ArticlePLoS neglected tropical diseases2015
A Large-Scale Community-Based Outbreak of Paratyphoid Fever Caused by Hospital-Derived Transmission in Southern China.
Article in PLoS neglected tropical diseases, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 21 citations in OpenAlex.
- Paratyphoid fever and the genomics of Salmonella enterica serovar Paratyphi A in Taiwan.PLoS neglected tropical diseases · 2025Article
- Genomic Surveillance ofOpen forum infectious diseases · 2023Article
- Paratype: a genotyping tool for Salmonella Paratyphi A reveals its global genomic diversity.Nature communications · 2022Article
- Mutational Diversity in the Quinolone Resistance-Determining Regions of Type-II Topoisomerases ofAntibiotics (Basel, Switzerland) · 2021Review
- Survival ofFoods (Basel, Switzerland) · 2021Article
- Enteric Fever in Cambodia: Community Perceptions and Practices Concerning Disease Transmission and Treatment.The American journal of tropical medicine and hygiene · 2018Article
- Laboratory and molecular surveillance of paediatric typhoidal Salmonella in Nepal: Antimicrobial resistance and implications for vaccine policy.PLoS neglected tropical diseases · 2018Article
- Transforming bacterial disease surveillance and investigation using whole-genome sequence to probe the trace.Frontiers of medicine · 2018Review
- Molecular and Clinical Epidemiology ofThe American journal of tropical medicine and hygiene · 2017Article
- Genomic analysis ofMicrobial genomics · 2016Article
- The emergence and outbreak of multidrug-resistant typhoid fever in China.Emerging microbes & infections · 2016Article
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Authors and funding
12 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSince the 1990s, paratyphoid fever caused by Salmonella Paratyphi A has emerged in Southeast Asia and China. In 2010, a large-scale outbreak involving 601 cases of paratyphoid fever occurred in the whole of Yuanjiang county in China. Epidemiological and laboratory investigations were conducted to determine the etiology, source and transmission factors of the outbreak. METHODOLOGY/PRINCIPAL
findingsA case-control study was performed to identify the risk factors for this paratyphoid outbreak. Cases were identified as patients with blood culture-confirmed S. Paratyphi A infection. Controls were healthy persons without fever within the past month and matched to cases by age, gender and geography. Pulsed-field gel electrophoresis and whole-genome sequencing of the S. Paratyphi A strains isolated from patients and environmental sources were performed to facilitate transmission analysis and source tracking. We found that farmers and young adults were the populations mainly affected in this outbreak, and the consumption of raw vegetables was the main risk factor associated with paratyphoid fever. Molecular subtyping and genome sequencing of S. Paratyphi A isolates recovered from improperly disinfected hospital wastewater showed indistinguishable patterns matching most of the isolates from the cases. An investigation showed that hospital wastewater mixed with surface water was used for crop irrigation, promoting a cycle of contamination. After prohibition of the planting of vegetables in contaminated fields and the thorough disinfection of hospital wastewater, the outbreak subsided. Further analysis of the isolates indicated that the origin of the outbreak was most likely from patients outside Yuanjiang county.
conclusionsThis outbreak is an example of the combined effect of social behaviors, prevailing ecological conditions and improper disinfection of hospital wastewater on facilitating a sustained epidemic of paratyphoid fever. This study underscores the critical need for strict treatment measures of hospital wastewater and the maintenance of independent agricultural irrigation systems in rural areas.
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