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Journal Title:

Lancet Global Health


Volume 5, Number 3


Elsevier | 2017-03-01, Pages e310-e323

Type of Work:

Article | Final Publisher PDF

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.

Subjects: Health Sciences, Epidemiology - Health Sciences, Pathology - Research Funding: This study was supported by the Bill and Melinda Gates Foundation OPPGH5231.

International Vaccine Institute acknowledges its donors, including the South Korea and the Swedish International Development Cooperation Agency Sida.

Research infrastructure at the Moshi site was supported by the US National Institutes of Health R01TW009237; U01 AI062563; R24 TW007988; D43 PA-03–018; U01 AI069484; U01 AI067854; P30 AI064518, and by the UK Biotechnology and Biological Sciences Research Council BB-J010367.

SB is a Sir Henry Dale Fellow, jointly funded by the Wellcome Trust and the Royal Society 100087-Z-12-Z.

Autor: Florian Marks, Vera von Kalckreuth, Peter Aaby, Yaw Adu-Sarkodie, Muna Ahmed El Tayeb, Mohammad Ali, Abraham Aseffa, Stephen Bake



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