The epidemiology of typhoid fever in children in nonendemic areas such as the U.S. has not been well described. We identified 55 cases of typhoid fever in children ≤18 yrs in Chicago and suburban Cook County from 1/1/88-12/31/94 (67% of all statewide typhoid fever cases in this age group). Cases had positive blood and/or stool cultures for S. typhi. Patients were Asian/Indian (25%), Hispanic (22%), Black (13%), White (9%), other (20%), and unknown (11%). Age distribution was 0-5 yrs=35%, 6-10 yrs=25%, 11-15 yrs=31%, 16-18 yrs=9%. 12 of 56 cases had not travelled in the prior 2 months. All patients recovered, and none became carriers. 41 charts were available for further analysis. Common symptoms were fever (100%), diarrhea (77%), vomiting (50%) and dehydration (30%). Bacteremia was documented in 27/41 (66%). 15 of 41 cases had household contacts who were food handlers or health care workers. One case was a food handler. Antibiotic susceptibility of 26 isolates indicated that 8(31%) were resistant to both ampicillin and trimethoprim/sulfamethoxazole. We conclude that typhoid fever in children in the Chicago area occurs frequently in the 0-5 age group (in contrast to reports from endemic areas), that 20% of patients have no travel history, and that multi-drug resistant strains are prevalent. Significant numbers of food handlers and health care workers in the households of these patients highlights the importance of prompt reporting of cases to local health departments to further reduce transmission of illness in the U.S. by investigation of contacts and sources of infection.