A Common-Source Water-Borne Outbr~ak of Multi-
drug-Resistant Typhoid Fever in a Rural Thai Com-
munity
WITAY A SWADDIWUDHIPONG, M.D.*,
JIRAPAT KANLAYANAPHOTPORN, M.D.**
Affiliation : * Department of Community and Social Medicine, Mae Sot General Hospital, Talc 63110,
** Field Epid~miology Training Programme, Division of Epidemiology, Ministry of Public Health, Nonthaburi 11000,
Thailand. '·
AbstractWe report an epidemiological investigation of an e:._ .... !osive water-borne outbreak caused
by multidrug-resistant (MDR) Salmonella Typhi in a non-endemic community with otherwise good
sanitation. Between 31 October and 11 November 1999, 11 cases of typhoid fever occurred in
Poppra District, Tak Province. Four cases were children ~14 years of age and the remaining 7 were
adults 15-24 years old. Hemoculture was performed in 10 of the 11 cases, of whom 5 (50.0%) were
positive for Salmonella Typhi. All the isolates were of Vi phage type El4 which was resistant to
chloramphenicol, ampicillin, co-trimoxazole, tetracycline, and streptomycin but sensitive to kana-
mycin, of.loxacin, ciprofloxacin, and cefotaxime. One confirmed case developed intestinal perforation
leading to death. A case-control study revealed a sig •• ~fi2:1nt association between disease and drink-
ing unboiled spring water. The implication of ~pring water was supported by the presence of faecal
contamination in the spring water source. Rapid id:ontificatiOn of the possible transmission source
and prompt implementation of control measun:s curtailed the spread of this outbreak.
Keywords : Disease Outbreak, Salmonella Typhi, Natural Water Source
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