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Bhattacharjee A, Hosen MR, Lamisa AB, Ahammad I, Chowdhury ZM, Jamal TB, Sohag MMH, Hossain MU, Das KC, Keya CA, Salimullah M. An integrated comparative genomics, subtractive proteomics and immunoinformatics framework for the rational design of a Pan-Salmonella multi-epitope vaccine. PLoS One 2024; 19:e0292413. [PMID: 38959229 PMCID: PMC11221655 DOI: 10.1371/journal.pone.0292413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 04/23/2024] [Indexed: 07/05/2024] Open
Abstract
Salmonella infections pose a significant global public health concern due to the substantial expenses associated with monitoring, preventing, and treating the infection. In this study, we explored the core proteome of Salmonella to design a multi-epitope vaccine through Subtractive Proteomics and immunoinformatics approaches. A total of 2395 core proteins were curated from 30 different isolates of Salmonella (strain NZ CP014051 was taken as reference). Utilizing the subtractive proteomics approach on the Salmonella core proteome, Curlin major subunit A (CsgA) was selected as the vaccine candidate. csgA is a conserved gene that is related to biofilm formation. Immunodominant B and T cell epitopes from CsgA were predicted using numerous immunoinformatics tools. T lymphocyte epitopes had adequate population coverage and their corresponding MHC alleles showed significant binding scores after peptide-protein based molecular docking. Afterward, a multi-epitope vaccine was constructed with peptide linkers and Human Beta Defensin-2 (as an adjuvant). The vaccine could be highly antigenic, non-toxic, non-allergic, and have suitable physicochemical properties. Additionally, Molecular Dynamics Simulation and Immune Simulation demonstrated that the vaccine can bind with Toll Like Receptor 4 and elicit a robust immune response. Using in vitro, in vivo, and clinical trials, our findings could yield a Pan-Salmonella vaccine that might provide protection against various Salmonella species.
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Affiliation(s)
- Arittra Bhattacharjee
- Bioinformatics Division, National Institute of Biotechnology, Ganakbari, Ashulia, Savar, Dhaka, Bangladesh
| | - Md. Rakib Hosen
- Department of Genetic Engineering and Biotechnology, Jagannath University, Dhaka, Bangladesh
| | - Anika Bushra Lamisa
- Bioinformatics Division, National Institute of Biotechnology, Ganakbari, Ashulia, Savar, Dhaka, Bangladesh
| | - Ishtiaque Ahammad
- Bioinformatics Division, National Institute of Biotechnology, Ganakbari, Ashulia, Savar, Dhaka, Bangladesh
| | - Zeshan Mahmud Chowdhury
- Bioinformatics Division, National Institute of Biotechnology, Ganakbari, Ashulia, Savar, Dhaka, Bangladesh
| | - Tabassum Binte Jamal
- Bioinformatics Division, National Institute of Biotechnology, Ganakbari, Ashulia, Savar, Dhaka, Bangladesh
| | - Md. Mehadi Hasan Sohag
- Department of Genetic Engineering and Biotechnology, Jagannath University, Dhaka, Bangladesh
| | - Mohammad Uzzal Hossain
- Bioinformatics Division, National Institute of Biotechnology, Ganakbari, Ashulia, Savar, Dhaka, Bangladesh
| | - Keshob Chandra Das
- Molecular Biotechnology Division, National Institute of Biotechnology, Ganakbari, Ashulia, Savar, Dhaka, Bangladesh
| | - Chaman Ara Keya
- Department of Biochemistry and Microbiology, North South University, Bashundhara, Dhaka, Bangladesh
| | - Md Salimullah
- Molecular Biotechnology Division, National Institute of Biotechnology, Ganakbari, Ashulia, Savar, Dhaka, Bangladesh
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Kithan HM, Tyagi V, Singh N, Bhakhri BK, Singh DK. Clinical and antimicrobial susceptibility profile of typhoid fever in children in the era of antibiotic resistance. Trop Doct 2024; 54:112-115. [PMID: 38073124 DOI: 10.1177/00494755231217317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Enteric fever remains a significant public health problem in low- and middle-income countries with further challenges from emerging antimicrobial resistance. Our prospective study evaluated the current clinical and antimicrobial susceptibility profile of enteric fever in 88 children and compared it to previously established literature. Enteric fever usually presents with nonspecific signs and symptoms, with predominant respiratory complaints. A paradigm shift in the antimicrobial sensitivity pattern has been noted, with increasing resistance for first-line antibiotics and older antibiotics such as ampicillin, cotrimoxazole, and chloramphenicol showing good sensitivity. Thus, the introduction of the latter merits consideration.
