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Abstract
There is now a robust pipeline of licensed and World Health Organization (WHO)-prequalified typhoid conjugate vaccines with a steady progression of national introductions. However, typhoid fever is responsible for less than half the total global burden of Salmonella disease, and even less among children aged <5 years. Invasive nontyphoidal Salmonella disease is the dominant clinical presentation of Salmonella in Africa, and over a quarter of enteric fever in Asia is due to paratyphoid A. In this article, we explore the case for combination Salmonella vaccines, review the current pipeline of these vaccines, and discuss key considerations for their development, including geographies of use, age of administration, and pathways to licensure. While a trivalent typhoid/nontyphoidal Salmonella vaccine is attractive for Africa, and a bivalent enteric fever vaccine for Asia, a quadrivalent vaccine covering the 4 main disease-causing serovars of Salmonella enterica would provide a single vaccine option for global Salmonella coverage.
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Affiliation(s)
- Calman A MacLennan
- Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington, USA
- Jenner Institute, University of Oxford, Oxford, United Kingdom
| | - Jeffrey Stanaway
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Stephanie Grow
- Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Kirsten Vannice
- Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - A Duncan Steele
- Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington, USA
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Tráj P, Sebők C, Mackei M, Kemény Á, Farkas O, Kákonyi Á, Kovács L, Neogrády Z, Jerzsele Á, Mátis G. Luteolin: A Phytochemical to Mitigate S. Typhimurium Flagellin-Induced Inflammation in a Chicken In Vitro Hepatic Model. Animals (Basel) 2023; 13:ani13081410. [PMID: 37106972 PMCID: PMC10135145 DOI: 10.3390/ani13081410] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/05/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
The use of natural feed supplements is an alternative tool to diminish the damage caused by certain bacteria, improving animal health and productivity. The present research aimed to investigate the proinflammatory effect of flagellin released from the bacterial flagellum of Salmonella enterica serovar Typhimurium and to attenuate the induced inflammation with luteolin as a plant-derived flavonoid on a chicken primary hepatocyte-non-parenchymal cell co-culture. Cells were cultured in a medium supplemented with 250 ng/mL flagellin and 4 or 16 µg/mL luteolin for 24 h. Cellular metabolic activity, lactate dehydrogenase (LDH) activity, interleukin-6, 8, 10 (IL-6, IL-8, IL-10), interferon-α, γ (IFN-α, IFN-γ), hydrogen peroxide (H2O2) and malondialdehyde (MDA) concentrations were determined. Flagellin significantly increased the concentration of the proinflammatory cytokine IL-8 and the ratio of IFN-γ/IL-10, while it decreased the level of IL-10, indicating that the model served adequate to study inflammation in vitro. Luteolin treatment at 4 µg/mL did not prove to be cytotoxic, as reflected by metabolic activity and extracellular LDH activity, and significantly reduced the flagellin-triggered IL-8 release of the cultured cells. Further, it had a diminishing effect on the concentration of IFN-α, H2O2 and MDA and restored the level of IL-10 and the ratio of IFN-γ/IL-10 when applied in combination with flagellin. These results suggest that luteolin at lower concentrations may protect hepatic cells from an excessive inflammatory response and act as an antioxidant to attenuate oxidative damage.
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Affiliation(s)
- Patrik Tráj
- Division of Biochemistry, Department of Physiology and Biochemistry, University of Veterinary Medicine, István utca 2., H-1078 Budapest, Hungary
| | - Csilla Sebők
- Division of Biochemistry, Department of Physiology and Biochemistry, University of Veterinary Medicine, István utca 2., H-1078 Budapest, Hungary
| | - Máté Mackei
- Division of Biochemistry, Department of Physiology and Biochemistry, University of Veterinary Medicine, István utca 2., H-1078 Budapest, Hungary
- National Laboratory of Infectious Animal Diseases, Antimicrobial Resistance, Veterinary Public Health and Food Chain Safety, University of Veterinary Medicine, István utca 2., H-1078 Budapest, Hungary
| | - Ágnes Kemény
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, Szigeti út 12., H-7624 Pécs, Hungary
| | - Orsolya Farkas
- National Laboratory of Infectious Animal Diseases, Antimicrobial Resistance, Veterinary Public Health and Food Chain Safety, University of Veterinary Medicine, István utca 2., H-1078 Budapest, Hungary
- Department of Pharmacology and Toxicology, University of Veterinary Medicine, István utca 2., H-1078 Budapest, Hungary
| | - Ákos Kákonyi
- Division of Biochemistry, Department of Physiology and Biochemistry, University of Veterinary Medicine, István utca 2., H-1078 Budapest, Hungary
| | - László Kovács
- Department of Animal Hygiene, Herd Health and Mobile Clinic, University of Veterinary Medicine, István utca 2., H-1078 Budapest, Hungary
| | - Zsuzsanna Neogrády
- Division of Biochemistry, Department of Physiology and Biochemistry, University of Veterinary Medicine, István utca 2., H-1078 Budapest, Hungary
| | - Ákos Jerzsele
- National Laboratory of Infectious Animal Diseases, Antimicrobial Resistance, Veterinary Public Health and Food Chain Safety, University of Veterinary Medicine, István utca 2., H-1078 Budapest, Hungary
- Department of Pharmacology and Toxicology, University of Veterinary Medicine, István utca 2., H-1078 Budapest, Hungary
| | - Gábor Mátis
- Division of Biochemistry, Department of Physiology and Biochemistry, University of Veterinary Medicine, István utca 2., H-1078 Budapest, Hungary
- National Laboratory of Infectious Animal Diseases, Antimicrobial Resistance, Veterinary Public Health and Food Chain Safety, University of Veterinary Medicine, István utca 2., H-1078 Budapest, Hungary
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Lin FH, Chen BC, Chou YC, Hsieh CJ, Yu CP. Incidence and Risk Factors for Notifiable Typhoid and Paratyphoid in Taiwan during the Period 2011-2020. Healthcare (Basel) 2021; 9:healthcare9101316. [PMID: 34682996 PMCID: PMC8544365 DOI: 10.3390/healthcare9101316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/23/2021] [Accepted: 09/29/2021] [Indexed: 11/24/2022] Open
Abstract
The risk of the geographic transmission of emerging infectious diseases through air travel varies greatly. In this study, we collected data on cases of food-borne diseases between the years 2011 and 2020 in Taiwan to access the epidemiological features, differences, and trends in domestic and imported cases of typhoid and paratyphoid in terms of patient sex, age, month of confirmation, and area of residence. In this study, we made use of the open data website provided by Taiwan’s Centers for Disease Control (TCDC) to extract the reported numbers of cases of typhoid and paratyphoid between January and December from 2011 to 2020 for comparison. Univariate analysis was performed using the Chi-square test for categorical variables. Fisher’s exact test was performed if an expected frequency was less than 5. A total of 226 typhoid cases and 61 paratyphoid cases were analyzed from the database. The incidences of typhoid and paratyphoid per million of the population were 0.42–2.11 and 0–0.39, respectively. There was a significant difference in the incidence of the diseases between the age groups (p = 0.019), with a gradual increase in the 20–40 years group. A distinct seasonal (between fall and spring) variation was also observed (p = 0.012). There were 34 cases of children with typhoid in the period 2011–2015 and 12 cases of children with typhoid in the period 2016–2020. During these periods, there were two cases of paratyphoid. This study indicated that the risk of children suffering from typhoid has been significantly reduced in the last five years. Furthermore, we found that more women have acquired typhoid and paratyphoid than men, and that living in the Taipei metropolitan area and the northern area was a potential risk factor. Furthermore, the number of imported cases of typhoid (n = 3) and paratyphoid (n = 0) reported during the COVID-19 pandemic was lower than that reported for the same disease from 2011 to 2020. More typhoid and paratyphoid cases were imported from Indonesia, India, Myanmar, and Cambodia. This study represents the first report on confirmed cases of acquired typhoid and paratyphoid from surveillance data from Taiwan’s CDC for the period 2011–2020. This study also demonstrates that the cases of typhoid and paratyphoid decreased in Taiwan during the COVID pandemic. Big data were used in this study, which may inform future surveillance and research efforts in Taiwan.
