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Clin Infect Dis. 2018 Mar 7. doi: 10.1093/cid/ciy190. [Epub ahead of print]

Case fatality rate of enteric fever in endemic countries: A systematic review and meta-analysis.

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Department of Vaccine & Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium; Department of Mathematics and Statistics, Hasselt University, Diepenbeek, Belgium.
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America.
Department of Vaccine & Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium.


Enteric fever is a febrile illness, occurring mostly in Asia and Africa, which can present as a severe and possibly fatal disease. Currently, a case fatality rate (CFR) of 1% is assumed when evaluating the global burden of enteric fever. Until now, no meta-analysis has been conducted to summarize mortality from enteric fever. Therefore, we conducted a systematic review and meta-analysis to aggregate all available evidence. We estimated an overall CFR of 2.49% (95% CI: 1.65%-3.75%, n=44), and a CFR in hospitalized patients of 4.45% 4.45% (95% CI: 2.85%-6.88%, n=21/44). There was considerably heterogeneity in estimates of the CFR from individual studies. Neither age nor antimicrobial resistance were significant prognostic factors, but there was limited data available for these analyses. The combined estimate of the CFR for enteric fever is higher than previously estimated, and the evaluation of prognostic factors including antimicrobial resistance urgently requires more data.


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