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Affiliation(s)
- Hachumlo M Kithan
- Junior Resident, Department of Pediatrics, Post Graduate Institute of Child Health (affiliated to Atal Bihari Bajpai Medical University, Lucknow), Noida, UP, India
| | - Vernika Tyagi
- Assistant Professor, Department of Pediatrics, Post Graduate Institute of Child Health (affiliated to Atal Bihari Bajpai Medical University, Lucknow), Noida, UP, India
| | - Nupur Singh
- Ex. Senior Resident, Department of Pediatrics, Post Graduate Institute of Child Health (affiliated to Atal Bihari Bajpai Medical University, Lucknow), Noida, UP, India
| | - Bhanu Kiran Bhakhri
- Additional Professor, Department of Pediatrics, Post Graduate Institute of Child Health (affiliated to Atal Bihari Bajpai Medical University, Lucknow), Noida, UP, India
| | - Dharmendra Kumar Singh
- Professor and Head, Department of Pediatrics, Post Graduate Institute of Child Health (affiliated to Atal Bihari Bajpai Medical University, Lucknow), Noida, UP, India
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Onken A, Moyo S, Miraji MK, Bohlin J, Marijani M, Manyahi J, Kibwana KO, Müller F, Jenum PA, Abeid KA, Reimers M, Langeland N, Mørch K, Blomberg B. Predominance of multidrug-resistant Salmonella Typhi genotype 4.3.1 with low-level ciprofloxacin resistance in Zanzibar. PLoS Negl Trop Dis 2024; 18:e0012132. [PMID: 38630840 PMCID: PMC11057722 DOI: 10.1371/journal.pntd.0012132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 04/29/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Typhoid fever is a common cause of febrile illness in low- and middle-income countries. While multidrug-resistant (MDR) Salmonella Typhi (S. Typhi) has spread globally, fluoroquinolone resistance has mainly affected Asia. METHODS Consecutively, 1038 blood cultures were obtained from patients of all age groups with fever and/or suspicion of serious systemic infection admitted at Mnazi Mmoja Hospital, Zanzibar in 2015-2016. S. Typhi were analyzed with antimicrobial susceptibility testing and with short read (61 strains) and long read (9 strains) whole genome sequencing, including three S. Typhi strains isolated in a pilot study 2012-2013. RESULTS Sixty-three S. Typhi isolates (98%) were MDR carrying blaTEM-1B, sul1 and sul2, dfrA7 and catA1 genes. Low-level ciprofloxacin resistance was detected in 69% (43/62), with a single gyrase mutation gyrA-D87G in 41 strains, and a single gyrA-S83F mutation in the non-MDR strain. All isolates were susceptible to ceftriaxone and azithromycin. All MDR isolates belonged to genotype 4.3.1 lineage I (4.3.1.1), with the antimicrobial resistance determinants located on a composite transposon integrated into the chromosome. Phylogenetically, the MDR subgroup with ciprofloxacin resistance clusters together with two external isolates. CONCLUSIONS We report a high rate of MDR and low-level ciprofloxacin resistant S. Typhi circulating in Zanzibar, belonging to genotype 4.3.1.1, which is widespread in Southeast Asia and African countries and associated with low-level ciprofloxacin resistance. Few therapeutic options are available for treatment of typhoid fever in the study setting. Surveillance of the prevalence, spread and antimicrobial susceptibility of S. Typhi can guide treatment and control efforts.