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Affiliation(s)
- Fu-Huang Lin
- School of Public Health, National Defense Medical Center, Taipei City 11490, Taiwan; (F.-H.L.); (Y.-C.C.)
| | - Bao-Chung Chen
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan;
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei City 11490, Taiwan; (F.-H.L.); (Y.-C.C.)
| | - Chi-Jeng Hsieh
- Department of Health Care Administration, Asia Eastern University of Science and Technology, New Taipei City 22061, Taiwan;
| | - Chia-Peng Yu
- School of Public Health, National Defense Medical Center, Taipei City 11490, Taiwan; (F.-H.L.); (Y.-C.C.)
- Correspondence:
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4
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Abstract
This article presents a selection of practical issues, questions, and tradeoffs in methodological choices to consider when conducting a cost of illness (COI) study on enteric fever in low- to lower-middle-income countries. The experiences presented are based on 2 large-scale COI studies embedded within the Surveillance for Enteric Fever in Asia Project II (SEAP II), in Bangladesh, Nepal, and Pakistan; and the Severe Typhoid Fever Surveillance in Africa (SETA) Program in Burkina Faso, Ethiopia, Ghana, and Madagascar. Issues presented include study design choices such as controlling for background patient morbidity and healthcare costs, time points for follow-up, data collection methods for sensitive income and spending information, estimating enteric fever-specific health facility cost information, and analytic approaches in combining patient and health facility costs. The article highlights the potential tradeoffs in time, budget, and precision of results to assist those commissioning, conducting, and interpreting enteric fever COI studies.
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Affiliation(s)
- Nelly Mejia
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Enusa Ramani
- Policy and Economic Research Department, Public Health, Access and Vaccine Epidemiology Unit, International Vaccine Institute, Seoul, Korea
| | - Sarah W Pallas
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dayoung Song
- Policy and Economic Research Department, Public Health, Access and Vaccine Epidemiology Unit, International Vaccine Institute, Seoul, Korea
| | - Taiwo Abimbola
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Vittal Mogasale
- Policy and Economic Research Department, Public Health, Access and Vaccine Epidemiology Unit, International Vaccine Institute, Seoul, Korea
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Sajib MSI, Tanmoy AM, Hooda Y, Rahman H, Andrews JR, Garrett DO, Endtz HP, Saha SK, Saha S. Tracking the Emergence of Azithromycin Resistance in Multiple Genotypes of Typhoidal Salmonella. mBio 2021; 12:e03481-20. [PMID: 33593966 PMCID: PMC8545119 DOI: 10.1128/mbio.03481-20] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/05/2021] [Indexed: 11/29/2022] Open
Abstract
The rising prevalence of antimicrobial resistance in Salmonella enterica serovars Typhi and Paratyphi A, causative agents of typhoid and paratyphoid, have led to fears of untreatable infections. Of specific concern is the emerging resistance against azithromycin, the only remaining oral drug to treat extensively drug resistant (XDR) typhoid. Since the first report of azithromycin resistance from Bangladesh in 2019, cases have been reported from Nepal, India, and Pakistan. The genetic basis of this resistance is a single point mutation in the efflux pump AcrB (R717Q/L). Here, we report 38 additional cases of azithromycin-resistant (AzmR) Salmonella Typhi and Paratyphi A isolated in Bangladesh between 2016 and 2018. Using genomic analysis of 56 AzmR isolates from South Asia with AcrB-R717Q/L, we confirm that this mutation has spontaneously emerged in different Salmonella Typhi and Paratyphi A genotypes. The largest cluster of AzmR Typhi belonged to genotype 4.3.1.1; Bayesian analysis predicts the mutation to have emerged sometime in 2010. A travel-related Typhi isolate with AcrB-R717Q belonging to 4.3.1.1 was isolated in the United Kingdom, increasing fears of global spread. For real-time detection of AcrB-R717Q/L, we developed an extraction-free, rapid, and low-cost mismatch amplification mutation assay (MAMA). Validation of MAMA using 113 AzmR and non-AzmR isolates yielded >98% specificity and sensitivity versus phenotypic and whole-genome sequencing assays currently used for azithromycin resistance detection. With increasing azithromycin use, AcrB-R717Q/L is likely to be acquired by XDR strains. The proposed tool for active detection and surveillance of this mutation may detect pan-oral drug resistance early, giving us a window to intervene.IMPORTANCE In the early 1900s, with mortality of ∼30%, typhoid and paratyphoid ravaged parts of the world; with improved water, sanitation, and hygiene in resource-rich countries and the advent of antimicrobials, mortality dwindled to <1%. Today, the burden rests disproportionately on South Asia, where the primary means for combatting the disease is antimicrobials. However, prevalence of antimicrobial resistance is rising and, in 2016, an extensively drug resistant Typhi strain triggered an ongoing outbreak in Pakistan, leaving only one oral drug, azithromycin, to treat it. Since the description of emergence of azithromycin resistance, conferred by a point mutation in acrB (AcrB-R717Q/L) in 2019, there have been increasing numbers of reports. Using genomics and Bayesian analysis, we illustrate that this mutation emerged in approximately 2010 and has spontaneously arisen multiple times. Emergence of pan-oral drug resistant Salmonella Typhi is imminent. We developed a low-cost, rapid PCR tool to facilitate real-time detection and prevention policies.
