epidemic typhoid fever–Dushanbe, Tajikistan, 1997

Typhoid fever, a severe systemic illness transmitted through food or water, is caused by the bacterium Salmonella serotype Typhi. This report describes a major epidemic of typhoid fever in Dushanbe, Tajikistan, that resulted from contamination of the municipal water system. In Tajikistan, the Sanitary Epidemiologic Service (SES) maintains records for reportable diseases. Dushanbe (1997 population: 600,000) residents receive health care through assigned polyclinics; surveillance for reportable diseases is based on polyclinic records. A case of typhoid fever is defined as physician diagnosis or isolation of S. Typhi from stool, blood, or urine cultures. In February 1997, a sudden increase in the number of typhoid fever cases was identified by SES in Dushanbe, with approximately 2000 cases registered during a 2-week period. In March, the Ministry of Health of Tajikistan requested assistance from CDC. In collaboration with local authorities and nongovernmental partners, CDC reviewed epidemiologic and laboratory surveillance; conducted a case-control study to identify risk factors for infection; and evaluated municipal drinking water quality, water wastage, and health-education campaigns.