An evidence-based review of current guidelines for the public health control of typhoid in Australia: A case for simplification and resource savings

Abstract

Background: Although an uncommon disease in Australia, public health control measures for typhoid remain important to prevent further cases, however, they are labour intensive. Methods: We reviewed current guidelines from all Australian states and territories, England and the United States to ascertain whether recommended control measures for typhoid are supported by evidence from the medical literature or data from Victorian typhoid notifications. Results: Guidelines lacked consistency and were overly complex, particularly with reference to the frequency and timing of faecal specimens required to demonstrate eradication of typhoid from cases and contacts. Data from the medical literature are limited and do not support the superiority of any one approach, or multiple approaches based on risk groups of cases or contacts. Victorian data suggest that a general approach, with a reduction in the number of specimens collected and duration of follow-up is reasonable. Conclusions: Potential exists for simplification and improved consistency between guidelines for the public health control of typhoid, with associated resource savings.