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Affiliation(s)
- Mohammad S I Sajib
- Child Health Research Foundation, Dhaka, Bangladesh
- Institute of Biodiversity, Animal Health, and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Arif M Tanmoy
- Child Health Research Foundation, Dhaka, Bangladesh
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Yogesh Hooda
- Child Health Research Foundation, Dhaka, Bangladesh
- MRC-Laboratory Molecular Biology, Cambridge, United Kingdom
| | | | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | | | - Hubert P Endtz
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
- Fondation Mérieux and Centre International de Recherche en Infectiologie, INSERM, Lyon, France
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
- Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
- Bangladesh Institute of Child Health, Dhaka, Bangladesh
| | - Senjuti Saha
- Child Health Research Foundation, Dhaka, Bangladesh
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Mejia N, Pallas SW, Saha S, Udin J, Sayeed KMI, Garrett DO, Date K, Abimbola T. Typhoid and Paratyphoid Cost of Illness in Bangladesh: Patient and Health Facility Costs From the Surveillance for Enteric Fever in Asia Project II. Clin Infect Dis 2020; 71:S293-S305. [PMID: 33258940 PMCID: PMC7750988 DOI: 10.1093/cid/ciaa1334] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We conducted a cost of illness study to assess the economic burden of pediatric enteric fever (typhoid and paratyphoid) in Bangladesh. Results can inform public health policies to prevent enteric fever. METHODS The study was conducted at 2 pediatric health facilities in Dhaka. For the patient and caregiver's perspective, we administered questionnaires on costs incurred from illness onset until the survey dates to caregivers of patients with blood culture positive cases at enrollment and 6 weeks later to estimate the direct medical, direct nonmedical, and indirect costs. From the perspective of the health care provider, we collected data on quantities and prices of resources used by the 2 hospitals to estimate the direct medical economic costs to treat a case of enteric fever. We collected costs in Bangladeshi takas and converted them into 2018 US dollars. We multiplied the unit cost per procedure by the frequency of procedures in the surveillance case cohort to calculate the average cost per case. RESULTS Among the 1772 patients from whom we collected information, the median cost of illness per case of enteric fever from the patient and caregiver perspective was US $64.03 (IQR: US $33.90 -$173.48). Median direct medical and nonmedical costs per case were 3% of annual labor income across the sample. From the perspective of the healthcare provider, the average direct medical cost per case was US $58.64 (range: US $37.25 at Hospital B, US $73.27 at Hospital A). CONCLUSIONS Our results show substantial economic burden of enteric fever in Bangladesh, with higher costs for patients receiving inpatient care. As antimicrobial resistance increases globally, the cost of illness could increase, due to more expensive and potent drugs required for treatment.
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Affiliation(s)
- Nelly Mejia
- Global Immunization Division, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Sarah W Pallas
- Global Immunization Division, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Samir Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Jamal Udin
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | - Denise O Garrett
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | - Kashmira Date
- Global Immunization Division, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Taiwo Abimbola
- Global Immunization Division, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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Mejia N, Qamar F, Yousafzai MT, Raza J, Garrett DO, Date K, Abimbola T, Pallas SW. Typhoid and Paratyphoid Cost of Illness in Pakistan: Patient and Health Facility Costs From the Surveillance for Enteric Fever in Asia Project II. Clin Infect Dis 2020; 71:S319-S335. [PMID: 33258941 PMCID: PMC7750929 DOI: 10.1093/cid/ciaa1336] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The objective of this study was to estimate the cost of illness from enteric fever (typhoid and paratyphoid) at selected sites in Pakistan. METHODS We implemented a cost-of-illness study in 4 hospitals as part of the Surveillance for Enteric Fever in Asia Project (SEAP) II in Pakistan. From the patient and caregiver perspective, we collected direct medical, nonmedical, and indirect costs per case of enteric fever incurred since illness onset by phone after enrollment and 6 weeks later. From the health care provider perspective, we collected data on quantities and prices of resources used at 3 of the hospitals, to estimate the direct medical economic costs to treat a case of enteric fever. We collected costs in Pakistani rupees and converted them into 2018 US dollars. We multiplied the unit cost per procedure by the frequency of procedures in the surveillance case cohort to calculate the average cost per case. RESULTS We collected patient and caregiver information for 1029 patients with blood culture-confirmed enteric fever or with a nontraumatic terminal ileal perforation, with a median cost of illness per case of US $196.37 (IQR, US $72.89-496.40). The median direct medical and nonmedical costs represented 8.2% of the annual labor income. From the health care provider perspective, the estimated average direct medical cost per case was US $50.88 at Hospital A, US $52.24 at Hospital B, and US $11.73 at Hospital C. CONCLUSIONS Enteric fever can impose a considerable economic burden in Pakistan. These new estimates of the cost of illness of enteric fever can improve evaluation and modeling of the costs and benefits of enteric fever prevention and control measures, including typhoid conjugate vaccines.
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Affiliation(s)
- Nelly Mejia
- Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Jamal Raza
- National Institute of Child Health, Karachi, Pakistan
| | - Denise O Garrett
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | - Kashmira Date
- Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Taiwo Abimbola
- Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah W Pallas
- Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Mejia N, Abimbola T, Andrews JR, Vaidya K, Tamrakar D, Pradhan S, Shakya R, Garrett DO, Date K, Pallas SW. Typhoid and Paratyphoid Cost of Illness in Nepal: Patient and Health Facility Costs From the Surveillance for Enteric Fever in Asia Project II. Clin Infect Dis 2020; 71:S306-S318. [PMID: 33258938 PMCID: PMC7750979 DOI: 10.1093/cid/ciaa1335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Enteric fever is endemic in Nepal and its economic burden is unknown. The objective of this study was to estimate the cost of illness due to enteric fever (typhoid and paratyphoid) at selected sites in Nepal. METHODS We implemented a study at 2 hospitals in Nepal to estimate the cost per case of enteric fever from the perspectives of patients, caregivers, and healthcare providers. We collected direct medical, nonmedical, and indirect costs per blood culture-confirmed case incurred by patients and their caregivers from illness onset until after enrollment and 6 weeks later. We estimated healthcare provider direct medical economic costs based on quantities and prices of resources used to diagnose and treat enteric fever, and procedure frequencies received at these facilities by enrolled patients. We collected costs in Nepalese rupees and converted them into 2018 US dollars. RESULTS We collected patient and caregiver cost of illness information for 395 patients, with a median cost of illness per case of $59.99 (IQR, $24.04-$151.23). Median direct medical and nonmedical costs per case represented ~3.5% of annual individual labor income. From the healthcare provider perspective, the average direct medical economic cost per case was $79.80 (range, $71.54 [hospital B], $93.43 [hospital A]). CONCLUSIONS Enteric fever can impose a considerable economic burden on patients, caregivers, and health facilities in Nepal. These new estimates of enteric fever cost of illness can improve evaluation and modeling of the costs and benefits of enteric fever-prevention measures.
