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Koh DH, Duong M, Kipshidze N, Pitzer VE, Kim JH. Time series data on typhoid fever incidence during outbreaks from 2000 to 2022. Sci Data 2025; 12:94. [PMID: 39821093 PMCID: PMC11739417 DOI: 10.1038/s41597-024-04289-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 12/11/2024] [Indexed: 01/19/2025] Open
Abstract
This article presents a comprehensive dataset compiling reported cases of typhoid fever from culture-confirmed outbreaks across various geographical locations from 2000 through 2022, categorized into daily, weekly, and monthly time series. The dataset was curated by identifying peer-reviewed epidemiological studies available in PubMed, OVID-Medline, and OVID-Embase. Time-series incidence data were extracted from plots using WebPlotDigitizer, followed by verification of a subset of the dataset. The primary aim of this dataset is to serve as a foundational tool for researchers and policymakers, enabling the development of robust, model-based strategies for the control of typhoid fever outbreaks. The article describes the method by which the dataset has been compiled and how the quality of the data has been verified. Furthermore, it discusses the dataset's potential applications in optimizing vaccination campaigns, improving public health planning, and tailoring interventions to specific epidemiologic contexts. This article contributes significantly to the field of infectious disease modeling, offering a valuable resource for enhancing typhoid fever control measures globally.
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Affiliation(s)
- Dae-Hyup Koh
- Epidemiology, Public Health, Impact, International Vaccine Institute, Seoul, Korea
- Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Monica Duong
- Epidemiology, Public Health, Impact, International Vaccine Institute, Seoul, Korea
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Nodar Kipshidze
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Jong-Hoon Kim
- Epidemiology, Public Health, Impact, International Vaccine Institute, Seoul, Korea.
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Perkins JM, Kakuhikire B, Baguma C, Meadows M, Abayateye R, Rasmussen JD, Satinsky EN, Gumisiriza P, Kananura J, Namara EB, Bangsberg DR, Tsai AC. Water Treatment Practices and Misperceived Social Norms among Women Living with Young Children in Rural Uganda. Am J Trop Med Hyg 2024; 111:627-637. [PMID: 38981491 PMCID: PMC11376185 DOI: 10.4269/ajtmh.23-0723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/26/2024] [Indexed: 07/11/2024] Open
Abstract
Access to water safe for consumption is critical for health and well-being, yet substantial structural barriers often necessitate household action to make water safer. Social norms about water treatment practices are understudied as a driver of personal water treatment practice. This study assesses reported and perceived water treatment practices among women in a rural, water insecure setting. We used cross-sectional data from a population-based study of women living with children under 5 years old across eight villages in southwest Uganda. Participants reported their typical household water treatment practices and what they perceived to be the common practices among most other women with young children in their own village. Modified multivariable Poisson regression models estimated the association between individual behavior and perceptions. Of 274 participants (78% response rate), 221 (81%) reported boiling water and 228 (83%) reported taking at least one action to make water safer. However, 135 (49%) misperceived most women with young children in their village not to boil their water, and 119 (43%) misperceived most to take no action. Participants who misperceived these norms were less likely to practice safe water treatment (e.g., for boiling water, adjusted relative risk = 0.80; 95% CI 0.69-0.92, P = 0.002), adjusting for other factors. Future research should assess whether making actual descriptive norms about local water treatment practices visible and salient (e.g., with messages such as "most women in this village boil their drinking water") corrects misperceived norms and increases safe water treatment practices by some and supports consistent safe practices by others.
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Affiliation(s)
- Jessica M Perkins
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, Tennessee
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Meredith Meadows
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, Tennessee
| | | | | | - Emily N Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychology, University of Southern California, Los Angeles, California
| | | | - Justus Kananura
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - David R Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda
- VinUniversity, Hanoi, Vietnam
| | - Alexander C Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts
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Phillips MT, Antillon M, Bilcke J, Bar-Zeev N, Limani F, Debellut F, Pecenka C, Neuzil KM, Gordon MA, Thindwa D, Paltiel AD, Yaesoubi R, Pitzer VE. Cost-effectiveness analysis of typhoid conjugate vaccines in an outbreak setting: a modeling study. BMC Infect Dis 2023; 23:143. [PMID: 36890448 PMCID: PMC9993384 DOI: 10.1186/s12879-023-08105-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 02/20/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Several prolonged typhoid fever epidemics have been reported since 2010 throughout eastern and southern Africa, including Malawi, caused by multidrug-resistant Salmonella Typhi. The World Health Organization recommends the use of typhoid conjugate vaccines (TCVs) in outbreak settings; however, current data are limited on how and when TCVs might be introduced in response to outbreaks. METHODOLOGY We developed a stochastic model of typhoid transmission fitted to data from Queen Elizabeth Central Hospital in Blantyre, Malawi from January 1996 to February 2015. We used the model to evaluate the cost-effectiveness of vaccination strategies over a 10-year time horizon in three scenarios: (1) when an outbreak is likely to occur; (2) when an outbreak is unlikely to occur within the next ten years; and (3) when an outbreak has already occurred and is unlikely to occur again. We considered three vaccination strategies compared to the status quo of no vaccination: (a) preventative routine vaccination at 9 months of age; (b) preventative routine vaccination plus a catch-up campaign to 15 years of age; and (c) reactive vaccination with a catch-up campaign to age 15 (for Scenario 1). We also explored variations in outbreak definitions, delays in implementation of reactive vaccination, and the timing of preventive vaccination relative to the outbreak. RESULTS Assuming an outbreak occurs within 10 years, we estimated that the various vaccination strategies would prevent a median of 15-60% of disability-adjusted life-years (DALYs). Reactive vaccination was the preferred strategy for WTP values of $0-300 per DALY averted. For WTP values > $300, introduction of preventative routine TCV immunization with a catch-up campaign was the preferred strategy. Routine vaccination with a catch-up campaign was cost-effective for WTP values above $890 per DALY averted if no outbreak occurs and > $140 per DALY averted if implemented after the outbreak has already occurred. CONCLUSIONS Countries for which the spread of antimicrobial resistance is likely to lead to outbreaks of typhoid fever should consider TCV introduction. Reactive vaccination can be a cost-effective strategy, but only if delays in vaccine deployment are minimal; otherwise, introduction of preventive routine immunization with a catch-up campaign is the preferred strategy.
