The burden of typhoid fever in Klang Valley, Malaysia, 2011–2015

Abstract

Background Typhoid fever causes global morbidity and mortality and is a significant health burden, particularly in low- and middle-income countries. The direct fecal-oral route is the main transmission mode, but indirect environmental transmission could occur, particularly in urban settings. This study aimed to investigate the burden and trend of typhoid fever, reporting the coverage system between government and private practice and pattern of multidrug-resistant (MDR) typhoid cases in the urban Klang Valley area from 2011 to 2015. Methods The data from a cross-sectional study retrieved from the e-Notifikasi System, a national reporting system for communicable diseases provided by the Disease Control Division, Ministry of Health Malaysia and secondary data of all the typhoid cases were obtained from the public and private hospitals and laboratories in Klang Valley. Descriptive analysis was performed to examine the sociodemographic characteristics, spatial mapping was conducted to examine trends, and the crude incidence rates of confirmed typhoid cases and percentage of reporting coverage were calculated. Significant differences between MDR and non-MDR Salmonella typhi were determined in the patient’s sociodemographic characteristics, which were analyzed using χ2 test. P values < 0.05 were considered statistically significant. Results In total, 507 typhoid fever cases were reported in Klang Valley; however, only 265 cases were confirmed by culture tests. The crude incidence rates of confirmed cases were between 0.5 to 0.7 but peaked at 1.42 per 100,000 population in 2015. Most typhoid fever cases were observed among men (55.6%), individuals aged 21 to 30 years (27.6%), Malaysians (86.3%) and individuals of Malay ethnicity (52.1%). The reporting coverage of confirmed cases was 78.9% and non-reporting coverage of unconfirmed typhoid cases was 79.5%. The predictive value positive (PVP) was 89.3, and 7.5% were detected as MDR Salmonella typhi. Statistical significance was found in gender, citizenship and ethnicity regarding MDR Salmonella typhi (p = 0.004, p = 0.008 and p = 0.034, respectively). Conclusions The local transmission of typhoid is still prevalent in the Klang Valley despite rapid urbanization and development in recent years. These findings are essential for policy makers to plan and implement focused and effective preventative activities to curb typhoid infection in urban areas.

Typhoid fever presenting as acute psychosis in a young adult: case report and literature review of typhoid psychosis

“…Although there is concern about the increasing number of multidrug-resistant Salmonella Typhi isolated globally, local data in Malaysia showed that this isolate occurred in only 7.5% of Salmonella Typhi and the highest resistance rate was found in ciprofloxacin with 24.1% (Muhammad et al, 2020). The ceftriaxone which is the first line of antimicrobial used in Salmonella Typhi infection had a very low resistance rate at 1.6% (Muhammad et al, 2020). The bacterial isolate from our patient was sensitive to all the tested antibiotics.…”

“…Thus, improvement in microbiologic quality of drinking water and better sanitation system leads to a reduction in typhoid fever incidence (Crump, 2019). The latest epidemiological study in Malaysia which was conducted in the most developed state in the country showed the peak incidence of 1.42 cases per 100,000 population in 2015 (Muhammad et al, 2020). Nevertheless, typhoid fever is still being reported particularly in the endemic area and the neuropsychiatric manifestation of typhoid fever continued to be reported.…”

“…Administration of the appropriate antimicrobial therapy resulted in complete resolution of psychotic symptoms without the need to use antipsychotic medication as shown in many cases (Adogu, 1990;Ukwaja, 2010;Alexander et al, 2017). Although there is concern about the increasing number of multidrug-resistant Salmonella Typhi isolated globally, local data in Malaysia showed that this isolate occurred in only 7.5% of Salmonella Typhi and the highest resistance rate was found in ciprofloxacin with 24.1% (Muhammad et al, 2020). The ceftriaxone which is the first line of antimicrobial used in Salmonella Typhi infection had a very low resistance rate at 1.6% (Muhammad et al, 2020).…”

Advancement in Salmonella Detection Methods: From Conventional to Electrochemical-Based Sensing Detection

“…Typhoid disease is rare in developed countries, but still prevalent in certain areas of developing countries with limited access to clean water and poor sanitation [ 42 , 43 ]. In Malaysia, it was estimated that 0.5 to 0.7 confirmed cases of Salmonella infection per 100,000 population were reported in 2015 [ 44 ]. Even though most of the outbreaks are endemic, the cases of both typhoid and paratyphoid fever declined globally by 45% from the year 1990 to 2017.…”

Performance of Immunodiagnostic Tests for Typhoid Fever: A Systematic Review and Meta-Analysis

“…In Malaysia, recent estimates suggest that approximately 0.58 to 1.42 cases of S . Typhi infection per 100,000 population were reported each year between 2011 and 2015 and most of the cases were due to travelers returning from an endemic region, migrants and food chains being contaminated by food handlers [ 3 ].…”