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Affiliation(s)
- Nelly Mejia
- Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Taiwo Abimbola
- Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Krista Vaidya
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Dipesh Tamrakar
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
- Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Sailesh Pradhan
- Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Rajani Shakya
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Denise O Garrett
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | - Kashmira Date
- Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah W Pallas
- Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Abstract
Enteric fever remains a public health concern in communities lacking sanitation infrastructure to separate sewage from drinking water. To bridge the gap until large-scale civil-engineering projects are implemented in high-burden countries, typhoid conjugate vaccine presents a promising disease-prevention technology. A new typhoid conjugate vaccine was prequalified by the World Health Organization in 2017 and is beginning to be introduced in countries around the world. To help inform vaccine introduction, the Surveillance for Enteric Fever in Asia Project (SEAP) conducts prospective enteric fever surveillance in Bangladesh, Nepal, and Pakistan. This supplement presents findings from Phase II of the study (2016-2019) on burden of disease, clinical presentation, the growing spread of drug-resistant strains, and policy and economic ramifications. These findings are delivered to support policymakers in their deliberations on strategies to introduce typhoid conjugate vaccine as a preventive tool against enteric fever.
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Affiliation(s)
- Alice S Carter
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Denise O Garrett
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
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Hagmann SHF, Angelo KM, Huits R, Plewes K, Eperon G, Grobusch MP, McCarthy A, Libman M, Caumes E, Leung DT, Asgeirsson H, Jensenius M, Schwartz E, Sánchez-Montalvá A, Kelly P, Pandey P, Leder K, Bourque DL, Yoshimura Y, Mockenhaupt FP, van Genderen PJJ, Odolini S, Schlagenhauf P, Connor BA, Hamer DH. Epidemiological and Clinical Characteristics of International Travelers with Enteric Fever and Antibiotic Resistance Profiles of Their Isolates: a GeoSentinel Analysis. Antimicrob Agents Chemother 2020; 64:e01084-20. [PMID: 32816733 DOI: 10.1128/AAC.01084-20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/11/2020] [Indexed: 11/20/2022] Open
Abstract
Enteric fever, caused by Salmonella enterica serovar Typhi (S Typhi) and S. enterica serovar Paratyphi (S Paratyphi), is a common travel-related illness. Limited data are available on the antimicrobial resistance (AMR) patterns of these serovars among travelers. Records of travelers with a culture-confirmed diagnosis seen during or after travel from January 2007 to December 2018 were obtained from GeoSentinel. Traveler demographics and antimicrobial susceptibility data were analyzed. Isolates were classified as nonsusceptible if intermediate or resistant or as susceptible in accordance with the participating site's national guidelines. A total of 889 travelers (S Typhi infections, n = 474; S Paratyphi infections, n = 414; coinfection, n = 1) were included; 114 (13%) were children of <18 years old. Most individuals (41%) traveled to visit friends and relatives (VFRs) and acquired the infection in South Asia (71%). Child travelers with S Typhi infection were most frequently VFRs (77%). The median trip duration was 31 days (interquartile range, 18 to 61 days), and 448 of 691 travelers (65%) had no pretravel consultation. Of 143 S Typhi and 75 S Paratyphi isolates for which there were susceptibility data, nonsusceptibility to antibiotics varied (fluoroquinolones, 65% and 56%, respectively; co-trimoxazole, 13% and 0%; macrolides, 8% and 16%). Two S Typhi isolates (1.5%) from India were nonsusceptible to third-generation cephalosporins. S Typhi fluoroquinolone nonsusceptibility was highest when infection was acquired in South Asia (70 of 90 isolates; 78%) and sub-Saharan Africa (6 of 10 isolates; 60%). Enteric fever is an important travel-associated illness complicated by AMR. Our data contribute to a better understanding of region-specific AMR, helping to inform empirical treatment options. Prevention measures need to focus on high-risk travelers including VFRs and children.
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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: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Abstract
Background Enteric fever is a serious public health problem in Pakistan. Growing problem of drug-resistant Salmonella strains and outbreak of ceftriaxone-resistant Salmonella typhi in Hyderabad during 2016-2017 is concerning. This study aimed to determine the antibiogram profile of Salmonella typhi and Salmonella paratyphi isolated from blood cultures of patients presenting in Pakistan Institute of Medical Sciences (PIMS), Islamabad. Materials and methods A retrospective cross-sectional study conducted in PIMS. A case of enteric fever was defined as a patient with blood culture positive for either S. typhi or S. paratyphi. Demographics and antibiogram profile of the 664 cases who presented during 2012-2018 were included in this study. Results Out of 664 cases, S. typhi was isolated from 528 and S. paratyphi was isolated from 136 cases. Males accounted for the majority of the cases (n = 440, 66.3%). Clustering of the cases was observed in young adults (18-25 years). Incidence was highest during months of summer and monsoon (May-September). Most of the S. typhi isolates were resistant to the first-line antibiotics (amoxicillin 57.6%, co-trimoxazole 61.4%, chloramphenicol 46.9%) and ciprofloxacin (62.7%). Antibiotic resistance rates were lowest for imipenem (3.8%) and ceftriaxone (4.4%). Among S. typhi isolates tested for all first-line antibiotics, 44.6% (149/334) were multidrug-resistant (MDR). In contrast, only 12.2% (11/90) of the S. paratyphi isolates were MDR. 0.7% (2/283) of the tested S. typhi isolates were extensively drug-resistant (XDR). XDR strains were sensitive to imipenem. There was an overall reduction in first-line antibiotic resistance rates from 2012 to 2018. Conclusion S. typhi accounted for the majority of the cases of enteric fever. Most S. typhi isolates were resistant to first-line antibiotics. S. paratyphi exhibited lower antibiotic resistance rates. This study recommends third-generation cephalosporins for empirical therapy and for treatment of MDR cases of enteric fever. Imipenem should be reserved for the treatment of XDR Salmonella cases. A decreasing trend in first-line antibiotic resistance rates over time is promising. Antibiotic stewardship is the need of the hour.
