Outbreak of Typhoid Fever with Orange Juice as the Vehicle, Illustrating the Value of Immunization.

ASMALL localized epidemic of typhoid fever occurred in the E home, a residential hotel for business women, in Cleveland, Ohio, during January, 1944. Approximately 360 young women including 150 SPARS lived in the Home, among whom 18 cases of typhoid fever developed with 1 death. The outbreak is interesting because of the unusual vel;icle of the infection and because it affords an opportunity to observe the influence of vaccination against Eberthella typhosa. The first hint of the epidemic came on January 16, 1944, when a private. physician notified the Division of Health that he was treating two young women suffering from fever of unknown origin. The first of these had been hospitalized on January 5, the second on January 14. Both were -residents of the E 'Home. On January 16, a third resident was hospitalized with similar symptoms. On January 17, blood serum from the first patient agglutinafed E. typhosa in a relatively high titer (H 1:640, 0 1:2560). Epidemiological investigation was begun on January 18. Stool cultures and blood specimens were obtained immediately from all individuals who had had any contact with food handling [34. since November 1, 1943, including those who had left the service of the hotel. A plumbing survey was insti-' tuted and water samples from outlets on every floor were examined. Serving of food within the hotel was discontinued on January 19. All guests and employees were checked daily for suspicious symptoms. Letters were sent to all former guests who had resided at the Home during December and January with the request that the Division of Health be notified of any illness occurring within 30 days of departure from the Home. Replies were received from 23 of 49 letters sent. Information obtained revealed that 3 cases had occurred in this group, 1 of which had terminated fatally. The dates of onset of the 18 reported cases were as follows: