Program Schedule

Typhoid fever among immigration detainees: infection control challenges and potential for intra-and inter-facility spread

Session: Poster Abstract Session: Infectious Diseases in Travelers, Immigrants, and Refugees
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: In 2013, five patients with confirmed typhoid fever were diagnosed while in U.S. Immigration and Customs Enforcement (ICE) or U.S. Customs and Border Protection (CBP) custody.  Four patients required hospitalization; two of the patients, both from a South Asian country, were infected with drug resistant isolates. All hospitalized patients survived without sequelae and were returned to the respective law enforcement agency in stable clinical condition.

Methods: Confirmed cases had fever as well as a stool and/or blood culture positive for Salmonella typhi. Potential contacts were calculated for each typhoid fever case based on facility layout and dormitory census. Each patient was housed in at least two distinct facilities during their period of ICE custody; some patients transferred multiple times. The census of ICE detainees housed in these facilities ranged from approximately 180 to 1800 detainees. 

Results: These cases had close contact with an estimated 1300 other detainees in a total of nine facilities.  All of cases were barred from kitchen duties.  Challenges were encountered during the education of infected patients and other detainees due to low English proficiency and cultural diversity requiring the use of multilingual, low literacy posters and the use of telephonic translators.

Conclusion: Although the average time in custody prior to diagnosis and treatment was less than one week, asymptomatic carriers pose a unique risk given the potential for direct contact for extended periods of time and contamination of food as kitchen workers. Providers seeing patients in the immigration detention setting who present with febrile illness, even after extended custody stays, should consider typhoid fever in the differential diagnosis given the potential of intra- and inter-facility transmission. Hand hygiene, sanitary toileting practices and food handling training are cornerstones in prevention of spread within the detention setting.

Edith Lederman, MD, MPH1, Jennifer Merte, MPH1, Michael Reed, BSN, RN1, Ingrid St. Amand, MSN, BSN, RN1, Akara Ingram, BSN, RN1, Brent Stephen, MBA, MSHS1, Mark Nienhuis, PA-C1, Duane Caneva, MD2 and Diana Elson, DrPH, MA1, (1)ICE Health Service Corps, Washington, DC, (2)U.S. Customs and Border Protection, Washington, DC


E. Lederman, None

J. Merte, None

M. Reed, None

I. St. Amand, None

A. Ingram, None

B. Stephen, None

M. Nienhuis, None

D. Caneva, None

D. Elson, None

Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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