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Lee SY, Howard-Jones AR, Ln Lavu V, Norton S, Sintchenko V, Britton PN, Bag S, Khatami A. The increasing healthcare burden of enteric fever in a Low-Incidence setting. Infect Dis Now 2024:104919. [PMID: 38643864 DOI: 10.1016/j.idnow.2024.104919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/10/2024] [Accepted: 04/16/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVES Enteric fever carries appreciable morbidity in non-endemic settings, particularly in returned travelers. This study aimed to characterize the healthcare burden of enteric fever in a low-incidence setting and to identify risk factors and opportunities for preventative interventions. METHODS Analysis of a retrospective case series from a tertiary pediatric center (2015-2019), augmented by public health notification and microbiological laboratory data (2018-2019), from Western Sydney, Australia, a region with frequent travel links to South Asia. RESULTS Eighty-nine (89) patients were diagnosed with enteric fever, including 43 children with complete demographic and travel data. Enteric fever cases increased over time (by 4.9 % per year) and incidence was three times higher in the pediatric population (<15 years old) compared to adults. Travel to India and visiting friends and relatives (VFR) travel were risk factors. Few children received enteric fever vaccination prior to travel, as pre-travel advice most commonly was not sought. CONCLUSIONS Children visiting relatives in high-incidence countries are increasingly at risk for enteric fever, particularly when travelling to South Asia. Targeted health advice to travelers visiting friends and relatives is warranted to mitigate the healthcare burden of enteric fever in low-incidence settings.
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Affiliation(s)
- Seung Y Lee
- Department of General Paediatrics, The Children's Hospital at Westmead, Westmead NSW 2145 Australia.
| | - Annaleise R Howard-Jones
- The Children's Hospital at Westmead Clinical School, University of Sydney, Westmead NSW 2145 Australia; New South Wales Health Pathology - Institute for Clinical Pathology and Medical Research, Westmead Hospital, Westmead NSW 2145 Australia
| | - Venkata Ln Lavu
- Western Sydney Public Health Unit, Centre for Population Health, North Parramatta, NSW 2150 Australia
| | - Sophie Norton
- Western Sydney Public Health Unit, Centre for Population Health, North Parramatta, NSW 2150 Australia; Faculty of Medicine and Health, Westmead Clinical School, University of Sydney, Westmead NSW 2145 Australia
| | - Vitali Sintchenko
- New South Wales Health Pathology - Institute for Clinical Pathology and Medical Research, Westmead Hospital, Westmead NSW 2145 Australia; Faculty of Medicine and Health, Westmead Clinical School, University of Sydney, Westmead NSW 2145 Australia; Sydney Institute for Infectious Diseases, The University of Sydney, Westmead NSW 2145 Australia
| | - Philip N Britton
- The Children's Hospital at Westmead Clinical School, University of Sydney, Westmead NSW 2145 Australia; Department of Infectious Diseases & Microbiology, The Children's Hospital at Westmead, Westmead NSW 2145 Australia
| | - Shopna Bag
- Western Sydney Public Health Unit, Centre for Population Health, North Parramatta, NSW 2150 Australia; Faculty of Medicine and Health, Westmead Clinical School, University of Sydney, Westmead NSW 2145 Australia
| | - Ameneh Khatami
- The Children's Hospital at Westmead Clinical School, University of Sydney, Westmead NSW 2145 Australia; Department of Infectious Diseases & Microbiology, The Children's Hospital at Westmead, Westmead NSW 2145 Australia
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Soukavong M, Luangasanatip N, Chanthavilay P, Teerawattananon Y, Dabak SV, Pan-Ngum W, Roberts T, Ashley EA, Mayxay M. Cost-effectiveness analysis of typhoid vaccination in Lao PDR. BMC Public Health 2023; 23:2270. [PMID: 37978481 PMCID: PMC10656839 DOI: 10.1186/s12889-023-17221-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Typhoid vaccination has been shown to be an effective intervention to prevent enteric fever and is under consideration for inclusion in the national immunization program in Lao PDR. METHODS A cost-utility analysis was performed using an age-structured static decision tree model to estimate the costs and health outcomes of introducing TCV. Vaccination strategies combined with five delivery approaches in different age groups compared to no vaccination were considered from the societal perspective, using the Gavi price of 1.5 USD per dose. The vaccination program was considered to be cost-effective if the incremental cost-effectiveness ratio was less than a threshold of 1 GDP per capita for Lao PDR, equivalent to USD 2,535 in 2020. RESULTS In the model, we estimated 172.2 cases of enteric fever, with 1.3 deaths and a total treatment cost of USD 7,244, based on a birth cohort of 164,662 births without TCV vaccination that was followed over their lifetime. To implement a TCV vaccination program over the lifetime horizon, the estimated cost of the vaccine and administration costs would be between USD 470,934 and USD 919,186. Implementation of the TCV vaccination program would prevent between 14 and 106 cases and 0.1 to 0.8 deaths. None of the vaccination programs appeared to be cost-effective. CONCLUSIONS Inclusion of TCV in the national vaccination program in Lao PDR would only be cost-effective if the true typhoid incidence is 25-times higher than our current estimate.
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Affiliation(s)
- Mick Soukavong
- Faculty of Medicine, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | | | - Phetsavanh Chanthavilay
- Unit for Health Evidence and Policy, Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Wirichada Pan-Ngum
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Tamalee Roberts
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Quai Fa Ngum, Lao People's Democratic Republic, Vientiane, Laos
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Elizabeth A Ashley
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Quai Fa Ngum, Lao People's Democratic Republic, Vientiane, Laos.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
| | - Mayfong Mayxay
- Unit for Health Evidence and Policy, Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao People's Democratic Republic
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Quai Fa Ngum, Lao People's Democratic Republic, Vientiane, Laos
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Hedley-Whyte J, Milamed DR. Paratyphoid blamed on Ulster: a nursing odyssey. Ulster Med J 2008; 77:119-26. [PMID: 18711624 PMCID: PMC2516427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/01/2007] [Indexed: 11/23/2022]
Abstract
The aim of the Modicum mission from the United States was to determine the fate of the Western World, the Second Front and the Manhattan Project plans for development of atomic weapons. The Modicum mission was appointed in March 1942 by Franklin Delano Roosevelt as President and Commander-in-Chief of the US forces. The journey via the Anglican Cathedral in Bermuda, to Gander, to London, to Ulster was eventful. There was a clay-pigeon shooting contest in Gander. Generals Marshall, Eisenhower, Clark and Averell Harriman were outshot by their pilot. In Ulster, an escorting US sergeant killed a Londonderry bus driver with three shots. At a house party requested by King George VI and General Marshall, at Ashbrook, Ardmore, near Londonderry, it is alleged Averell Harriman was poisoned with Salmonella schottmülleri. He was delirious and 'gravely ill' for three weeks at 3 Grosvenor Square next to the American Embassy. He subsequently married his "other nurse", Pamela. Ambassador Pamela Churchill Harriman, a long-time ardent supporter of the Clintons, died in February 1997 following a stroke.
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