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Background  Enteric fever is an endemic problem in Nepal and Widal agglutination test is widely used for its diagnosis but a normal baseline titer in healthy population and cutoff values have not been established.    Methods  We measured average baseline antibody titers against "O" and "H" antigens of  Salmonella enterica  serotype  Typhi  and "H" antigens of serotypes  Paratyphi A  and  Paratyphi B  among apparently healthy blood donors in Nepal. The antibody titers were measured using Standard Widal Confirmatory Quantitative Tube test.    Results  Among the 100 blood samples collected from healthy volunteers, 62 individuals had significant antibody titers (≥ 1:20) against one of the four antigens against  S. enterica . Among 54 samples with an anti-O titer against serotype  Typhi , 15 and 36 samples had titers of ≥ 1:60 and ≥ 1:40, respectively. A significant proportion (12% of all) had anti-O titer of ≥ 1:80. Similarly, among the 59 samples demonstrating anti-H titers of ≥ 1:20 to  S. enterica  serotype  Typhi , 29 had a titer of ≥ 1:80 and 12 had 1:160. For  S. enterica  serotypes  Paratyphi A  and  B , anti-H titers of ≥ 1:20 were found only in 12% and 3%, respectively, of all samples tested.    Conclusion  When a single Widal agglutination titer is used for the diagnosis of enteric fever, it will be more appropriate to change the currently used cutoff levels against  S. enterica  serotype T yphi  to > 1:80 for anti-O and > 1:160 for anti-H titers for Nepal.

Distribution of antibody titer against Salmonella enterica among healthy individuals in nepal