Typhoid Fever in Young Children of the North Indian Province of Punjab: Time to Include Conjugate Typhoid Vaccine for National Immunisation Schedule

Background: In highly endemic countries like India, typhoid fever is the most common bacteremic illness.The clinical presentation of typhoid fever in infants and young children can be varied and non specific.Typhoidal illness can present as a mild,non specific febrile illness to severe illness with features of the classic typhoidal syndrome of high fever,toxicity,hepatomegaly and splenomegaly.

Results: During the study period (March 2015- March 2018), 11014 children were admitted in pediatrics department,out of which 328 were diagnosed as cases of typhoid fever and out of these 211 were blood culture positive.Out of these 211 cases ,35(16.6%) were in children less than 2 years.Male to female ratio was 1.7:1.Maximum number of cases (43%) were seen during the months of July,August and September.All the patients (100%) had fever at presentation,followed by diarrhea(48.5%),vomiting(31.4%).On examination anemia was present in 31 (88.5%),hepatomegaly (48.5%),splenomegaly (25.7%).Maximum patients (80%) had defervescence within first 7 days of starting antibiotics.On laboratory investigations ALT was raised in 30 (85.7%) cases,LDH (31.4%),Serology i.e. widal test(TO titres more than 160) was reactive in 6 (17.1%) cases.Out of total 35 cases salmonella typhi was seen in 31(88.5%) and paratyphi in 4(11.5%) cases.Out of total 35 salmonella isolates all (100%) were resistant to naldixic acid,10(28.5%) were resistant to aminoglycosides,2 (5.7%) to fluroquinolones and 9 (25.7%) to both.All patients were unimmunized against typhoid vaccine.29 out of 35 patients were being bottle fed