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Affiliation(s)
- Masab Umair
- General (Internal) Medicine, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, PAK
| | - Shajee Ahmad Siddiqui
- General (Internal) Medicine, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, PAK
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13
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Purcell R, Pollard AJ. Elimination of typhoid: Possibility or pipe dream? J Paediatr Child Health 2020; 56:1340-1342. [PMID: 32767815 DOI: 10.1111/jpc.15088] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/06/2020] [Indexed: 11/28/2022]
Abstract
The elimination of typhoid would have a substantial impact on the health of millions of people living in South and Southeast Asia and sub-Saharan Africa. Like many diseases before it, there are significant challenges to elimination, including access to safe drinking water and adequate sanitation practices, the availability of a vaccine, the identification and management of chronic carriers and the emergence of anti-microbial resistance. While provision of clean water and adequate sanitation must remain the ultimate goal, in the short term, required to cornerstone elimination in endemic areas, is an efficacious vaccine. Recent evidence of effectiveness with a tetanus-toxoid conjugate vaccine offers an opportunity for an immunogenic and safe vaccine able to be delivered to young children. Shown to be efficacious in Nepal, where infection is endemic, it may be a viable option in public health programmes moving towards elimination.
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Affiliation(s)
- Rachael Purcell
- Department of Infection and Immunity, Monash Children's Hospital, Melbourne, Victoria, Australia.,Infectious Diseases Unit, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Andrew J Pollard
- NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom.,Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
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14
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Kumar S, Nodoushani A, Khanam F, DeCruz AT, Lambotte P, Scott R, Bogoch II, Vaidya K, Calderwood SB, Bhuiyan TR, Esfandiari J, Ryan ET, Qadri F, Andrews JR, Charles RC. Evaluation of a Rapid Point-of-Care Multiplex Immunochromatographic Assay for the Diagnosis of Enteric Fever. mSphere 2020; 5:e00253-20. [PMID: 32522777 PMCID: PMC7289704 DOI: 10.1128/msphere.00253-20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/25/2020] [Indexed: 12/04/2022] Open
Abstract
There is a critical need for an improved rapid diagnostic for enteric fever. We have previously demonstrated that serum IgA responses targeting Salmonella enterica serovar Typhi hemolysin E (HlyE) and lipopolysaccharide (LPS) are able to discriminate patients with acute typhoid from healthy controls in areas where enteric fever is endemic (healthy endemic controls) and from patients with other bacterial infections. We now have data demonstrating that IgA antibody responses against these antigens also work well for identifying patients with acute S. Paratyphi A infection. To develop a test for acute enteric fever detection, we have adapted a point-of-care immunochromatographic dual-path platform technology (DPP), which improves on the traditional lateral flow technology by using separate sample and conjugate paths and a compact, portable reader, resulting in diagnostics with higher sensitivity and multiplexing abilities. In this analysis, we have compared our standard enzyme-linked immunosorbent assay (ELISA) method to the DPP method in detecting acute phase plasma/serum anti-HlyE and anti-LPS IgA antibodies in a cohort of patients with culture-confirmed S. Typhi (n = 30) and Paratyphi A infection (n = 20), healthy endemic controls (n = 25), and febrile endemic controls (n = 25). We found that the DPP measurements highly correlated with ELISA results, and both antigens had an area under the curve (AUC) of 0.98 (sensitivity of 92%, specificity of 94%) with all controls and an AUC of 0.98 (sensitivity of 90%, specificity of 96%) with febrile endemic controls. Our results suggest that the point-of-care DPP Typhoid System has high diagnostic accuracy for the rapid detection of enteric fever and warrants further evaluation.IMPORTANCE Enteric fever remains a significant global problem, and control programs are significantly limited by the lack of an optimal assay for identifying individuals with acute infection. This is especially critical considering the recently released World Health Organization (WHO) position paper endorsing the role of the typhoid conjugate vaccine in communities where enteric fever is endemic. A reliable diagnostic test is needed to assess and evaluate typhoid intervention strategies and determine which high-burden areas may benefit most from a vaccine intervention. Our collaborative team has developed and evaluated a point-of-care serodiagnostic assay based on detection of anti-HlyE and LPS IgA. Our finding of the high diagnostic accuracy of the DPP Typhoid System for the rapid detection of enteric fever has the potential to have significant public health impact by allowing for improved surveillance and for control and prevention programs in areas with limited laboratory capacity.
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Affiliation(s)
| | - Ariana Nodoushani
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Farhana Khanam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Paul Lambotte
- Chembio Diagnostic Systems, Inc., Medford, New York, USA
| | - Robert Scott
- Chembio Diagnostic Systems, Inc., Medford, New York, USA
| | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Ontario, Canada
| | | | - Stephen B Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Taufiqur R Bhuiyan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Richelle C Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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15
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Saha S, Islam MS, Sajib MSI, Saha S, Uddin MJ, Hooda Y, Hasan M, Amin MR, Hanif M, Shahidullah M, Islam M, Luby SP, Andrews JR, Saha SK. Epidemiology of Typhoid and Paratyphoid: Implications for Vaccine Policy. Clin Infect Dis 2020; 68:S117-S123. [PMID: 30845325 PMCID: PMC6405278 DOI: 10.1093/cid/ciy1124] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Typhoid and paratyphoid remain the most common bloodstream infections in many resource-poor settings. The World Health Organization recommends typhoid conjugate vaccines for country-specific introduction, but questions regarding typhoid and paratyphoid epidemiology persist, especially regarding their severity in young children. Methods We conducted enteric fever surveillance in Bangladesh from 2004 through 2016 in the inpatient departments of 2 pediatric hospitals and the outpatient departments of 1 pediatric hospital and 1 private consultation clinic. Blood cultures were conducted at the discretion of the treating physicians; cases of culture-confirmed typhoid/paratyphoid were included. Hospitalizations and durations of hospitalizations were used as proxies for severity in children <12 years old. Results We identified 7072 typhoid and 1810 paratyphoid culture-confirmed cases. There was no increasing trend in the proportion of paratyphoid over the 13 years. The median age in the typhoid cases was 60 months, and 15% of the cases occurred in children <24 months old. The median age of the paratyphoid cases was significantly higher, at 90 months (P < .001); 9.4% were in children <24 months old. The proportion of children (<12 years old) hospitalized with typhoid and paratyphoid (32% and 21%, respectively) decreased with age; there was no significant difference in durations of hospitalizations between age groups. However, children with typhoid were hospitalized for longer than those with paratyphoid. Conclusions Typhoid and paratyphoid fever are common in Dhaka, including among children under 2 years old, who have equivalent disease severity as older children. Early immunization with typhoid conjugate vaccines could avert substantial morbidity, but broader efforts are required to reduce the paratyphoid burden.
