Typhoid fever outbreak linked to Rainbow gathering in Northern Italy

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On 10 September 2017, French authorities reported to the European Centre for Disease Prevention and Control (ECDC) three cases of typhoid fever linked to the European Rainbow gathering that took place in Tramonti di Sopra, Friuli-Venezia Giulia region, Italy, from 23 July to 21 August 2017. On 12 September, German authorities reported a case linked to this Rainbow gathering. Additional cases are possibly associated with this event.

Typhoid fever is an infection caused by Salmonella Typhi, which is a rare disease in Europe but endemic in many parts of the world and causing approximately 21 million cases and 222 000 deaths annually worldwide.  The infection is usually associated with poor sanitation, food contamination and lack of clean drinking water. Severe forms of the disease can be lethal especially without adequate treatment.

Typhoid fever incubation period is usually 1-2 weeks but can be up to 60 days. Some individuals can become chronic carriers with the possibility to further transmit the disease to their close contacts without presenting with symptoms. The risk of further transmission is increased in the case of a chronic carrier involved in food handling activities. Therefore, infected participants returning home from Rainbow events may further transmit the disease.

It is important to note that typhoid fever is not the same disease as typhus fever. Further information on typhoid fever symptoms is available on ECDC Facts about typhoid fever.

Preventive measures include regular hand washing with soap, scrupulous food handling hygiene, eating thoroughly cooked food, and avoiding use of unsafe water without boiling it first. In natural circumstances, latrines should be located at a site distant from water sources. Typhoid fever vaccine is a safe vaccine with a moderate protective effect that can be considered for travellers to endemic areas, or people at increased risk for infection.

People presenting with fever and/or gastrointestinal symptoms after a potential exposure to persons infected with Salmonella Typhi should seek medical advice without delay.