Evaluation of a New Assay for Vi Antibody in Chronic Carriers of Salmonella typhi

Abstract

The assay for serum antibody to the Salmonella typhi capsular polysaccharide (Vi) antigen has recently been revised because of the availability of a purified, highly polymerized Vi antigen. We compared this revised Vi antibody assay to the traditional one for potential usefulness in the surveillance of chronic enteric carriers of S. typhi. The purified Vi antigen of Citrobacter freundii was incorporated into a passive hemagglutination assay for serum Vi antibody; the standard Vi antibody assay was also a hemagglutination assay that employed as the Vi antigen a crude extract of Citrobacter (Ballerup O group 29). As determined by the revised assay, Vi antibody was found in the sera of 22 (71%) of 31 current typhoid carriers, none of 6 resolved carriers, and none of 22 control subjects. According to the traditional assay, Vi antibody was present in 23 of those current carriers (74%), 1 of the resolved carriers (17%), and 4 of the control subjects (18%). The rate of false-positive Vi antibody tests among resolved carriers and control subjects was less with the revised assay ( P < 0.05). Successful antimicrobial therapy resulted in a reversion to seronegativity within 1 year in 8 of 10 Vipositive carriers according to the revised assay, but in only 3 of 11 according to the standard assay ( P < 0.05). During a 2-year period of observation, 15 (94%) of 16 current typhoid carriers had at least one positive purified Vi antibody test; among 12 of those patients with Vi titers of 1:40 or greater, 9 (75%) were continuously Vi positive. Thus, the revised Vi antibody assay is more specific and no less sensitive than the standard assay for the condition of current enteric carriage of S. typhi. This serological test could be of value in the surveillance of typhoid carriers by public health agencies.