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John J, Bavdekar A, Rongsen-Chandola T, Dutta S, Gupta M, Kanungo S, Sinha B, Srinivasan M, Shrivastava A, Bansal A, Singh A, Koshy RM, Jinka DR, Thomas MS, Alexander AP, Thankaraj S, Ebenezer SE, Karthikeyan AS, Kumar D, Njarekkattuvalappil SK, Raju R, Sahai N, Veeraraghavan B, Murhekar MV, Mohan VR, Natarajan SK, Ramanujam K, Samuel P, Lo NC, Andrews J, Grassly NC, Kang G. Burden of Typhoid and Paratyphoid Fever in India. N Engl J Med 2023; 388:1491-1500. [PMID: 37075141 PMCID: PMC10116367 DOI: 10.1056/nejmoa2209449] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND In 2017, more than half the cases of typhoid fever worldwide were projected to have occurred in India. In the absence of contemporary population-based data, it is unclear whether declining trends of hospitalization for typhoid in India reflect increased antibiotic treatment or a true reduction in infection. METHODS From 2017 through 2020, we conducted weekly surveillance for acute febrile illness and measured the incidence of typhoid fever (as confirmed on blood culture) in a prospective cohort of children between the ages of 6 months and 14 years at three urban sites and one rural site in India. At an additional urban site and five rural sites, we combined blood-culture testing of hospitalized patients who had a fever with survey data regarding health care use to estimate incidence in the community. RESULTS A total of 24,062 children who were enrolled in four cohorts contributed 46,959 child-years of observation. Among these children, 299 culture-confirmed typhoid cases were recorded, with an incidence per 100,000 child-years of 576 to 1173 cases in urban sites and 35 in rural Pune. The estimated incidence of typhoid fever from hospital surveillance ranged from 12 to 1622 cases per 100,000 child-years among children between the ages of 6 months and 14 years and from 108 to 970 cases per 100,000 person-years among those who were 15 years of age or older. Salmonella enterica serovar Paratyphi was isolated from 33 children, for an overall incidence of 68 cases per 100,000 child-years after adjustment for age. CONCLUSIONS The incidence of typhoid fever in urban India remains high, with generally lower estimates of incidence in most rural areas. (Funded by the Bill and Melinda Gates Foundation; NSSEFI Clinical Trials Registry of India number, CTRI/2017/09/009719; ISRCTN registry number, ISRCTN72938224.).
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Affiliation(s)
- Jacob John
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Ashish Bavdekar
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Temsunaro Rongsen-Chandola
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Shanta Dutta
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Madhu Gupta
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Suman Kanungo
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Bireshwar Sinha
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Manikandan Srinivasan
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Ankita Shrivastava
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Adarsh Bansal
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Ashita Singh
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Roshine M Koshy
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Dasharatha R Jinka
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Mathew S Thomas
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Anna P Alexander
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Shajin Thankaraj
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Sheena E Ebenezer
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Arun S Karthikeyan
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Dilesh Kumar
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Swathi K Njarekkattuvalappil
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Reshma Raju
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Nikhil Sahai
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Balaji Veeraraghavan
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Manoj V Murhekar
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Venkata R Mohan
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Sindhu K Natarajan
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Karthikeyan Ramanujam
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Prasanna Samuel
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Nathan C Lo
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Jason Andrews
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Nicholas C Grassly
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Gagandeep Kang
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
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