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Affiliation(s)
- Maile T Phillips
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College St., P.O. Box 208034, New Haven, CT, 06520-8034, USA
| | - Marina Antillon
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Joke Bilcke
- Center for Health Economics Research and Modeling Infectious Diseases, University of Antwerp, Antwerp, Belgium
| | - Naor Bar-Zeev
- International Vaccine Access Center, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Malawi Liverpool Wellcome Programme, Blantyre, Malawi
| | - Fumbani Limani
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi.,Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Clint Pecenka
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Melita A Gordon
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi.,Kamuzu University of Health Sciences, Blantyre, Malawi.,Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Deus Thindwa
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - A David Paltiel
- Department of Health Policy, Yale School of Public Health, New Haven, CT, USA
| | - Reza Yaesoubi
- Department of Health Policy, Yale School of Public Health, New Haven, CT, USA
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College St., P.O. Box 208034, New Haven, CT, 06520-8034, USA.
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Moyo TM, Juru TP, Sibanda E, Marape G, Gombe NT, Govha E, Tshimanga M. Risk factors for contracting watery diarrhoea in Mzilikazi, Bulawayo City, Zimbabwe, 2020: a case control study. Pan Afr Med J 2022; 41:145. [PMID: 35519157 PMCID: PMC9046859 DOI: 10.11604/pamj.2022.41.145.30551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Mzilikazi clinic had an upsurge of diarrhoea cases with 41 cases from the 28th to the 30th of September 2020, against a threshold of 11. We therefore, investigated the risk factors associated with this outbreak to recommend prevention and control measures. Methods we conducted a 1:1 unmatched case-control study. A case was any person who suffered from diarrhoea, and was resident in the clinic´s catchment since the 21st of September 2020. Demographic data, knowledge and practices related to diarrhoea were collected using a standard questionnaire for both cases and controls. Environmental assessment, water quality and stool testing was also done. We conducted univariate and multivariate analysis at 95% confidence interval, to determine factors independently associated with contracting diarrhoea. Results the median age was 30 years (Q1=12, Q3=46) for cases and 30 years (Q1=22, Q3=48) for controls. The dominant gender was female for cases and male for controls. The independent risk factors were: drinking borehole water [adjusted Odds Ratio (aOR)=2.66; 95%CI=(1.41-5.00)], storing water in open container [aOR=2.76; 95%CI=(1.38-5.53)] and being under-five years old [aOR=5.73; 95%CI=(2.06-15.89)]. Boiling drinking water [aOR=0.39; 95%CI=(0.20-0.75)] was protective. Coliforms were detected from boreholes and stored water samples, and Shigella flexneri was isolated from 2 of the 13 stool specimens collected. Residents accessed water from decommissioned boreholes due to severe municipal water rationing. Conclusion being under-five years old, drinking borehole water and storing water in open containers were independent risk factors. Health education on home water treatment, distribution of water storage containers, and Aquatabs was done.
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Affiliation(s)
- Tshebukani Mzingaye Moyo
- Department of Primary Health Care Sciences, Family Medicine, Global and Public Health Unit, University of Zimbabwe, Harare, Zimbabwe
| | - Tsitsi Patience Juru
- Department of Primary Health Care Sciences, Family Medicine, Global and Public Health Unit, University of Zimbabwe, Harare, Zimbabwe,,Corresponding author: Tsitsi Patience Juru, Department of Primary Health Care Sciences, Family Medicine, Global and Public Health Unit, University of Zimbabwe, Harare, Zimbabwe.
| | - Edwin Sibanda
- Department of Health, Bulawayo City Council, Bulawayo, Zimbabwe
| | - Gladys Marape
- Department of Health, Bulawayo City Council, Bulawayo, Zimbabwe
| | | | - Emmanuel Govha
- Department of Primary Health Care Sciences, Family Medicine, Global and Public Health Unit, University of Zimbabwe, Harare, Zimbabwe
| | - Mufuta Tshimanga
- Department of Primary Health Care Sciences, Family Medicine, Global and Public Health Unit, University of Zimbabwe, Harare, Zimbabwe
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Khaliq A, Yousafzai MT, Haq S, Yaseen R, Qureshi S, Rind F, Padhani ZA, Khan A, Kazi AM, Qamar FN. A review of toolkits and case definitions for detecting enteric fever outbreaks in Asian and African countries from 1965-2019. J Glob Health 2021; 11:04031. [PMID: 34131486 PMCID: PMC8183158 DOI: 10.7189/jogh.11.04031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background This review assessed the case definitions, diagnostic criteria, antimicrobial resistance, and methods used for enteric fever outbreaks and utilization of any unified outbreak score or checklist for early identification and response in Asia and Africa from 1965-2019. Methods We searched enteric fever outbreaks using PubMed, Google Scholar, and the Cochrane library. Studies describing a single outbreak event of enteric fever in Asia and Africa from 1965-2019 were reviewed. We excluded case reports, letter to editors, studies reporting typhoid in conjunction with other diseases, the Centers for Disease Control and Prevention (CDC) trip reports, the World Health Organization (WHO) bulletins report, data from mathematical modeling and simulation studies, reviews and ProMed alert. Also, non-typhoidal salmonella outbreaks were excluded. Results A total of 5063 articles were identified using the key terms and 68 studies were selected for data extraction. Most (48, 71%) outbreaks were from Asian countries, 20 (29%) were reported from Africa. Only 15 studies reported the case definition used for case identification during an outbreak and 8 of those were from Asia. A third (20, 29%) of the studies described antibiotic resistance pattern. 43 (63%) studies contained information regarding the source of the outbreak. Outcomes (hospitalization and deaths) were reported in a quarter of studies. Only 23 (29%) of the studies reported outbreak control strategies while none reported any unified outbreak score or a checklist to identify the outbreak. Conclusion This review highlights the variability in detection and reporting methods for enteric fever outbreaks in Asia and Africa. No standardized case definitions or laboratory methods were reported. Only a few studies reported strategies for outbreak control. There is a need for the development of a unified outbreak score or a checklist to identify and report enteric fever outbreaks globally.