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Affiliation(s)
- Senjuti Saha
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh.,Department of Infectious Diseases, Stanford University School of Medicine, California
| | - Md Shfiqul Islam
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | | | - Shampa Saha
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Mohammad Jamal Uddin
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Yogesh Hooda
- Department of Biochemistry, University of Toronto, Ontario, Canada
| | - Md Hasan
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Md Ruhul Amin
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh.,Bangladesh Institute of Child Health, Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh
| | - Mohammed Hanif
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh.,Bangladesh Institute of Child Health, Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh.,Popular Diagnostic Center, Dhaka, Bangladesh
| | - Mohammad Shahidullah
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.,Shishu Shasthya Foundation Hospital, Dhaka, Bangladesh
| | - Maksuda Islam
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Stephen P Luby
- Department of Infectious Diseases, Stanford University School of Medicine, California
| | - Jason R Andrews
- Department of Infectious Diseases, Stanford University School of Medicine, California
| | - Samir K Saha
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh.,Bangladesh Institute of Child Health, Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh.,Popular Diagnostic Center, Dhaka, Bangladesh
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16
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O'Reilly PJ, Pant D, Shakya M, Basnyat B, Pollard AJ. Progress in the overall understanding of typhoid fever: implications for vaccine development. Expert Rev Vaccines 2020; 19:367-382. [PMID: 32238006 DOI: 10.1080/14760584.2020.1750375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Typhoid fever continues to have a substantial impact on human health, especially in Asia and sub-Saharan Africa. Access to safe water, and adequate sanitation and hygiene remain the cornerstone of prevention, but these are not widely available in many impoverished settings. The emergence of antibiotic resistance affects typhoid treatment and adds urgency to typhoid control efforts. Vaccines provide opportunities to prevent and control typhoid fever in endemic settings. AREAS COVERED Literature search was performed looking for evidence concerning the global burden of typhoid and strategies for the prevention and treatment of typhoid fever. Cost of illness, available typhoid and paratyphoid vaccines and cost-effectiveness were also reviewed. The objective was to provide a critical overview of typhoid fever, in order to assess the current understanding and potential future directions for typhoid treatment and control. EXPERT COMMENTARY Our understanding of typhoid burden and methods of prevention has grown over recent years. However, typhoid fever still has a significant impact on health in low and middle-income countries. Introduction of typhoid conjugate vaccines to the immunization schedule is expected to make a major contribution to control of typhoid fever in endemic countries, although vaccination alone is unlikely to eliminate the disease.
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Affiliation(s)
- Peter J O'Reilly
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre , Oxford, UK
| | - Dikshya Pant
- Department of Paediatrics, Patan Academy of Health Sciences, Patan Hospital , Kathmandu, Nepal
| | - Mila Shakya
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences , Kathmandu, Nepal
| | - Buddha Basnyat
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences , Kathmandu, Nepal
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre , Oxford, UK
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17
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Abstract
Background & objectives: The temporal trends in the development of antimicrobial resistance (AMR) among Salmonella Typhi and Salmonella Paratyphi in India have not been systematically reported. We aimed to systematically review the temporal AMR trends (phenotypic and molecular mechanisms) in bacterial isolates from patients with enteric fever over two decades in India. Methods: To identify trends in AMR in India, resistance patterns among 4611 individual S. Typhi isolates and 800 S. Paratyphi A isolates, reported from 1992 to 2017 in 40 publications, were analysed. Molecular resistance determinants were extracted from 22 publications and also reviewed in accordance with the PRISMA guidelines. Articles were sourced using a predefined search strategy from different databases. Results: The analyses suggested that multidrug-resistant (MDR) enteric fever was declining in India and being replaced by fluoroquinolone (FQ) resistance. Mutations in gyrA and parC were key mechanisms responsible for FQ resistance, whereas MDR was largely driven by resistance determinants encoded on mobile genetic elements (plasmids, transposons). Interpretation & conclusions: The results reflect the effect of antimicrobial pressure which has been driving AMR in typhoidal Salmonella in India. Understanding these trends is important in planning future approaches to therapy, which serve as a baseline for assessment of the impact of new typhoid conjugate vaccines against these resistant organisms.
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Affiliation(s)
- Carl D Britto
- Department of Paediatrics, University of Oxford & NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Jacob John
- Department of Community Medicine, Christian Medical College, Vellore, India
| | - Valsan P Verghese
- Department of Paediatrics, Christian Medical College, Vellore, India
| | - Andrew J Pollard
- Department of Paediatrics, University of Oxford & NIHR Oxford Biomedical Research Centre, Oxford, UK
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18
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Pitzer VE, Meiring J, Martineau FP, Watson CH, Kang G, Basnyat B, Baker S. The Invisible Burden: Diagnosing and Combatting Typhoid Fever in Asia and Africa. Clin Infect Dis 2019; 69:S395-S401. [PMID: 31612938 PMCID: PMC6792124 DOI: 10.1093/cid/ciz611] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Measuring the burden of typhoid fever and developing effective strategies to reduce it require a surveillance infrastructure that is currently lacking in many endemic countries. Recent efforts and partnerships between local and international researchers have helped to provide new data on the incidence and control of typhoid in parts of Asia and Africa. Here, we highlight examples from India, Nepal, Vietnam, Fiji, Sierra Leone, and Malawi that summarize past and present experiences with the diagnosis, treatment, and prevention of typhoid fever in different locations with endemic disease. While there is no validated road map for the elimination of typhoid, the lessons learned in studying the epidemiology and control of typhoid in these settings can provide insights to guide future disease control efforts.
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Affiliation(s)
- Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut
| | - James Meiring
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the National Institute for Health Research Oxford Biomedical Research Centre, United Kingdom
| | | | - Conall H Watson
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Gagandeep Kang
- Translational Health Sciences Technology Institute, Faridabad, Haryana, India
| | - Buddha Basnyat
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Stephen Baker
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Department of Medicine, University of Cambridge, United Kingdom
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19
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Gu H, Yan C, Jiang Z, Li X, Chen E, Jiang J, Jiang Q, Zhou Y. Epidemiological Trend of Typhoid and Paratyphoid Fevers in Zhejiang Province, China from 1953 to 2014. Int J Environ Res Public Health 2018; 15:ijerph15112427. [PMID: 30388758 PMCID: PMC6266170 DOI: 10.3390/ijerph15112427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 12/01/2022]
Abstract
Background: The incidences of typhoid and paratyphoid remain high and these diseases still pose a public health problem in China and in Zhejiang Province in particular. This study aimed to investigate the trend of typhoid and paratyphoid in Zhejiang Province from 1953 to 2014 and to provide a theoretical basis for the prevention and control of these diseases. Methods: Included in this study were compiled epidemiological data of typhoid and paratyphoid cases in Zhejiang from 1953 to 2003 and epidemiological data of those from 2004 to 2014 registered in the China Information System for Diseases Control and Prevention. Description methods were employed to explore the epidemiological characteristics, including long-term trend, gender distribution, age distribution, and occupation distribution. Incidence maps were made to represent the annual average incidences for each municipality. Spearman’s rank correlation was performed to detect the correlation between incidence and average elevation, and circular distribution was calculated to identify the seasonality and peak days of the diseases. A p-value of <0.05 was considered statistically significant. Results: A total of 182,602 typhoid and paratyphoid cases were reported in Zhejiang Province from 1953 to 2014, and the average annual incidence was 7.89 per 100,000 population. The incidence in 2014 decreased by 93.82% compared with that in 1953 and by 95.00% compared with the highest incidence rate. The average incidence before 2003 was negatively correlated with the average elevation of each region in Zhejiang province (r < 0, p < 0.05), but there was no statistically significant correlation from 2003. The peak period of diseases fell in the months from April to October every year. The incidence among the population group aged over 35 rose gradually but declined sharply among those between 20 and 34. Conclusions: The incidence of typhoid and paratyphoid decreased in Zhejiang Province from 1953 to 2014 but remained high in some regions. Proper measures for prevention and control are warranted in the southeast coast areas and for high-risk populations.
