Typhoid and paratyphoid fever in south-eastern Sydney, 1992-1997

Notification records of typhoid and paratyphoid cases among residents of south-eastern Sydney during 1992-1997 were reviewed, with particular attention paid to identifying a source of infection and to completeness of follow up. Notifications comprised 30 cases of Salmonella Typhi, nine of S. Paratyphi A and five of S. Paratyphi B. These 44 cases had a median age of 20 years (range 2-62). Of the 39 cases with known country of birth, 30 were born overseas, predominantly in Asian countries. Of 39 cases with a known travel history, 33 were cases of overseas-acquired acute infection and two cases were asymptomatic chronic carriers. A source was identified in only one of four domestically acquired infections. Of eight household contacts in occupations posing a public health risk (seven food-handlers and one health-care worker), complete follow-up information was available for only five. Most cases were in overseas-born individuals who may have been infected when returning to their country of birth. Explicit follow-up protocols need to cover appropriate clinical management (including treatment of chronic carriage) and monitoring of those cases and contacts who could pose a public health risk.