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Affiliation(s)
- Asif Khaliq
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Aga Khan University Karachi, Pakistan.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Mohammad Tahir Yousafzai
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Aga Khan University Karachi, Pakistan.,Kirby Institute, University of New South Wales, Australia
| | - Salman Haq
- Ziauddin Medical College, Ziauddin University Karachi, Pakistan
| | - Rahima Yaseen
- Ziauddin Medical College, Ziauddin University Karachi, Pakistan
| | - Sonia Qureshi
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Aga Khan University Karachi, Pakistan
| | - Fahad Rind
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Aga Khan University Karachi, Pakistan
| | - Zahra A Padhani
- Institute of Global Health and Development, Aga Khan University Hospital, Karachi
| | - Ayub Khan
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Aga Khan University Karachi, Pakistan
| | - Abdul Momin Kazi
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Aga Khan University Karachi, Pakistan
| | - Farah Naz Qamar
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Aga Khan University Karachi, Pakistan
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Kim S, Lee KS, Pak GD, Excler JL, Sahastrabuddhe S, Marks F, Kim JH, Mogasale V. Spatial and Temporal Patterns of Typhoid and Paratyphoid Fever Outbreaks: A Worldwide Review, 1990-2018. Clin Infect Dis 2020; 69:S499-S509. [PMID: 31665782 PMCID: PMC6821269 DOI: 10.1093/cid/ciz705] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Analyses of the global spatial and temporal distribution of enteric fever outbreaks worldwide are important factors to consider in estimating the disease burden of enteric fever disease burden. METHODS We conducted a global literature review of enteric fever outbreak data by systematically using multiple databases from 1 January 1990 to 31 December 2018 and classified them by time, place, diagnostic methods, and drug susceptibility, to illustrate outbreak characteristics including spatial and temporal patterns. RESULTS There were 180 940 cases in 303 identified outbreaks caused by infection with Salmonella enterica serovar Typhi (S. Typhi) and Salmonella enterica serovar Paratyphi A or B (S. Paratyphi). The size of outbreak ranged from 1 to 42 564. Fifty-one percent of outbreaks occurred in Asia, 15% in Africa, 14% in Oceania, and the rest in other regions. Forty-six percent of outbreaks specified confirmation by blood culture, and 82 outbreaks reported drug susceptibility, of which 54% had multidrug-resistant pathogens. Paratyphoid outbreaks were less common compared to typhoid (22 vs 281) and more prevalent in Asia than Africa. Risk factors were multifactorial, with contaminated water being the main factor. CONCLUSIONS Enteric fever outbreak burden remains high in endemic low- and middle-income countries and, despite its limitations, outbreak data provide valuable contemporary evidence in prioritizing resources, public health policies, and actions. This review highlights geographical locations where urgent attention is needed for enteric fever control and calls for global action to prevent and contain outbreaks.
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Affiliation(s)
- Samuel Kim
- International Vaccine Institute, Seoul, Republic of Korea.,Imperial College London, United Kingdom
| | - Kang Sung Lee
- International Vaccine Institute, Seoul, Republic of Korea
| | - Gi Deok Pak
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea.,Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
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Kim JH, Im J, Parajulee P, Holm M, Cruz Espinoza LM, Poudyal N, Mogeni OD, Marks F. A Systematic Review of Typhoid Fever Occurrence in Africa. Clin Infect Dis 2020; 69:S492-S498. [PMID: 31665777 PMCID: PMC6821235 DOI: 10.1093/cid/ciz525] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Our current understanding of the burden and distribution of typhoid fever in Africa relies on extrapolation of data from a small number of population-based incidence rate estimates. However, many other records on the occurrence of typhoid fever are available, and those records contain information that may enrich our understanding of the epidemiology of the disease as well as secular trends in reporting by country and over time. METHODS We conducted a systematic review of typhoid fever occurrence in Africa, published in PubMed, Embase, and ProMED (Program for Monitoring Emerging Diseases). RESULTS At least one episode of culture-confirmed typhoid fever was reported in 42 of 57 African countries during 1900-2018. The number of reports on typhoid fever has increased over time in Africa and was highly heterogeneous between countries and over time. Outbreaks of typhoid fever were reported in 15 countries, with their frequency and size increasing over time. CONCLUSIONS Efforts should be made to leverage existing typhoid data, for example, by incorporating them into models for estimating the burden and distribution of typhoid fever.
