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Submitted: 16 May 2007
HERDIN Record #: PCHRDHE901695

Salmonella paratyphi A epidemic at Pilar Village, Las Pinas - June - July 1989.

 Pongol EZ,
 Bautista NB,
 White ME,
 Gacis FE,
 Dayrit MM

Between June 2-23, 1989, 150 typhoid cases were reported from Pilar Village subdivision (population 11,199). A cross-sectional survey was conducted to determine the extent of the epidemic, the source of the outbreak, its etiology and to determine effective control measures. A pre-tested self-administered questionnaire was distributed to 3,000 households. A case-control study was designed. A case was defined as an individual living in Pillar Village who reported having fever for =1 week or a febrile person who had Salmonella isolated from blood or stool. A control was defined as an individual living in Pilar Village who was well
Of the 824 (7%) residents surveyed, 110 (13%) cases were identified; 48% were males. The ages ranged from 2-57 years (median 29). Eight (42%) of 19 blood cultures grew S. paratyphi A.; 56 stool cultures grew no pathogens. Ninety four percent of the respondents were supplied with water from the Pilar Village waterworks and were eight times more likely to develop illness than those who used other sources of water (p 0.01 95% CI 1.4 - 350.8). Those who received water from the interconnected pipe system of five deep wells but usually treated their water (e.g. boiling) prior to the epidemic were more likely not to get sick (p 0.000 or 0.20 CI 0.12-0.33 by chi square test)
However, the protective effect of treating water was in the age groups above 6 years old. There was no association between food and illness. E. coli was positive in eight of nine water samples but not from two deep well samples
Undetectable chlorine in two deep well pumps inspected was due to infrequent stirring of the chlorine stock solution. Results of the water analysis of 25 households, after frequent stirring was advised, were negative for E. coli. Residual chlorine was detectable in 45 randomly selected households in the village; subsequetly, no more cases were reported. Residual chlorine and water analysis for E. coli are now regularly monitored by local health unit staff

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