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Prasad N, Jenkins AP, Naucukidi L, Rosa V, Sahu-Khan A, Kama M, Jenkins KM, Jenney AWJ, Jack SJ, Saha D, Horwitz P, Jupiter SD, Strugnell RA, Mulholland EK, Crump JA. Epidemiology and risk factors for typhoid fever in Central Division, Fiji, 2014-2017: A case-control study. PLoS Negl Trop Dis 2018; 12:e0006571. [PMID: 29883448 PMCID: PMC6010302 DOI: 10.1371/journal.pntd.0006571] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/20/2018] [Accepted: 05/29/2018] [Indexed: 11/26/2022] Open
Abstract
Background Typhoid fever is endemic in Fiji, with high reported annual incidence. We sought to identify the sources and modes of transmission of typhoid fever in Fiji with the aim to inform disease control. Methodology/Principal findings We identified and surveyed patients with blood culture-confirmed typhoid fever from January 2014 through January 2017. For each typhoid fever case we matched two controls by age interval, gender, ethnicity, and residential area. Univariable and multivariable analysis were used to evaluate associations between exposures and risk for typhoid fever. We enrolled 175 patients with typhoid fever and 349 controls. Of the cases, the median (range) age was 29 (2–67) years, 86 (49%) were male, and 84 (48%) lived in a rural area. On multivariable analysis, interrupted water availability (odds ratio [OR] = 2.17; 95% confidence interval [CI] 1.18–4.00), drinking surface water in the last 2 weeks (OR = 3.61; 95% CI 1.44–9.06), eating unwashed produce (OR = 2.69; 95% CI 1.48–4.91), and having an unimproved or damaged sanitation facility (OR = 4.30; 95% CI 1.14–16.21) were significantly associated with typhoid fever. Frequent handwashing after defecating (OR = 0.57; 95% CI 0.35–0.93) and using soap for handwashing (OR = 0.61; 95% CI 0.37–0.95) were independently associated with a lower odds of typhoid fever. Conclusions Poor sanitation facilities appear to be a major source of Salmonella Typhi in Fiji, with transmission by drinking contaminated surface water and consuming unwashed produce. Improved sanitation facilities and protection of surface water sources and produce from contamination by human feces are likely to contribute to typhoid control in Fiji. Modeling suggests that Oceania has surpassed Asia and sub-Saharan Africa as the region with the highest typhoid fever incidence. While Pacific Islands are often neglected due to small population sizes, there is an urgent need to understand the epidemiology of typhoid fever in the region. Fiji, an upper-middle income country in Oceania, has reported an increase in typhoid fever notifications over the last decade. However, the epidemiology of typhoid fever in Fiji is incompletely understood due to gaps in surveillance and lack of epidemiological research on local risk factors. We conducted a case-control study in the Central Division of Fiji to help inform prevention and control strategies. We found unimproved sanitation facilities to be major source of typhoid fever in Fiji, with transmission by drinking contaminated surface water and consumption of unwashed produce. We also found an association between poor water availability and poor hygiene with typhoid fever. Improvements in sanitation facilities to protect surface water and produce from contamination are likely to contribute to improved typhoid control in Fiji. Because of the distinct socio-demographic and environmental conditions found in Oceania, our findings may reflect sources and modes of transmission predominant elsewhere in the region.
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Affiliation(s)
- Namrata Prasad
- Centre for International Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- * E-mail: (NP); (JAC)
| | - Aaron P. Jenkins
- School of Science, Edith Cowan University, Joondalup, Australia
- School of Public Health, University of Sydney, Sydney, Australia
| | - Lanieta Naucukidi
- Fiji Centre for Communicable Disease Control, Fiji Ministry of Health, Suva, Fiji
| | - Varanisese Rosa
- Fiji Centre for Communicable Disease Control, Fiji Ministry of Health, Suva, Fiji
| | - Aalisha Sahu-Khan
- Fiji Centre for Communicable Disease Control, Fiji Ministry of Health, Suva, Fiji
| | - Mike Kama
- Fiji Centre for Communicable Disease Control, Fiji Ministry of Health, Suva, Fiji
| | - Kylie M. Jenkins
- Fiji Health Sector Support Program, Suva, Fiji
- Telethon Kids Institute, Perth, Western Australia
| | - Adam W. J. Jenney
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Susan J. Jack
- Centre for International Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Debasish Saha
- Centre for International Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Pierre Horwitz
- School of Science, Edith Cowan University, Joondalup, Australia
| | - Stacy D. Jupiter
- Wildlife Conservation Society, Melanesia Regional Program, Suva, Fiji
| | - Richard A. Strugnell
- Department of Microbiology and Immunology, University of Melbourne, Victoria, Australia
| | - E. Kim Mulholland
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - John A. Crump
- Centre for International Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- * E-mail: (NP); (JAC)
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