TY - JOUR
T1 - Incidence of invasive salmonella disease in sub-Saharan Africa
T2 - A multicentre population-based surveillance study
AU - Marks, Florian
AU - von Kalckreuth, Vera
AU - Aaby, Peter
AU - Adu-Sarkodie, Yaw
AU - El Tayeb, Muna Ahmed
AU - Ali, Mohammad
AU - Aseffa, Abraham
AU - Baker, Stephen
AU - Biggs, Holly M.
AU - Bjerregaard-Andersen, Morten
AU - Breiman, Robert F.
AU - Campbell, James I.
AU - Cosmas, Leonard
AU - Crump, John A.
AU - Espinoza, Ligia Maria Cruz
AU - Deerin, Jessica Fung
AU - Dekker, Denise Myriam
AU - Fields, Barry S.
AU - Gasmelseed, Nagla
AU - Hertz, Julian T.
AU - Van Minh Hoang, Nguyen
AU - Im, Justin
AU - Jaeger, Anna
AU - Jeon, Hyon Jin
AU - Kabore, Leon Parfait
AU - Keddy, Karen H.
AU - Konings, Frank
AU - Krumkamp, Ralf
AU - Ley, Benedikt
AU - Løfberg, Sandra Valborg
AU - May, Jürgen
AU - Meyer, Christian G.
AU - Mintz, Eric D.
AU - Montgomery, Joel M.
AU - Niang, Aissatou Ahmet
AU - Nichols, Chelsea
AU - Olack, Beatrice
AU - Pak, Gi Deok
AU - Panzner, Ursula
AU - Park, Jin Kyung
AU - Park, Se Eun
AU - Rabezanahary, Henintsoa
AU - Rakotozandrindrainy, Raphaël
AU - Raminosoa, Tiana Mirana
AU - Razafindrabe, Tsiriniaina Jean Luco
AU - Sampo, Emmanuel
AU - Schütt-Gerowitt, Heidi
AU - Sow, Amy Gassama
AU - Sarpong, Nimako
AU - Seo, Hye Jin
AU - Sooka, Arvinda
AU - Soura, Abdramane Bassiahi
AU - Tall, Adama
AU - Teferi, Mekonnen
AU - Thriemer, Kamala
AU - Warren, Michelle R.
AU - Yeshitela, Biruk
AU - Clemens, John D
AU - Wierzba, Thomas F.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85013156348&partnerID=8YFLogxK
U2 - 10.1016/S2214-109X(17)30022-0
DO - 10.1016/S2214-109X(17)30022-0
M3 - Article
C2 - 28193398
AN - SCOPUS:85013156348
SN - 2214-109X
VL - 5
SP - e310-e323
JO - The Lancet Global Health
JF - The Lancet Global Health
IS - 3
ER -