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Lancet Glob Health. 2017 Mar;5(3):e310-e323. doi: 10.1016/S2214-109X(17)30022-0.

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

Author information

1
International Vaccine Institute, SNU Research Park, Seoul, South Korea. Electronic address: fmarks@ivi.int.
2
International Vaccine Institute, SNU Research Park, Seoul, South Korea.
3
Bandim Health Project, Bissau, Guinea-Bissau; Research Center for Vitamins and Vaccines, Copenhagen, Denmark.
4
Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
5
Faculty of Medicine, University of Gezira, Wad Medani, Sudan.
6
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
7
Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
8
Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
9
Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA.
10
Centers for Disease Control and Prevention, Nairobi, Kenya; Global Health Institute, Emory University, Atlanta, GA, USA.
11
Centers for Disease Control and Prevention, Nairobi, Kenya; WHO-Kenya Country Office, Nairobi, Kenya.
12
Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA; Centre for International Health, University of Otago, Dunedin, New Zealand.
13
Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany.
14
Centers for Disease Control and Prevention, Nairobi, Kenya.
15
Faculty of Medicine, University of Gezira, Wad Medani, Sudan; Faculty of Science, University of Hafr Al Batin, Hafr Al Batin, Saudi Arabia.
16
Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
17
Schiphra Hospital, Ouagadougou, Burkina Faso.
18
National Institute for Communicable Diseases, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
19
International Vaccine Institute, SNU Research Park, Seoul, South Korea; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia.
20
Institute of Tropical Medicine, Eberhard-Karls University Tübingen, Tübingen, Germany; Duy Tan University, Da Nang, Vietnam.
21
National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
22
Institute Pasteur de Dakar, Dakar, Senegal.
23
Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.
24
Laboratory of Microbiology, University of Antananarivo, Antananarivo, Madagascar.
25
International Vaccine Institute, SNU Research Park, Seoul, South Korea; Institute of Medical Microbiology, University of Cologne, Cologne, Germany.
26
Institute Pasteur de Dakar, Dakar, Senegal; University Cheikh Anta Diop de Dakar, Dakar, Senegal.
27
Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany.
28
National Institute for Communicable Diseases, Johannesburg, South Africa.
29
Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso.
30
International Vaccine Institute, SNU Research Park, Seoul, South Korea; International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh; University of California Fielding School of Public Health, Los Angeles, CA, USA.

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 profiles 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 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.

Comment in

PMID:
28193398
PMCID:
PMC5316558
DOI:
10.1016/S2214-109X(17)30022-0
[Indexed for MEDLINE]
Free PMC Article

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