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Affiliation(s)
- Jong-Hoon Kim
- Public Health, Access, and Vaccine Epidemiology (PAVE) Unit, International Vaccine Institute, Seoul, Korea
| | - Justin Im
- Public Health, Access, and Vaccine Epidemiology (PAVE) Unit, International Vaccine Institute, Seoul, Korea
| | - Prerana Parajulee
- Public Health, Access, and Vaccine Epidemiology (PAVE) Unit, International Vaccine Institute, Seoul, Korea
| | - Marianne Holm
- Public Health, Access, and Vaccine Epidemiology (PAVE) Unit, International Vaccine Institute, Seoul, Korea
| | - Ligia Maria Cruz Espinoza
- Public Health, Access, and Vaccine Epidemiology (PAVE) Unit, International Vaccine Institute, Seoul, Korea
| | - Nimesh Poudyal
- Public Health, Access, and Vaccine Epidemiology (PAVE) Unit, International Vaccine Institute, Seoul, Korea
| | - Ondari D Mogeni
- Public Health, Access, and Vaccine Epidemiology (PAVE) Unit, International Vaccine Institute, Seoul, Korea
| | - Florian Marks
- Public Health, Access, and Vaccine Epidemiology (PAVE) Unit, International Vaccine Institute, Seoul, Korea.,Department of Medicine, University of Cambridge, United Kingdom
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Appiah GD, Chung A, Bentsi-Enchill AD, Kim S, Crump JA, Mogasale V, Pellegrino R, Slayton RB, Mintz ED. Typhoid Outbreaks, 1989-2018: Implications for Prevention and Control. Am J Trop Med Hyg 2020; 102:1296-1305. [PMID: 32228795 PMCID: PMC7253085 DOI: 10.4269/ajtmh.19-0624] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Typhoid fever remains an important public health problem in low- and middle-income countries, with large outbreaks reported from Africa and Asia. Although the WHO recommends typhoid vaccination for control of confirmed outbreaks, there are limited data on the epidemiologic characteristics of outbreaks to inform vaccine use in outbreak settings. We conducted a literature review for typhoid outbreaks published since 1990. We found 47 publications describing 45,215 cases in outbreaks occurring in 25 countries from 1989 through 2018. Outbreak characteristics varied considerably by WHO region, with median outbreak size ranging from 12 to 1,101 cases, median duration from 23 to 140 days, and median case fatality ratio from 0% to 1%. The largest number of outbreaks occurred in WHO Southeast Asia, 13 (28%), and African regions, 12 (26%). Among 43 outbreaks reporting a mode of disease transmission, 24 (56%) were waterborne, 17 (40%) were foodborne, and two (5%) were by direct contact transmission. Among the 34 outbreaks with antimicrobial resistance data, 11 (32%) reported Typhi non-susceptible to ciprofloxacin, 16 (47%) reported multidrug-resistant (MDR) strains, and one reported extensively drug-resistant strains. Our review showed a longer median duration of outbreaks caused by MDR strains (148 days versus 34 days for susceptible strains), although this difference was not statistically significant. Control strategies focused on water, sanitation, and food safety, with vaccine use described in only six (13%) outbreaks. As typhoid conjugate vaccines become more widely used, their potential role and impact in outbreak control warrant further evaluation.
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Affiliation(s)
- Grace D Appiah
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alexandria Chung
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Adwoa D Bentsi-Enchill
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Sunkyung Kim
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand.,Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina
| | - Vittal Mogasale
- Policy and Economic Research Department, Development and Delivery Unit, International Vaccine Institute, Seoul, South Korea
| | | | - Rachel B Slayton
- Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric D Mintz
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Mashe T, Gudza-Mugabe M, Tarupiwa A, Munemo E, Mtapuri-Zinyowera S, Smouse SL, Sooka A, Stray-Pedersen B, Smith AM, Mbanga J. Laboratory characterisation of Salmonella enterica serotype Typhi isolates from Zimbabwe, 2009-2017. BMC Infect Dis 2019; 19:487. [PMID: 31151421 PMCID: PMC6544939 DOI: 10.1186/s12879-019-4114-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/20/2019] [Indexed: 12/02/2022] Open
Abstract
Background Typhoid fever remains a major public health problem in Zimbabwe with recurrent outbreaks reported since 2009. To provide guidance on appropriate treatment choice in order to minimise the morbidity and mortality of typhoid fever and prevent large scale outbreaks, we investigated the antimicrobial susceptibility patterns, prevalence of Salmonella enterica serotype Typhi (S. Typhi) H58 haplotype and molecular subtypes of S. Typhi from outbreak strains isolated from 2009 to 2017 in Zimbabwe and compared these to isolates from neighbouring African countries. Methods Antimicrobial susceptibility testing was performed on all isolates using the disk diffusion, and E-Test, and results were interpreted using Clinical and Laboratory Standards Institute (CLSI) guidelines (2017). S. Typhi H58 haplotype screening was performed on 161 (58.3%) isolates. Pulsed-field gel electrophoresis (PFGE) was performed on 91 selected isolates across timelines using antibiotic susceptibility results and geographical distribution (2009 to 2016). Results Between 2009 and 2017, 16,398 suspected cases and 550 confirmed cases of typhoid fever were notified in Zimbabwe. A total of 276 (44.6%) of the culture-confirmed S. Typhi isolates were analysed and 243 isolates (88.0%) were resistant to two or more first line drugs (ciprofloxacin, ampicillin and chloramphenicol) for typhoid. The most common resistance was to ampicillin-chloramphenicol (172 isolates; 62.3%). Increasing ciprofloxacin resistance was observed from 2012 to 2017 (4.2 to 22.0%). Out of 161 screened isolates, 150 (93.2%) were haplotype H58. Twelve PFGE patterns were observed among the 91 isolates analysed, suggesting some diversity exists among strains circulating in Zimbabwe. PFGE analysis of 2013, 2014 and 2016 isolates revealed a common strain with an indistinguishable PFGE pattern (100% similarity) and indistinguishable from PFGE patterns previously identified in strains isolated from South Africa, Zambia and Tanzania. Conclusions Resistance to first line antimicrobials used for typhoid fever is emerging in Zimbabwe and the multidrug resistant S. Typhi H58 haplotype is widespread. A predominant PFGE clone circulating in Zimbabwe, South Africa, Zambia and Tanzania, argues for cross-border cooperation in the control of this disease. Electronic supplementary material The online version of this article (10.1186/s12879-019-4114-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tapfumanei Mashe
- Department of Applied Biology and Biochemistry, National University of Science and Technology, Bulawayo, Zimbabwe. .,National Microbiology Reference Laboratory, Harare, Zimbabwe. .,Letten Foundation Research Centre, Harare, Zimbabwe.
