Typhoid no longer an enemy of the past as study highlights risk for travellers to indian sub-continent

UK travellers visiting friends and relatives on the Indian sub-continent are carrying an unnecessary burden of typhoid and paratyphoid (also called enteric fevers), according to researchers at the Health Protection Agency.

Although the UK had its own typhoid problem several centuries ago, enteric fevers are now mainly confined to countries or regions of the world where sanitation and hygiene remain poor. In 2006, however, there were almost 500 cases (497) of enteric fever reported in England , Wales , and Northern Ireland – the highest level for 10 years.

Between May 2006 and April 2007 the Agency conducted a study to determine who is currently at risk of enteric fevers. Detailed information was collected for all laboratory confirmed cases including travel history, reason for travel, country of birth and ethnicity. The results show very clearly that the majority of cases occurred in people of Indian, Pakistani or Bangladeshi ethnicity, either UK- or non UK-born, who had travelled from the UK to their own or their family's country of origin to visit friends and relatives. Furthermore a substantive number of cases were infected with strains exhibiting resistance to antibiotics used for first-line treatment.

• Risk of infection was six-fold greater for those travelling to visit friends and relatives compared to those travelling for other reasons.

• India was the most reported country of travel but the highest rate of infection was in those who had travelled to Bangladesh .

• Only a small number of enteric fever cases reported were not linked to travel abroad, suggesting a minimal level of transmission, from travellers to other people, upon their return to the UK .

Enteric fevers are preventable by good food and water hygiene, including hand washing. Vaccination can also protect against typhoid (no vaccine is currently available against paratyphoid).

In the study people of Indian, Pakistani or Bangladeshi ethnicity were also the least likely to have sought pre-travel health advice and/or vaccination against typhoid before travelling.

Professor Peter Borriello, Director of the Health Protection Agency's Centre for Infections, said:

“It is really important that anyone travelling to areas where enteric fevers are a risk seeks medical advice at least a month before their trip. This is particularly true for people travelling to visit friends and relatives in the Indian sub-continent, irrespective of where they were born.

“Nearly a quarter of all cases reported to us were in children so everyone in the family needs to be protected to ensure that a reunion with relatives abroad does not get spoiled by an avoidable illness.”

Dr Jane Jones, Head of the Agency's Travel and Migrant Health Section, which co-ordinated the study, said:

“We have come a long way in the UK since the 19 th century when poor sanitation made typhoid a common disease and lack of effective treatment meant that many people died.

“Enteric fevers are serious, unpleasant diseases that often require hospitalisation and can be life-threatening. Thankfully today, enteric fevers are both preventable, through good hygiene practices and vaccination, and treatable with antibiotics.

“A worrying aspect of this study is that we have seen an increase in the number of infections becoming more resistant to the antibiotic of choice. This makes it all the more important to prevent disease in the first place.

“Healthcare professionals have a key role here to identify their at-risk patients and raise awareness of the simple steps necessary to protect their health when travelling.”