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Affiliation(s)
- Hua Gu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China.
- Zhejiang Provincial Center for Medical Science Technology & Education, Hangzhou 310006, China.
| | - Congcong Yan
- Department of Preventive Medicine, School of Medicine, Ningbo University, Ningbo 315211, China.
| | - Zhenggang Jiang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China.
| | - Xiuyang Li
- Department of Epidemiology & Health Statistics, Zhejiang University, Hangzhou 310058, China.
| | - Enfu Chen
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China.
| | - Jianmin Jiang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China.
| | - Qingwu Jiang
- Department of Epidemiology & Health Statistics, Fudan University, Shanghai 200032, China.
| | - Yibiao Zhou
- Department of Epidemiology & Health Statistics, Fudan University, Shanghai 200032, China.
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20
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Britto C, Pollard AJ, Voysey M, Blohmke CJ. An Appraisal of the Clinical Features of Pediatric Enteric Fever: Systematic Review and Meta-analysis of the Age-Stratified Disease Occurrence. Clin Infect Dis 2018; 64:1604-1611. [PMID: 28369224 PMCID: PMC5434381 DOI: 10.1093/cid/cix229] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 03/18/2017] [Indexed: 11/14/2022] Open
Abstract
Children bear a substantial proportion of the enteric fever disease burden in endemic areas. Controversy persists regarding which age groups are most affected, leading to uncertainty about optimal intervention strategies. We performed a systematic review and meta-analysis of studies in Asia and Africa to compare the relative proportion of children with enteric fever in the age groups <5 years, 5–9 years, and 10–14 years. Overall, studies conducted in Africa showed a relatively smaller occurrence of disease in the youngest age group, whereas in Asia the picture was more mixed with a very large degree of heterogeneity in estimates. The clinical features of enteric fever reviewed here differ between younger and older children and adults, likely leading to further uncertainty over disease burden. It is evident from our review that preschool children and infants also contribute a significant proportion of disease burden but have not been adequately targeted via vaccination programs, which have been focusing primarily on school-based vaccination campaigns.
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Affiliation(s)
- Carl Britto
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the National Institute for Health Research Oxford Biomedical Research Centre and
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the National Institute for Health Research Oxford Biomedical Research Centre and
| | - Merryn Voysey
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the National Institute for Health Research Oxford Biomedical Research Centre and.,Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
| | - Christoph J Blohmke
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the National Institute for Health Research Oxford Biomedical Research Centre and
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21
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Lane RJ, Holland D, McBride S, Perera S, Zeng I, Wilson M, Read K, Jelleyman T, Ingram RJH. Enteric fever in the Pacific: a regional retrospective study from Auckland, New Zealand. Intern Med J 2015; 45:148-55. [PMID: 25404003 DOI: 10.1111/imj.12644] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 07/17/2014] [Accepted: 11/09/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are limited clinical data on enteric fever in the Pacific and New Zealand (NZ) compared with the Indian subcontinent (ISC) and South-East Asia (SEA). Our objective was to describe enteric fever in Auckland - a large Pacific city, focusing on disease acquired in these regions. METHODS We reviewed enteric fever cases hospitalised in Auckland from January 2005 to December 2010. RESULTS Microbiologically confirmed EF was identified in 162 patients. Travel regions: Pacific, 40 cases (25%) (Samoa, 38; Fiji, two), ISC, 72 (44%), SEA, seven (4%), other, three (2%), no travel, 40 (25%). Enteric fever rates for Auckland resident travellers were: India 50.3/100 000; Samoa 19.7/100 000.All Pacific cases were Salmonella Typhi. Of local isolates (without travel history), 38 were S. Typhi (36 fully susceptible, one multi-drug resistant (MDR) + nalidixic acid resistant (NAR), one unknown) and two S. Paratyphi (both NAR). Of non-Pacific travel, 56/82 (69%) isolates were S. Typhi, the remainder S. Paratyphi (15 isolates were fully susceptible, only 1% were MDR). Significant associations of serotype and antibiotic resistance with different travel regions and similarity of phage types (local and Pacific) were observed. Headache, vomiting and acute kidney injuries were more frequent with Pacific travel, while abdominal distension and cholecystitis with local disease. Shorter duration of treatment in the Pacific group was seen despite length of stay in hospital not being reduced. Local cases were associated with longer hospital admissions. CONCLUSIONS One half of cases in Auckland are acquired either from Pacific or locally. Similarities mean that disease acquired locally is likely of Pacific origin.
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Affiliation(s)
- R J Lane
- Infectious Diseases Department, Middlemore Hospital, Auckland, New Zealand; Infectious Diseases Department, Auckland City Hospital, Auckland, New Zealand
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Young MK, Slinko V, Smith J, Carroll H, Bennett S, Appleton S, McCall BJ. Informing the public health management of typhoid and paratyphoid: the Australian context. Aust N Z J Public Health 2015; 39:577-81. [PMID: 26122725 DOI: 10.1111/1753-6405.12387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/01/2014] [Revised: 01/01/2015] [Accepted: 01/01/2015] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine outcomes of public health management of notified enteric fever cases in South-East Queensland over the past five years. METHODS Notification records of typhoid and paratyphoid infection in South-East Queensland 2008-2012 (inclusive) were reviewed to determine likelihood of cases and contacts adhering to present or previous recommendations for faecal clearance/screening, duration of infectiousness of cases and extent of local transmission to contacts. RESULTS Sixty-nine of 85 cases and 218 of 265 contacts submitted at least one faecal specimen. Cases were 2.7 (95%CI 1.2-6.0) and contacts were 4.4 (95%CI 3.0-6.4) times more likely to complete recommended faecal clearance/screening under previous compared to present guidelines (requiring more specimens). In ten cases with positive post-treatment specimens, last recorded infectiousness was 19 days to six months after notification. The documented rate of local transmission of infection was 18/1,000 contacts submitting at least one faecal specimen (95%CI 6-48/1,000). CONCLUSIONS Local transmission risk of enteric fever in South-East Queensland is low, although small numbers of cases may have prolonged bacilli excretion post-treatment. More complex clearance/screening regimens are associated with decreased compliance. IMPLICATIONS Pursuing extensive faecal clearance/screening regimens is unlikely to be effective in terms of public health management of enteric fever in South-East Queensland. We suggest a unified national approach focussing on cases/contacts at high risk of disease transmission.
