Investigation of an outbreak of several thousand cases of typhoid fever in Dushanbe, Tajikistan in 1997 that resulted from inadequately maintained public water supply.  

Learning Objectives:

After completing this case study, the student should be able to:

1. List health problems common in countries with economic hardships, deteriorating infrastructure, and displaced populations;
2. Discuss the steps typically used to develop hypotheses on the source of an infectious disease outbreak;
3. Interpret the results of a matched case-control study;
4. List activities that should be included in the evaluation of a public water system associated with an outbreak;
5. Define surface water and groundwater;
6. List the steps in collecting water samples from a point-of-use water tap;
7. Describe point-of-use water disinfection and give examples of proven approaches; and        
8. Describe the clinical features, epidemiology, and control of typhoid fever.