Distribution of antibody titer against Salmonella enterica among healthy individuals in nepal

Background: Enteric fever is an endemic problem in Nepal and Widal agglutination test is widely used for its diagnosis but a normal baseline titer in healthy population and cutoff values have not been established. Methods: We measured average baseline antibody titers against O and H antigens of Salmonella enterica serotype Typhi and H antigens of serotypes Paratyphi A and Paratyphi B among apparently healthy blood donors in Nepal. The antibody titers were measured using Standard Widal Confirmatory Quantitative Tube test. Results: Among the 100 blood samples collected from healthy volunteers, 62 individuals had significant antibody titers (>= 1:20) against one of the four antigens against S. enterica. Among 54 samples with an anti-O titer against serotype Typhi, 15 and 36 samples had titers of >= 1: 60 and >= 1:40, respectively. A significant proportion (12% of all) had anti-O titer of >= 1:80. Similarly, among the 59 samples demonstrating anti-H titers of >= 1:20 to S. enterica serotype Typhi, 29 had a titer of >= 1:80 and 12 had 1:160. For S. enterica serotypes Paratyphi A and B, anti-H titers of >= 1:20 were found only in 12% and 3%, respectively, of all samples tested. Conclusion: When a single Widal agglutination titer is used for the diagnosis of enteric fever, it will be more appropriate to change the currently used cutoff levels against S. enterica serotype Typhi to > 1:80 for anti-O and > 1:160 for anti-H titers for Nepal.