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Epidemiological characteristics and trends of notified enteric fevers in Germany, 2001 to 2023

Julia Enkelmann1, Sandra Simon2, Eva Trost2

  • 1Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany.

Euro Surveillance : Bulletin Europeen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin
|April 11, 2025
PubMed

Insights

Most enteric fever cases in Germany are imported, with significant antimicrobial resistance. Typhoid vaccination is underutilized, necessitating better strategies for at-risk travelers to prevent enteric fever (EF).

Area of Science:

  • Public Health
  • Infectious Diseases
  • Epidemiology

Background:

  • Enteric fevers (EF), caused by Salmonella Typhi (STY) and Salmonella Paratyphi (SP), are reportable in Germany and show increasing antimicrobial resistance (AMR).
  • Understanding the characteristics and trends of notified EF cases is crucial for public health interventions.

Purpose of the Study:

  • To analyze the characteristics and trends of enteric fever cases notified in Germany between 2001 and 2023.
  • To assess imported EF cases among air travelers and identify key countries of exposure.
  • To evaluate antimicrobial resistance patterns and vaccination uptake.

Main Methods:

  • Analysis of confirmed enteric fever notifications in Germany from 2001-2023.
  • Calculation of imported EF cases per 100,000 air travelers by country of exposure (2012-2023).
  • Assessment of clinical characteristics, hospitalization rates, mortality, AMR, and vaccination status.

Main Results:

  • 2,670 confirmed EF cases were notified (56% STY, 44% SP), with seasonal peaks.
  • Most cases (86%) were imported, primarily from India, Pakistan, and Türkiye; hospitalization rates were high (78%).
  • Significant ciprofloxacin resistance was observed in STY and SP cases; cefotaxime resistance noted in STY cases from Pakistan and India. Typhoid vaccination was reported in only 7% of STY cases.

Conclusions:

  • Enteric fever cases in Germany are predominantly imported, associated with high hospitalization rates and concerning antimicrobial resistance.
  • Underutilization of typhoid vaccination highlights the need for improved strategies to reach at-risk travelers with information and vaccination.
  • Monitoring travel-associated infectious diseases and AMR is essential for effective public health policy.
Keywords:
GermanySalmonella ParatyphiSalmonella TyphiTyphoid feverantimicrobial resistanceenteric feverparatyphoid feversurveillance data

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