A nationwide outbreak of coconut-associated paratyphoid A fever in Singapore.

A large outbreak of 167 cases of paratyphoid A was reported in Singapore during the period 15 February to 4 May 1996. Cases were distributed all over the country and no specific food establishment was implicated. The attack rate was highest among the Indian ethnic group between the ages of 25 and 34 years. A case-control study showed that consumption of a variety of food items in which imported deshelled coconut was used as an ingredient was statistically significantly associated with the illness (P < 0.001). As soon as the vehicle of transmission was suspected, the import of deshelled coconut was banned. No further cases were reported four weeks after the ban. The outbreak highlighted the need to maintain a high degree of vigilance against the introduction of infectious diseases through imported food.