| | | | - Andrew Tarupiwa
- National Microbiology Reference Laboratory, Harare, Zimbabwe
| | - Ellen Munemo
- National Microbiology Reference Laboratory, Harare, Zimbabwe
| | | | - Shannon L Smouse
- Centre for Enteric Diseases, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Arvinda Sooka
- Centre for Enteric Diseases, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Babill Stray-Pedersen
- Division of Women, Rikshospitalet, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anthony M Smith
- Centre for Enteric Diseases, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joshua Mbanga
- Department of Applied Biology and Biochemistry, National University of Science and Technology, Bulawayo, Zimbabwe
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Reddy C, Kuonza L, Ngobeni H, Mayet NT, Doyle TJ, Williams S. South Africa field epidemiology training program: developing and building applied epidemiology capacity, 2007-2016. BMC Public Health 2019; 19:469. [PMID: 32326914 PMCID: PMC6696662 DOI: 10.1186/s12889-019-6788-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In 2007, South Africa (SA) launched a field epidemiology training program (SAFETP) to enhance its capacity to prevent, detect, and respond to public health threats through training in field epidemiology. The SAFETP began as a collaboration between the SA National Department of Health (NDOH), National Institute for Communicable Diseases (NICD), and the University of Pretoria (UP), with technical and financial support from the U.S. Centers for Disease Control and Prevention (CDC). In 2010, the CDC in collaboration with the NICD, established a Global Disease Detection (GDD) Center in SA, and the SAFETP became a core activity of the GDD center. Similar to other FETPs globally, the SAFETP is a 2-year, competency-based, applied epidemiology training program, following an apprenticeship model of ‘learn by doing’. SAFETP residents spend approximately 25% of the training in classroom-based didactic learning activities, and 75% in field activities to attain core competencies in epidemiology, biostatistics, outbreak investigation, scientific communication, surveillance evaluation, teaching others, and public health leadership. Residents earn a Master’s in Public Health (MPH) degree from UP upon successfully completing a planned research study that serves as a mini-dissertation. Since 2007, SAFETP has enrolled an average of 10 residents each year and, in 2017, enrolled its 11th cohort. During the first 10 years of the program, 98 residents have been enrolled, 89% completed the 2-year program, and of these, 76 (87%) earned an MPH degree. Of those completing the program, 88% are employed in the public health sector, and work at NICD, NDOH, Provincial Health Departments, foreign health institutions, or non-governmental organizations. In the first 10 years of the program, the combined outputs of trainees included over 130 outbreak investigations, more than 150 abstracts presented at national and international scientific conferences, more than 80 surveillance system evaluations, and more than 45 manuscripts published in peer-reviewed scientific journals. The SAFETP is having an impact in building epidemiology capacity for public health in South Africa. Developing methods to directly link and measure the impact of the program is planned for the future.
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Affiliation(s)
- Carl Reddy
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.
| | - Lazarus Kuonza
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Hetani Ngobeni
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Natalie T Mayet
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Timothy J Doyle
- Center for Global Health, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Seymour Williams
- Center for Global Health, Centers for Disease Control and Prevention, Pretoria, South Africa
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Characterization of Disinfection By-Products Levels at an Emergency Surface Water Treatment Plant in a Refugee Settlement in Northern Uganda. WATER 2019. [DOI: 10.3390/w11040647] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The reliance on chlorination in humanitarian operations has raised concerns among practitioners about possible health risks associated with disinfection by-products; however, to date, there has not been an evaluation of disinfection by-product (DBP) levels in an emergency water supply intervention. This study aimed to investigate DBP levels at a surface-water treatment plant serving a refugee settlement in northern Uganda using the colorimetric Hach THM Plus Method. The plant had two treatment processes: (1) Simultaneous clarification–chlorination (“rapid treatment”); and (2) pre-clarification and chlorination in separate tanks (“standard treatment”). For both standard (n = 17) and rapid (n = 3) treatment processes, DBP levels in unique parcels of water were tested at 30 min post-chlorination and after 24 h of storage (to simulate what refugees actually consume). DBP levels after 24 h did not exceed the World Health Organization (WHO) guideline limit of 300 ppb equivalent chloroform, either for standard treatment (mean: 85.1 ppb; 95% confidence interval (C.I.): 71.0–99.1 ppb; maximum: 133.7 ppb) or for rapid treatment (mean: 218.0 ppb; 95% C.I.: 151.2–284.8; maximum: 249.0 ppb). Observed DBPs levels do not appear to be problematic with respect to the general population, but may pose sub-chronic exposure risks to specifically vulnerable populations that warrant further investigation.
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12
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Keddy KH, Smith AM, Sooka A, Tau NP, Ngomane HMP, Radhakrishnan A, Als D, Benson FG. The Burden of Typhoid Fever in South Africa: The Potential Impact of Selected Interventions. Am J Trop Med Hyg 2018; 99:55-63. [PMID: 30047360 PMCID: PMC6128358 DOI: 10.4269/ajtmh.18-0182] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Typhoid fever is notifiable in South Africa but clinical notification is notoriously poor. South Africa has an estimated annual incidence rate of 0.1 cases per 100,000 population of culture-confirmed typhoid fever, decreased from 17 cases per 100,000 population in the 1980s. This work was undertaken to identify the reasons for this decrease and identify potential weaknesses that may result in an increase of observed cases. Culture-confirmed cases, with additional demographic and clinical data have been collected from selected sentinel sites since 2003. Data on contextual factors (gross domestic product [GDP], sanitation, female education, and childhood diarrhea mortality) were collected. National incidence rates of culture-confirmed typhoid fever have remained constant for the past 13 years, with the exception of an outbreak in 2005: incidence was 0.4 per 100,000 population. Paratyphoid fever remains a rare disease. Antimicrobial susceptibility data suggest resistance to ciprofloxacin and azithromycin is emerging. The South African population increased from 27.5 million in 1980 to 55.0 million in 2015: urbanization increased from 50% to 65%, GDP increased from United States Dollar (USD) $2,910 to USD $6,167, access to sanitation improved from 64.4% to 70.0% in the urban population and 26.4% to 60.5% in rural areas. Female literacy levels improved from 74.8% to 92.6% over the period. Improved socioeconomic circumstances in South Africa have been temporally associated with decreasing incidence rates of typhoid fever over a 35-year period. Ongoing challenges remain including potential for large outbreaks, a large immigrant population, and emerging antimicrobial resistance. Continued active surveillance is mandatory.
