Evaluation of the effectiveness and efficiency of the public health management of cases of infection due to Salmonella typhi/paratyphi in North East London

SummaryObjectivesTo evaluate the public health management of cases of Salmonella typhi/paratyphi in North East London in relation to national Public Health Laboratory Service (PHLS) guidelines and to determine the effectiveness and efficiency of current practice.Study designA retrospective case-note review of laboratory-diagnosed cases of infection due to S. typhi/paratyphi in North East London in the 36 months from January 2002 to June 2004.ResultsEighty-one cases were diagnosed with infection due to S. typhi/paratyphi during the study period. Sixty-seven cases (83%) were notified to the relevant local authority and 38 of these had at least the minimum number of follow-up samples recommended in national guidelines. A total of 251 contacts were screened with between one and six stool samples. One contact was identified who appeared to be a chronic carrier of S. typhi. The cost of identifying one person with a positive stool sample was estimated to be £3463 and the cost of detecting one probable chronic carrier was estimated at £17 315.Conclusions:There have been considerable difficulties in ensuring that case follow-up and contact screening is carried out according to national guidelines in North East London. Amongst those screened, the detection of excretors of pathogenic organisms was low. No chronic carriers were detected amongst the contacts of cases that acquired their infection abroad. Screening all such contacts is difficult to carry out and appears to be an inefficient use of resources.