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Clin Infect Dis. 2018 Nov 28;67(12):1824-1830. doi: 10.1093/cid/ciy386.

Determining the Best Immunization Strategy for Protecting African Children Against Invasive Salmonella Disease.

Author information

1
International Vaccine Institute, Seoul, Republic of Korea.
2
Kumasi Center for Collaborative Research in Tropical Medicine, Kumasi, Ghana.
3
Departments of Global and International Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
4
Departments of Clinical Microbiology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
5
Institute Pasteur de Dakar.
6
Université Cheikh Anta Diop de Dakar, Senegal.
7
Institut Supérieur des Sciences de la Population, University of Ouagadougou, Burkina Faso.
8
Faculty of Medicine, University of Gezira, Wad Medani, Sudan.
9
Faculty of Science, University of Hafr Al Batin, Saudi Arabia.
10
National Institute for Communicable Diseases, Johannesburg, South Africa.
11
Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
12
Bandim Health Project, Bissau, Guinea-Bissau.
13
Research Center for Vitamins and Vaccines, Copenhagen, Denmark.
14
Armauer Hansen Research Institute, ALERT Campus, Addis Ababa, Ethiopia.
15
Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
16
Division of Infectious Diseases and International Health, Duke University Medical Center.
17
Duke Global Health Institute, Duke University, Durham, North Carolina.
18
Centre for International Health, University of Otago, Dunedin, New Zealand.
19
Global Health Institute, Emory University, Atlanta, Georgia.
20
Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
21
Bernhard Nocht Institute for Tropical Medicine, Hamburg.
22
Institute of Tropical Medicine, Eberhard-Karls University Tübingen, Germany.
23
Duy Tan University, Da Nang, Vietnam.
24
Division of Infectious Diseases and Geographic Medicine, Stanford University, California.
25
University of Antananarivo, Madagascar.
26
Department of Medicine, University of Cambridge, United Kingdom.
27
Department of Medicine, University of Maryland School of Medicine, Baltimore.
28
World Health Organization, Geneva, Switzerland.
29
International Centre for Diarrheal Disease Research, Bangladesh, Dhaka.
30
Fielding School of Public Health, University of California, Los Angeles.
31
Korea University School of Medicine, Seoul, Republic of Korea.

Abstract

Background:

The World Health Organization recently prequalified a typhoid conjugate vaccine (TCV), recommending its use in persons ≥6 months to 45 years residing in typhoid fever (TF)-endemic areas. We now need to consider how TCVs can have the greatest impact in the most vulnerable populations.

Methods:

The Typhoid Fever Surveillance in Africa Program (TSAP) was a blood culture-based surveillance of febrile patients from defined populations presenting at healthcare facilities in 10 African countries. TF and invasive non-typhoidal Salmonella (iNTS) disease incidences were estimated for 0-10 year-olds in one-year age increments.

Results:

Salmonella Typhi and iNTS were the most frequently isolated pathogens; 135 and 94 cases were identified, respectively. Analysis from three countries was excluded (incomplete person-years of observation (PYO) data). Thirty-seven of 123 TF cases (30.1%) and 71/90 iNTS disease cases (78.9%) occurred in children aged <5 years. No TF and 8/90 iNTS infections (8.9%) were observed in infants aged <9 months. The TF incidences (/100 000 PYO) for children aged <1 year and 1 to <2 years were 5 and 39, respectively; the highest incidence was 304 per 100 000 PYO in 4 to <5 year-olds. The iNTS disease incidence in the defined age groups ranged between 81 and 233 per 100 000 PYO, highest in 1 to <2 year-olds. TF and iNTS disease incidences were higher in West Africa.

Conclusions:

High burden of TF detected in young children strengthens the need for TCV introduction. Given the concurrent iNTS disease burden, development of a trivalent vaccine against S. Typhi, S. Typhimurium, and S. Enteritidis may be timely in this region.

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