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Affiliation(s)
- Megan K Young
- Metro North Public Health Unit, Metro North Hospital and Health Service, Queensland.,MHIQ and School of Medicine, Griffith University, Queensland
| | - Vicki Slinko
- Metro South Public Health Unit, Metro South Hospital and Health Service, Queensland
| | - James Smith
- Metro North Public Health Unit, Metro North Hospital and Health Service, Queensland
| | | | | | | | - Brad J McCall
- Metro South Public Health Unit, Metro South Hospital and Health Service, Queensland
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Elhadad D, McClelland M, Rahav G, Gal-Mor O. Feverlike Temperature is a Virulence Regulatory Cue Controlling the Motility and Host Cell Entry of Typhoidal Salmonella. J Infect Dis 2014; 212:147-56. [PMID: 25492917 DOI: 10.1093/infdis/jiu663] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 08/01/2014] [Accepted: 11/11/2014] [Indexed: 12/11/2022] Open
Abstract
Human infection with typhoidal Salmonella serovars causes a febrile systemic disease, termed enteric fever. Here we establish that in response to a temperature equivalent to fever (39 °C-42 °C) Salmonella enterica serovars Typhi, Paratyphi A, and Sendai significantly attenuate their motility, epithelial cell invasion, and uptake by macrophages. Under these feverlike conditions, the residual epithelial cell invasion of S. Paratyphi A occurs in a type III secretion system (T3SS) 1-independent manner and results in restrained disruption of epithelium integrity. The impaired motility and invasion are associated with down-regulation of T3SS-1 genes and class II and III (but not I) of the flagella-chemotaxis regulon. In contrast, we demonstrate up-regulation of particular Salmonella pathogenicity island 2 genes (especially spiC) and increased intraepithelial growth in a T3SS-2-dependent manner. These results indicate that elevated physiological temperature is a novel cue controlling virulence phenotypes in typhoidal serovars, which is likely to play a role in the distinct clinical manifestations elicited by typhoidal and nontyphoidal salmonellae.
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Affiliation(s)
- Dana Elhadad
- The Infectious Diseases Research Laboratory, Sheba Medical Center, Tel-Hashomer The Department of Clinical Microbiology and Immunology Sackler School of Medicine, Tel Aviv University, Israel
| | - Michael McClelland
- Department of Microbiology and Molecular Genetics, University of California, Irvine
| | - Galia Rahav
- The Infectious Diseases Research Laboratory, Sheba Medical Center, Tel-Hashomer Sackler School of Medicine, Tel Aviv University, Israel
| | - Ohad Gal-Mor
- The Infectious Diseases Research Laboratory, Sheba Medical Center, Tel-Hashomer The Department of Clinical Microbiology and Immunology Sackler School of Medicine, Tel Aviv University, Israel
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Karki S, Shakya P, Cheng AC, Dumre SP, Leder K. Trends of etiology and drug resistance in enteric fever in the last two decades in Nepal: a systematic review and meta-analysis. Clin Infect Dis 2013; 57:e167-76. [PMID: 23985342 DOI: 10.1093/cid/cit563] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Prospective time-trend analyses on shifting etiology and trends of drug resistance in enteric fever are scarce. Using published and unpublished datasets from Nepal, we performed a systematic review and meta-analysis to understand the trends in etiology and resistance to antimicrobials that have occurred since 1993. Thirty-two studies involving 21 067 Salmonella enterica serotype Typhi (ST) and S. enterica serotype Paratyphi A (SPA) isolates were included. There was an increasing trend in enteric fever caused by SPA during the last 2 decades (P < .01). We observed sharply increasing trends in resistance to nalidixic acid and ciprofloxacin for both ST and SPA. In contrast, multi-drug resistance (MDR), resistance to traditional first-line antibiotics such as chloramphenicol and co-trimoxazole have significantly decreased for both organisms. The resistance to ceftriaxone has remained low, suggesting it is likely to remain useful as a reserve antibiotic for treatment. Trends in decreasing resistance to traditional first-line antibiotics and decreasing MDR provide an opportunity to reconsider these first-line antimicrobials as therapeutic options.
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Affiliation(s)
- Surendra Karki
- Infectious Disease Epidemiology Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Pandit V, Kumar A, Kulkarni MM, Pattanshetty SM, Samarasinghe C, Kamath S. Study of clinical profile and antibiotic sensitivity in paratyphoid Fever cases admitted at teaching hospital in South India. J Family Med Prim Care 2012; 1:118-21. [PMID: 24479019 PMCID: PMC3893971 DOI: 10.4103/2249-4863.104981] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Globally, there has been an increase in incidence of paratyphoid fever, including paratyphoid fever caused by antimicrobial-resistant strains. Studying the clinical profile and antimicrobial sensitivity of paratyphoid fever would help in early diagnosis, appropriate treatment, rational use of antibiotics and prevent drug resistance. AIM The aim of the study was to evaluate the clinical profile and sensitivity patterns of antibiotics used in the treatment of paratyphoid fever. SETTINGS AND DESIGN A record-based study was done in tertiary care hospital, South India. MATERIALS AND METHODS A retrospective analysis of culture-proven cases of paratyphoid fever was done in a tertiary care hospital. The socio-demographic characteristics, mode of presentation and the sensitivity pattern of isolates from blood culture were recorded. One hundred and ten case files of Salmonella paratyphi were reviewed from the medical records section and the required data (data regarding the clinical profile and antibiotic sensitivity) was collected and analyzed using SPSS version 11.5. RESULTS Fever was present in all patients. All the cases were sensitive for third-generation cephalosporins, and only 31.8% of the cases were sensitive for quinolones. Sensitivity towards other antibiotics in descending order was as follows: ampicillin 93.6%, chloramphenicol 91.8%, aminoglycosides 90.4% and sulphonamides 76.4%. CONCLUSIONS Research shows that there is increasing resistance to fluoroquinolones and sensitivity to chloramphenicol. Considering the changing trend in the sensitivity pattern, the recommendations of treatment for enteric fever need to be rationalized and re-considered.
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Affiliation(s)
- Vinay Pandit
- Department of Medicine, Kasturba Medical College, Manipal University, Manipal, India
| | - Ashwini Kumar
- Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal, India
| | | | - Sanjay M Pattanshetty
- Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal, India
| | - Charmine Samarasinghe
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal University, Manipal, India
| | - Sneha Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal, India
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