Incidence of invasive salmonella disease in sub-Saharan Africa: a multicentre population-based surveillance study

Marks, Florian and von Kalckreuth, Vera and Aaby, Peter and Adu-Sarkodie, Yaw and Ahmed El Tayeb, Muna and Ali, Mohammad and Aseffa, Abraham and Baker, Stephen and M Biggs, Holly and Bjerregaard-Andersen, Morten and F Breiman, Robert and I Campbell, James and Cosmas, Leonard and A Crump, John and Maria Cruz Espinoza, Ligia and Fung Deerin, Jessica and Myriam Dekker, Denise and S Fields, Barry and Gasmelseed, Nagla and T Hertz, Julian and Van Minh Hoang, Nguyen and Im, Justin and Jaeger, Anna and Jin Jeon, Hyon and Parfait Kabore, Leon and H Keddy, Karen and Konings, Frank and Krumkamp, Ralf and Ley, Benedikt and Valborg Løfb erg, Sandra and May, Jürgen and G Meyer, Christian and D Mintz, Eric and M Montgomery, Joel and Ahmet Niang, Aissatou and Nichols, Chelsea and Olack, Beatrice and Pak, Gi Deok and Panzner, Ursula and Kyung Park, Jin and Eun Park, Se and Rabezanahary, Henintsoa and Rakotozandrindrainy, Raphaël and Mirana Raminosoa, Tiana and Jean Luco Razafi ndrabe, Tsiriniaina and Sampo, Emmanuel and Schütt-Gerowitt, Heidi and Gassama Sow, Amy and Sarpong, Nimako and Jin Seo, Hye and Sooka, Arvinda and Bassiahi Soura, Abdramane and Tall, Adama and Teferi, Mekonnen and Thriemer, Kamala and R Warren, Michelle and Yeshitela, Biruk and D Clemens, John and F Wierzba, Thomas (2017) Incidence of invasive salmonella disease in sub-Saharan Africa: a multicentre population-based surveillance study. The Lancet Global Health, 5 (3). e310-e320. ISSN 0140-6736

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Abstract

Background Available incidence data for invasive salmonella disease in sub-Saharan Africa are scarce. Standardised, multicountry data are required to better understand the nature and burden of disease in Africa. We aimed to measure the adjusted incidence estimates of typhoid fever and invasive non-typhoidal salmonella (iNTS) disease in sub- Saharan Africa, and the antimicrobial susceptibility profi les of the causative agents. Methods We established a systematic, standardised surveillance of blood culture-based febrile illness in 13 African sentinel sites with previous reports of typhoid fever: Burkina Faso (two sites), Ethiopia, Ghana, Guinea-Bissau, Kenya, Madagascar (two sites), Senegal, South Africa, Sudan, and Tanzania (two sites). We used census data and health-care records to defi ne study catchment areas and populations. Eligible participants were either inpatients or outpatients who resided within the catchment area and presented with tympanic (≥38·0°C) or axillary temperature (≥37·5°C). Inpatients with a reported history of fever for 72 h or longer were excluded. We also implemented a health-care utilisation survey in a sample of households randomly selected from each study area to investigate health-seeking behaviour in cases of self-reported fever lasting less than 3 days. Typhoid fever and iNTS disease incidences were corrected for health-careseeking behaviour and recruitment. Findings Between March 1, 2010, and Jan 31, 2014, 135 Salmonella enterica serotype Typhi (S Typhi) and 94 iNTS isolates were cultured from the blood of 13 431 febrile patients. Salmonella spp accounted for 33% or more of all bacterial pathogens at nine sites. The adjusted incidence rate (AIR) of S Typhi per 100 000 person-years of observation ranged from 0 (95% CI 0–0) in Sudan to 383 (274–535) at one site in Burkina Faso; the AIR of iNTS ranged from 0 in Sudan, Ethiopia, Madagascar (Isotry site), and South Africa to 237 (178–316) at the second site in Burkina Faso. The AIR of iNTS and typhoid fever in individuals younger than 15 years old was typically higher than in those aged 15 years or older. Multidrug-resistant S Typhi was isolated in Ghana, Kenya, and Tanzania (both sites combined), and multidrug-resistant iNTS was isolated in Burkina Faso (both sites combined), Ghana, Kenya, and Guinea-Bissau. Interpretation Typhoid fever and iNTS disease are major causes of invasive bacterial febrile illness in the sampled locations, most commonly aff ecting children in both low and high population density settings. The development of iNTS vaccines and the introduction of S Typhi conjugate vaccines should be considered for high-incidence settings, such as those identifi ed in this study.

Item Type: Article
Subjects: WA Public Health
Divisions: Faculty of Medicin
Depositing User: Touba Derakhshande
Date Deposited: 12 Sep 2017 07:14
Last Modified: 12 Sep 2017 07:14
URI: http://eprints.bpums.ac.ir/id/eprint/5922

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