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Affiliation(s)
- Annette Onken
- Department of Clinical Science, University of Medicine, Bergen, Norway
- National Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
- Department of Microbiology, Vestre Viken Hospital Trust, Drammen, Norway
| | - Sabrina Moyo
- Department of Clinical Science, University of Medicine, Bergen, Norway
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Jon Bohlin
- Department of methods and analysis, Section of modelling and bioinformatics, Domain of Infection Control, Oslo, Norway
- Center for Fertility and Health analysis, Norwegian Institute of Public Health, Oslo, Norway
| | - Msafiri Marijani
- Pathology Laboratory Department, Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - Joel Manyahi
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kibwana Omar Kibwana
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Fredrik Müller
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pål A. Jenum
- Department of Microbiology, Vestre Viken Hospital Trust, Drammen, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Khamis Ali Abeid
- Department of Pediatrics, Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - Marianne Reimers
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
| | - Nina Langeland
- Department of Clinical Science, University of Medicine, Bergen, Norway
- National Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
| | - Kristine Mørch
- Department of Clinical Science, University of Medicine, Bergen, Norway
- National Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
| | - Bjørn Blomberg
- Department of Clinical Science, University of Medicine, Bergen, Norway
- National Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
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Meiring JE, Khanam F, Basnyat B, Charles RC, Crump JA, Debellut F, Holt KE, Kariuki S, Mugisha E, Neuzil KM, Parry CM, Pitzer VE, Pollard AJ, Qadri F, Gordon MA. Typhoid fever. Nat Rev Dis Primers 2023; 9:71. [PMID: 38097589 DOI: 10.1038/s41572-023-00480-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 12/18/2023]
Abstract
Typhoid fever is an invasive bacterial disease associated with bloodstream infection that causes a high burden of disease in Africa and Asia. Typhoid primarily affects individuals ranging from infants through to young adults. The causative organism, Salmonella enterica subsp. enterica serovar Typhi is transmitted via the faecal-oral route, crossing the intestinal epithelium and disseminating to systemic and intracellular sites, causing an undifferentiated febrile illness. Blood culture remains the practical reference standard for diagnosis of typhoid fever, where culture testing is available, but novel diagnostic modalities are an important priority under investigation. Since 2017, remarkable progress has been made in defining the global burden of both typhoid fever and antimicrobial resistance; in understanding disease pathogenesis and immunological protection through the use of controlled human infection; and in advancing effective vaccination programmes through strategic multipartner collaboration and targeted clinical trials in multiple high-incidence priority settings. This Primer thus offers a timely update of progress and perspective on future priorities for the global scientific community.
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Affiliation(s)
- James E Meiring
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
| | - Farhana Khanam
- International Centre for Diarrhoel Disease Research, Dhaka, Bangladesh
| | - Buddha Basnyat
- Oxford University Clinical Research Unit, Kathmandu, Nepal
| | - Richelle C Charles
- Massachusetts General Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | - Kathryn E Holt
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Samuel Kariuki
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Emmanuel Mugisha
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christopher M Parry
- Department of Clinical Sciences and Education, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases and Public Health Modelling Unit, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Firdausi Qadri
- International Centre for Diarrhoel Disease Research, Dhaka, Bangladesh
| | - Melita A Gordon
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi.
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.
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Parry CM, Qamar FN, Rijal S, McCann N, Baker S, Basnyat B. What Should We Be Recommending for the Treatment of Enteric Fever? Open Forum Infect Dis 2023; 10:S26-S31. [PMID: 37274536 PMCID: PMC10236504 DOI: 10.1093/ofid/ofad179] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Patients with suspected enteric (typhoid and paratyphoid) fever are predominantly managed as outpatients in endemic regions. Nonspecific clinical presentation, lack of accurate diagnostic tools, and widespread antimicrobial resistance makes management challenging. Resistance has been described for all antimicrobials including chloramphenicol, amoxycillin, trimethoprim-sulfamethoxazole, ciprofloxacin, ceftriaxone, and azithromycin. No significant differences have been demonstrated between these antimicrobials in their ability to treat enteric fever in systematic reviews of randomized controlled trials (RCTs). Antimicrobial choice should be guided by local resistance patterns and national guidance. Extensively drug-resistant typhoid isolates require treatment with azithromycin and/or meropenem. Combining antimicrobials that target intracellular and extracellular typhoid bacteria is a strategy being explored in the Azithromycin and Cefixime in Typhoid Fever (ACT-SA) RCT, in progress in South Asia. Alternative antimicrobials, such as the oral carbapenem, tebipenem, need clinical evaluation. There is a paucity of evidence to guide the antimicrobial management of chronic fecal carriers.
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Affiliation(s)
- Christopher M Parry
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Medical Microbiology, Alder Hey Children’s Hospital, Liverpool, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Farah N Qamar
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Samita Rijal
- Oxford University Clinical Research Unit-Nepal, Kathmandu, Nepal
| | - Naina McCann
- Hospital for Tropical Diseases, UCL, London, United Kingdom
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Stephen Baker
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Buddha Basnyat
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit-Nepal, Kathmandu, Nepal
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6
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Chattopadhyay A, Arya S, Bisht S, Sharma R, Gupta N. