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