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Affiliation(s)
- Karen H Keddy
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Centre for Enteric Diseases, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Anthony M Smith
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Centre for Enteric Diseases, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Arvinda Sooka
- Centre for Enteric Diseases, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Nomsa P Tau
- Centre for Enteric Diseases, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Hlengiwe M P Ngomane
- Centre for Enteric Diseases, National Institute for Communicable Diseases, Johannesburg, South Africa
| | | | - Daina Als
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Frew G Benson
- Gauteng Provincial Health Department, Johannesburg, South Africa
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13
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Walldorf JA, Date KA, Sreenivasan N, Harris JB, Hyde TB. Lessons Learned from Emergency Response Vaccination Efforts for Cholera, Typhoid, Yellow Fever, and Ebola. Emerg Infect Dis 2018; 23. [PMID: 29155670 PMCID: PMC5711321 DOI: 10.3201/eid2313.170550] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Countries must be prepared to respond to public health threats associated with emergencies, such as natural disasters, sociopolitical conflicts, or uncontrolled disease outbreaks. Rapid vaccination of populations vulnerable to epidemic-prone vaccine-preventable diseases is a major component of emergency response. Emergency vaccination planning presents challenges, including how to predict resource needs, expand vaccine availability during global shortages, and address regulatory barriers to deliver new products. The US Centers for Disease Control and Prevention supports countries to plan, implement, and evaluate emergency vaccination response. We describe work of the Centers for Disease Control and Prevention in collaboration with global partners to support emergency vaccination against cholera, typhoid, yellow fever, and Ebola, diseases for which a new vaccine or vaccine formulation has played a major role in response. Lessons learned will help countries prepare for future emergencies. Integration of vaccination with emergency response augments global health security through reducing disease burden, saving lives, and preventing spread across international borders.
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14
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Bennett SD, Lowther SA, Chingoli F, Chilima B, Kabuluzi S, Ayers TL, Warne TA, Mintz E. Assessment of water, sanitation and hygiene interventions in response to an outbreak of typhoid fever in Neno District, Malawi. PLoS One 2018; 13:e0193348. [PMID: 29474394 PMCID: PMC5825105 DOI: 10.1371/journal.pone.0193348] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 02/09/2018] [Indexed: 11/19/2022] Open
Abstract
On May 2, 2009 an outbreak of typhoid fever began in rural villages along the Malawi-Mozambique border resulting in 748 illnesses and 44 deaths by September 2010. Despite numerous interventions, including distribution of WaterGuard (WG) for in-home water treatment and education on its use, cases of typhoid fever continued. To inform response activities during the ongoing Typhoid outbreak information on knowledge, attitudes, and practices surrounding typhoid fever, safe water, and hygiene were necessary to plan future outbreak interventions. In September 2010, a survey was administered to female heads in randomly selected households in 17 villages in Neno District, Malawi. Stored household drinking water was tested for free chlorine residual (FCR) levels using the N,N diethyl-p-phenylene diamine colorimetric method (HACH Company, Loveland, CO, USA). Attendance at community-wide educational meetings was reported by 56% of household respondents. Respondents reported that typhoid fever is caused by poor hygiene (77%), drinking unsafe water (49%), and consuming unsafe food (25%), and that treating drinking water can prevent it (68%). WaterGuard, a chlorination solution for drinking water treatment, was observed in 112 (56%) households, among which 34% reported treating drinking water. FCR levels were adequate (FCR ≥ 0.2 mg/L) in 29 (76%) of the 38 households who reported treatment of stored water and had stored water available for testing and an observed bottle of WaterGuard in the home. Soap was observed in 154 (77%) households, among which 51% reported using soap for hand washing. Educational interventions did not reach almost one-half of target households and knowledge remains low. Despite distribution and promotion of WaterGuard and soap during the outbreak response, usage was low. Future interventions should focus on improving water, sanitation and hygiene knowledge, practices, and infrastructure. Typhoid vaccination should be considered.
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Affiliation(s)
- Sarah D. Bennett
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Sara A. Lowther
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Benson Chilima
- Community Health Services Unit, Ministry of Health, Lilongwe, Malawi
| | - Storn Kabuluzi
- Community Health Services Unit, Ministry of Health, Lilongwe, Malawi
| | - Tracy L. Ayers
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Thomas A. Warne
- Division of Global HIV AIDS, Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Eric Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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15
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Cohen A, Colford JM. Effects of Boiling Drinking Water on Diarrhea and Pathogen-Specific Infections in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Am J Trop Med Hyg 2017; 97:1362-1377. [PMID: 29016318 PMCID: PMC5817760 DOI: 10.4269/ajtmh.17-0190] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/05/2017] [Indexed: 12/21/2022] Open
Abstract
Globally, approximately 2 billion people lack microbiologically safe drinking water. Boiling is the most prevalent household water treatment method, yet evidence of its health impact is limited. To conduct this systematic review, we searched four online databases with no limitations on language or publication date. Studies were eligible if health outcomes were measured for participants who reported consuming boiled and untreated water. We used reported and calculated odds ratios (ORs) and random-effects meta-analysis to estimate pathogen-specific and pooled effects by organism group and nonspecific diarrhea. Heterogeneity and publication bias were assessed using I2, meta-regression, and funnel plots; study quality was also assessed. Of the 1,998 records identified, 27 met inclusion criteria and reported extractable data. We found evidence of a significant protective effect of boiling for Vibrio cholerae infections (OR = 0.31, 95% confidence interval [CI] = 0.13-0.79, N = 4 studies), Blastocystis (OR = 0.35, 95% CI = 0.17-0.69, N = 3), protozoal infections overall (pooled OR = 0.61, 95% CI = 0.43-0.86, N = 11), viral infections overall (pooled OR = 0.83, 95% CI = 0.7-0.98, N = 4), and nonspecific diarrheal outcomes (OR = 0.58, 95% CI = 0.45-0.77, N = 7). We found no evidence of a protective effect for helminthic infections. Although our study was limited by the use of self-reported boiling and non-experimental designs, the evidence suggests that boiling provides measureable health benefits for pathogens whose transmission routes are primarily water based. Consequently, we believe a randomized controlled trial of boiling adherence and health outcomes is needed.
