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Original ArticleOpen Access
A Common-Source Water-Borne Outbreak of Multidrug-Resistant Typhoid Fever in a Rural Thai Community
Swaddiwudhipong W 
,
Kanlayanaphotpom J
,
Kanlayanaphotpom J We report an epidemiological investigation of an e:._
.... !osive water-borne outbreak caused
by multidrug-resistant (MDR)
Salmonella
Typhi in a non-endemic community with otherwise good
sanitation. Between 31 October and 11 November 1999, 11 cases of typhoid fever occurred in
Poppra District, Tak Province. Four cases were children
~14
years of age and the remaining 7 were
adults 15-24 years old. Hemoculture was performed in 10 of the 11 cases, of whom 5 (50.0%) were
positive for
Salmonella
Typhi. All the isolates were of Vi phage type El4 which was resistant to
chloramphenicol, ampicillin, co-trimoxazole, tetracycline, and streptomycin but sensitive to kana-
mycin, of.loxacin, ciprofloxacin, and cefotaxime. One confirmed case developed intestinal perforation
leading to death. A case-control study revealed a sig **
~fi2:1nt
association between disease and drink-
ing unboiled spring water. The implication of
~pring
water was supported by the presence of faecal
contamination in the spring water source. Rapid id:ontificatiOn of the possible transmission source
and prompt implementation of control measun:s curtailed the spread of this outbreak.
Key word : Disease Outbreak,
Salmonella
Typhi, Natural Water Source
.... !osive water-borne outbreak caused
by multidrug-resistant (MDR)
Salmonella
Typhi in a non-endemic community with otherwise good
sanitation. Between 31 October and 11 November 1999, 11 cases of typhoid fever occurred in
Poppra District, Tak Province. Four cases were children
~14
years of age and the remaining 7 were
adults 15-24 years old. Hemoculture was performed in 10 of the 11 cases, of whom 5 (50.0%) were
positive for
Salmonella
Typhi. All the isolates were of Vi phage type El4 which was resistant to
chloramphenicol, ampicillin, co-trimoxazole, tetracycline, and streptomycin but sensitive to kana-
mycin, of.loxacin, ciprofloxacin, and cefotaxime. One confirmed case developed intestinal perforation
leading to death. A case-control study revealed a sig **
~fi2:1nt
association between disease and drink-
ing unboiled spring water. The implication of
~pring
water was supported by the presence of faecal
contamination in the spring water source. Rapid id:ontificatiOn of the possible transmission source
and prompt implementation of control measun:s curtailed the spread of this outbreak.
Key word : Disease Outbreak,
Salmonella
Typhi, Natural Water Source
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