Publication:
Burden of enteric fever at three urban sites in Africa and Asia: a multicentre population-based study

Issued Date

2021-12-01

Resource Type

Article

ISSN

2214109X

DOI

10.1016/S2214-109X(21)00370-3

Other identifier(s)

2-s2.0-85119582511

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

The Lancet Global Health. Vol.9, No.12 (2021), e1688-e1696

Suggested Citation

James E. Meiring, Mila Shakya, Farhana Khanam, Merryn Voysey, Maile T. Phillips, Susan Tonks, Deus Thindwa, Thomas C. Darton, Sabina Dongol, Abilasha Karkey, K. Zaman, Stephen Baker, Christiane Dolecek, Sarah J. Dunstan, Gordon Dougan, Kathryn E. Holt, Robert S. Heyderman, Firdausi Qadri, Virginia E. Pitzer, Buddha Basnyat, Melita A. Gordon, John Clemens, Andrew J. Pollard Burden of enteric fever at three urban sites in Africa and Asia: a multicentre population-based study. The Lancet Global Health. Vol.9, No.12 (2021), e1688-e1696. doi:10.1016/S2214-109X(21)00370-3 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/77476

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Title

Burden of enteric fever at three urban sites in Africa and Asia: a multicentre population-based study

Author(s)

James E. Meiring
 Mila Shakya
 Farhana Khanam
 Merryn Voysey
 Maile T. Phillips
 Susan Tonks
 Deus Thindwa
 Thomas C. Darton
 Sabina Dongol
 Abilasha Karkey
 K. Zaman
 Stephen Baker
 Christiane Dolecek
 Sarah J. Dunstan
 Gordon Dougan
 Kathryn E. Holt
 Robert S. Heyderman
 Firdausi Qadri
 Virginia E. Pitzer
 Buddha Basnyat
 Melita A. Gordon
 John Clemens
 Andrew J. Pollard

Other Contributor(s)

Oxford University Clinical Research Unit
 Department of Medicine
 Malawi-Liverpool-Wellcome Trust Clinical Research Programme
 University of Malawi College of Medicine
 Friends of Patan Hospital Nepal
 London School of Hygiene & Tropical Medicine
 University of Melbourne
 University College London
 University of Liverpool
 Faculty of Medicine, Nursing and Health Sciences
 Mahidol University
 International Centre for Diarrhoeal Disease Research Bangladesh
 Nuffield Department of Medicine
 Yale University
 University of Oxford Medical Sciences Division
 The University of Sheffield

Abstract

Background: Enteric fever is a serious public health concern in many low-income and middle-income countries. Numerous data gaps exist concerning the epidemiology of Salmonella enterica serotype Typhi (S Typhi) and Salmonella enterica serotype Paratyphi (S Paratyphi), which are the causative agents of enteric fever. We aimed to determine the burden of enteric fever in three urban sites in Africa and Asia. Methods: In this multicentre population-based study, we did a demographic census at three urban sites in Africa (Blantyre, Malawi) and Asia (Kathmandu, Nepal and Dhaka, Bangladesh) between June 1, 2016, and Sept 25, 2018. Households were selected randomly from the demographic census. Participants from within the geographical census area presenting to study health-care facilities were approached for recruitment if they had a history of fever for 72 h or more (later changed to >48 h) or temperature of 38·0°C or higher. Facility-based passive surveillance was done between Nov 11, 2016, and Dec 31, 2018, with blood-culture collection for febrile illness. We also did a community-based serological survey to obtain data on Vi-antibody defined infections. We calculated crude incidence for blood-culture-confirmed S Typhi and S Paratyphi infection, and calculated adjusted incidence and seroincidence of S Typhi blood-culture-confirmed infection. Findings: 423 618 individuals were included in the demographic census, contributing 626 219 person-years of observation for febrile illness surveillance. 624 S Typhi and 108 S Paratyphi A isolates were collected from the blood of 12 082 febrile patients. Multidrug resistance was observed in 44% S Typhi isolates and fluoroquinolone resistance in 61% of S Typhi isolates. In Blantyre, the overall crude incidence of blood-culture confirmed S Typhi was 58 cases per 100 000 person-years of observation (95% CI 48–70); the adjusted incidence was 444 cases per 100 000 person-years of observation (95% credible interval [CrI] 347–717). The corresponding rates were 74 (95% CI 62–87) and 1062 (95% CrI 683–1839) in Kathmandu, and 161 (95% CI 145–179) and 1135 (95% CrI 898–1480) in Dhaka. S Paratyphi was not found in Blantyre; overall crude incidence of blood-culture-confirmed S Paratyphi A infection was 6 cases per 100 000 person-years of observation (95% CI 3–11) in Kathmandu and 42 (95% CI 34–52) in Dhaka. Seroconversion rates for S Typhi infection per 100 000 person-years estimated from anti-Vi seroconversion episodes in serological surveillance were 2505 episodes (95% CI 1605–3727) in Blantyre, 7631 (95% CI 5913–9691) in Kathmandu, and 3256 (95% CI 2432–4270) in Dhaka. Interpretation: High disease incidence and rates of antimicrobial resistance were observed across three different transmission settings and thus necessitate multiple intervention strategies to achieve global control of these pathogens. Funding: Wellcome Trust and the Bill & Melinda Gates Foundation.

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/77476

Collections

Scopus 2021