Informing the public health management of typhoid and paratyphoid: the Australian context

Abstract Objective: To examine outcomes of public health management of notified enteric fever cases in South‐East Queensland over the past five years. Methods: Notification records of typhoid and paratyphoid infection in South‐East Queensland 2008–2012 (inclusive) were reviewed to determine likelihood of cases and contacts adhering to present or previous recommendations for faecal clearance/screening, duration of infectiousness of cases and extent of local transmission to contacts. Results: Sixty‐nine of 85 cases and 218 of 265 contacts submitted at least one faecal specimen. Cases were 2.7 (95%CI 1.2–6.0) and contacts were 4.4 (95%CI 3.0–6.4) times more likely to complete recommended faecal clearance/screening under previous compared to present guidelines (requiring more specimens). In ten cases with positive post‐treatment specimens, last recorded infectiousness was 19 days to six months after notification. The documented rate of local transmission of infection was 18/1,000 contacts submitting at least one faecal specimen (95%CI 6–48/1,000). Conclusions: Local transmission risk of enteric fever in South‐East Queensland is low, although small numbers of cases may have prolonged bacilli excretion post‐treatment. More complex clearance/screening regimens are associated with decreased compliance. Implications: Pursuing extensive faecal clearance/screening regimens is unlikely to be effective in terms of public health management of enteric fever in South‐East Queensland. We suggest a unified national approach focussing on cases/contacts at high risk of disease transmission.