Background: Typhoid fever remains endemic in the Apulia region of southern Italy. Here we investigate why this occurs despite increasing levels of environmental public health measures.
Method: We collected morbidity data for typhoid fever in the Puglia region of Italy in the years 2000 to 2006 from the national mandatory surveillance system for infectious disease.
Results: In the last six years the rate of notified cases reduced substantially from approximately 1.1 per 100,000 in 2000 to 0.4 per 100,000 in 2006. Higher rates were observed in the Puglia region when compared to the national rates.
Discussion: A reduction in the number of cases and chronic carriers occurred alongside improvements in environmental and public health measures. In particular, in recent years, the improvement in the depuration of raw fish and the elimination of sewage discharge into the sea seem to have led to a sharp decline in the incidence of typhoid fever in southern Italy.