Typhoid fever continues to be a global health problem particularly in the developing world where hygiene and sanitation are inadequate. The emergence and spread of drug resistance in Salmonella typhi has aggravated the situation leading to enormous morbidity, increased mortality and high cost of treatment. The first epidemic of drug-resistant typhoid fever (DRFT) in the Philippines hit Metro Manila and the surrounding provinces in 1993-1994. As an integral part of the coordinated efforts to control the outbreak, the Philippine Society for Microbiology and Infectious Diseases (PSMID) initiated a special surveillance system to monitor trends and patterns of antibiotic resistance of S. typhi using laboratory data from 13 hospitals in Metro Manila. The initial cases of DRTF reported in July-August 1993 clustered in Mandaluyong and Makati and harbored Salmonella typhi which was resistant to chloramphenicol and co-trimoxazole but susceptible to ampicillin. Subsequently, almost all municipalities/cities of Metro Manila and some sites in Rizal, Laguna, Cavite and Bulacan were affected. Males predominance with a male-female ratio of 1.5:1. School age children, adolescents and young adults were most frequently affected. While no common source for drug-resistant Salmonella typhi (DRST) was found, case-control studies implicated consumption of foods bought outside the home and served by street food vendors as a significant risk factor. Molecular work demonstrated that there was clonal dissemination of a single strain of DRST which could have acquired a resistance plasmid from other organisms; alternatively, the resistant strain could have been imported from another geographical region. The outbreak gradually subsided within one and a half years. No increase in case-fatality rates was reported. (Author)
General Objectives: To improve treatment of multidrug-resistant typhoid fever (MDR-TF) and recommend specific control measures to prevent spread of endemic MDR-TFSpecific Objectives:1. to sustain an existing hospital-based surveillance system for MDR-TF in Metro Manila2. to determine resistance rates of S. typhi and paratyphi A to various antimicrobials used in the treatment of typhoid fever3. to establish a bank of drug-resistant isolates for further study4. to provide specific recommendations on therapy and control measures to prevent transmission and spread of MDR-TF.