Changing epidemiology of enteric fevers in Singapore.

INTRODUCTION We studied the epidemiological trends of enteric fevers (typhoid and paratyphoid fever) in Singapore from 1990 to 2009 and carried out a review of the current prevention and control measures. MATERIALS AND METHODS Epidemiological records of all reported enteric fevers maintained by the Communicable Diseases Division, Ministry of Health from 1990 to 2009 were analysed. RESULTS A total of 2464 laboratory confirmed cases of enteric fevers (1699 cases of typhoid and 765 cases of paratyphoid) were reported. Of these, 75% were imported, mainly from India and Indonesia. There had been a significant fall in the mean annual incidence rate of indigenous enteric fevers from 4.3 per 100,000 population in 1990 to 0.26 per 100,000 population in 2009 (P <0.005) with a corresponding increase in the proportion of imported cases from 71% between 1990 and 1993 to 92% between 2006 and 2009 (P <0.0005). Imported cases involving foreign contract workers increased significantly from 12.8% between 1990 and 1993 to 40.4% between 2006 and 2009 (P <0.0005). CONCLUSION Singapore has experienced a marked decline in the incidence of enteric fevers that is now comparable to that of other developed countries. Continued vigilance and proactive measures that address the changing epidemiology of enteric fevers in Singapore are necessary to sustain the milestone achieved in the past 2 decades.