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Affiliation(s)
- Alasdair Cohen
- Division of Epidemiology, School of Public Health, University of California at Berkeley, Berkeley, California
- Department of Environmental Science, Policy and Management, University of California at Berkeley, Berkeley, California
| | - John M. Colford
- Division of Epidemiology, School of Public Health, University of California at Berkeley, Berkeley, California
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16
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Pitzer VE, Feasey NA, Msefula C, Mallewa J, Kennedy N, Dube Q, Denis B, Gordon MA, Heyderman RS. Mathematical Modeling to Assess the Drivers of the Recent Emergence of Typhoid Fever in Blantyre, Malawi. Clin Infect Dis 2015; 61 Suppl 4:S251-8. [PMID: 26449939 PMCID: PMC4596932 DOI: 10.1093/cid/civ710] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Multiyear epidemics of Salmonella enterica serovar Typhi have been reported from countries across eastern and southern Africa in recent years. In Blantyre, Malawi, a dramatic increase in typhoid fever cases has recently occurred, and may be linked to the emergence of the H58 haplotype. Strains belonging to the H58 haplotype often exhibit multidrug resistance and may have a fitness advantage relative to other Salmonella Typhi strains. METHODS To explore hypotheses for the increased number of typhoid fever cases in Blantyre, we fit a mathematical model to culture-confirmed cases of Salmonella enterica infections at Queen Elizabeth Central Hospital, Blantyre. We explored 4 hypotheses: (1) an increase in the basic reproductive number (R0) in response to increasing population density; (2) a decrease in the incidence of cross-immunizing infection with Salmonella Enteritidis; (3) an increase in the duration of infectiousness due to failure to respond to first-line antibiotics; and (4) an increase in the transmission rate following the emergence of the H58 haplotype. RESULTS Increasing population density or decreasing cross-immunity could not fully explain the observed pattern of typhoid emergence in Blantyre, whereas models allowing for an increase in the duration of infectiousness and/or the transmission rate of typhoid following the emergence of the H58 haplotype provided a good fit to the data. CONCLUSIONS Our results suggest that an increase in the transmissibility of typhoid due to the emergence of drug resistance associated with the H58 haplotype may help to explain recent outbreaks of typhoid in Malawi and similar settings in Africa.
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Affiliation(s)
- Virginia E. Pitzer
- Departmentof Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Nicholas A. Feasey
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre
- Liverpool School of Tropical Medicine, United Kingdom
| | - Chisomo Msefula
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre
- Department of Microbiology
| | | | - Neil Kennedy
- Department of Paediatrics and Child Health, University of Malawi College of Medicine, Blantyre
| | - Queen Dube
- Department of Paediatrics and Child Health, University of Malawi College of Medicine, Blantyre
| | - Brigitte Denis
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre
| | - Melita A. Gordon
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre
- Institute of Infection and Global Health, University of Liverpool
| | - Robert S. Heyderman
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre
- Division of Infection and Immunity, University College London, United Kingdom
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17
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Feasey NA, Gaskell K, Wong V, Msefula C, Selemani G, Kumwenda S, Allain TJ, Mallewa J, Kennedy N, Bennett A, Nyirongo JO, Nyondo PA, Zulu MD, Parkhill J, Dougan G, Gordon MA, Heyderman RS. Rapid emergence of multidrug resistant, H58-lineage Salmonella typhi in Blantyre, Malawi. PLoS Negl Trop Dis 2015; 9:e0003748. [PMID: 25909750 PMCID: PMC4409211 DOI: 10.1371/journal.pntd.0003748] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 04/08/2015] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Between 1998 and 2010, S. Typhi was an uncommon cause of bloodstream infection (BSI) in Blantyre, Malawi and it was usually susceptible to first-line antimicrobial therapy. In 2011 an increase in a multidrug resistant (MDR) strain was detected through routine bacteriological surveillance conducted at Queen Elizabeth Central Hospital (QECH). METHODS Longitudinal trends in culture-confirmed Typhoid admissions at QECH were described between 1998-2014. A retrospective review of patient cases notes was conducted, focusing on clinical presentation, prevalence of HIV and case-fatality. Isolates of S. Typhi were sequenced and the phylogeny of Typhoid in Blantyre was reconstructed and placed in a global context. RESULTS Between 1998-2010, there were a mean of 14 microbiological diagnoses of Typhoid/year at QECH, of which 6.8% were MDR. This increased to 67 in 2011 and 782 in 2014 at which time 97% were MDR. The disease predominantly affected children and young adults (median age 11 [IQR 6-21] in 2014). The prevalence of HIV in adult patients was 16.7% [8/48], similar to that of the general population (17.8%). Overall, the case fatality rate was 2.5% (3/94). Complications included anaemia, myocarditis, pneumonia and intestinal perforation. 112 isolates were sequenced and the phylogeny demonstrated the introduction and clonal expansion of the H58 lineage of S. Typhi. CONCLUSIONS Since 2011, there has been a rapid increase in the incidence of multidrug resistant, H58-lineage Typhoid in Blantyre. This is one of a number of reports of the re-emergence of Typhoid in Southern and Eastern Africa. There is an urgent need to understand the reservoirs and transmission of disease and how to arrest this regional increase.
