Designing Comprehensive Public Health Surveillance for Enteric Fever in Endemic Countries: Importance of Including Different Healthcare Facilities.

BACKGROUND

Designing comprehensive surveillance to generate credible burden estimates of enteric fever in an endemic country can be challenging because care-seeking behavior is complex and surveillance in different healthcare facilities may lead to documentation of different epidemiological characteristics.

METHODS

We conducted retrospective surveillance in 3 healthcare facilities to identify culture-confirmed enteric fever cases in Dhaka, Bangladesh, from January 2012 through December 2016. The study settings included (1) hospital in-patient department (IPD), (2) hospital out-patient department (OPD), and (3) private consultation center OPD. We analyzed the cases to understand their distribution, age ranges, and antibiotic susceptibility patterns across the settings.

RESULTS

Of the 1837 culture-confirmed enteric fever cases, 59% (1079 of 1837) were OPD cases. Children with enteric fever hospitalized in the IPDs were younger than children seeking care at the hospital OPD (median age: 45 vs 60 months) or private OPD (median age: 45 vs 72 months). Multidrug resistance rates were slightly higher in hospital IPD cases than in private OPD cases (26% vs 24%).

CONCLUSIONS

In each facility, we identified different epidemiological characteristics, and lack of consideration of any of these may result in misinterpretation of disease burden, identification of different age groups, and/or antibiotic susceptibility patterns.