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Affiliation(s)
- Nicholas A. Feasey
- Malawi Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
- * E-mail:
| | - Katherine Gaskell
- Malawi Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
| | - Vanessa Wong
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Chisomo Msefula
- Malawi Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- University of Malawi College of Medicine, Blantyre, Malawi
| | - George Selemani
- Malawi Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
| | - Save Kumwenda
- University of Malawi, The Polytechnic, Blantyre, Malawi
| | | | - Jane Mallewa
- Malawi Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- University of Malawi College of Medicine, Blantyre, Malawi
| | - Neil Kennedy
- University of Malawi College of Medicine, Blantyre, Malawi
| | - Aisleen Bennett
- Malawi Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Institute for Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | | | | | | | | | - Gordon Dougan
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Melita A. Gordon
- Institute for Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Robert S. Heyderman
- Malawi Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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18
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Carias C, Walters MS, Wefula E, Date KA, Swerdlow DL, Vijayaraghavan M, Mintz E. Economic evaluation of typhoid vaccination in a prolonged typhoid outbreak setting: The case of Kasese district in Uganda. Vaccine 2015; 33:2079-85. [DOI: 10.1016/j.vaccine.2015.02.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 01/17/2015] [Accepted: 02/11/2015] [Indexed: 10/24/2022]
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Kutsuna S, Hayakawa K, Kato Y, Fujiya Y, Mawatari M, Takeshita N, Kanagawa S, Ohmagari N. Comparison of clinical characteristics and laboratory findings of malaria, dengue, and enteric fever in returning travelers: 8-year experience at a referral center in Tokyo, Japan. J Infect Chemother 2014; 21:272-6. [PMID: 25592811 DOI: 10.1016/j.jiac.2014.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 11/28/2014] [Accepted: 12/09/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Without specific symptoms, diagnosis of febrile illness in returning travelers is challenging. Dengue, malaria, and enteric fever are common causes of fever in returning travelers and timely and appropriate treatment is important. However, differentiation is difficult without specific diagnostic tests. METHODS A retrospective study was conducted at the National Centre for Global Health and Medicine (NCGM) from April 2005 to March 2013. Febrile travelers returning from overseas who were diagnosed with dengue, malaria, or enteric fever were included in this study. Clinical characteristics and laboratory findings were compared for each diagnosis. RESULTS During the study period, 86 malaria, 85 dengue, and 31 enteric fever cases were identified. The mean age of the study cohort was 33.1 ± 12 years and 134 (66.3%) study participants were male. Asia was the most common area visited by returning travelers with fevers (89% of dengue, 18.6% of malaria, and 100% of enteric fever cases), followed by Africa (1.2% of dengue and 70.9% of malaria cases). Clinical characteristics and laboratory findings were significantly different among each group with each diagnosis. Decision tree models revealed that returning from Africa and CRP levels <10 mg/L were factors specific for diagnosis of malaria and dengue fever, respectively. CONCLUSION Clinical manifestations, simple laboratory test results, and regions of travel are helpful to distinguish between dengue, malaria, and enteric fever in febrile returning travelers with non-specific symptoms.
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Affiliation(s)
- Satoshi Kutsuna
- National Centre for Global Health and Medicine, Disease Control and Prevention Center, Japan.
| | - Kayoko Hayakawa
- National Centre for Global Health and Medicine, Disease Control and Prevention Center, Japan
| | - Yasuyuki Kato
- National Centre for Global Health and Medicine, Disease Control and Prevention Center, Japan
| | - Yoshihiro Fujiya
- National Centre for Global Health and Medicine, Disease Control and Prevention Center, Japan
| | - Momoko Mawatari
- National Centre for Global Health and Medicine, Disease Control and Prevention Center, Japan
| | - Nozomi Takeshita
- National Centre for Global Health and Medicine, Disease Control and Prevention Center, Japan
| | - Shuzo Kanagawa
- National Centre for Global Health and Medicine, Disease Control and Prevention Center, Japan
| | - Norio Ohmagari
- National Centre for Global Health and Medicine, Disease Control and Prevention Center, Japan
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Blum LS, Dentz H, Chingoli F, Chilima B, Warne T, Lee C, Hyde T, Gindler J, Sejvar J, Mintz ED. Formative investigation of acceptability of typhoid vaccine during a typhoid fever outbreak in Neno District, Malawi. Am J Trop Med Hyg 2014; 91:729-37. [PMID: 25002303 PMCID: PMC4183395 DOI: 10.4269/ajtmh.14-0067] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 05/02/2014] [Indexed: 11/07/2022] Open
Abstract
Typhoid fever affects an estimated 22 million people annually and causes 216,000 deaths worldwide. We conducted an investigation in August and September 2010 to examine the acceptability of typhoid vaccine in Neno District, Malawi where a typhoid outbreak was ongoing. We used qualitative methods, including freelisting exercises, key informant and in-depth interviews, and group discussions. Respondents associated illness with exposure to "bad wind," and transmission was believed to be airborne. Typhoid was considered extremely dangerous because of its rapid spread, the debilitating conditions it produced, the number of related fatalities, and the perception that it was highly contagious. Respondents were skeptical about the effectiveness of water, sanitation, and hygiene (WaSH) interventions. The perceived severity of typhoid and fear of exposure, uncertainty about the effectiveness of WaSH measures, and widespread belief in the efficacy of vaccines in preventing disease resulted in an overwhelming interest in receiving typhoid vaccine during an outbreak.
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Affiliation(s)
- Lauren S Blum
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - Holly Dentz
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - Felix Chingoli
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - Benson Chilima
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - Thomas Warne
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - Carla Lee
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - Terri Hyde
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - Jacqueline Gindler
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - James Sejvar
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - Eric D Mintz
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
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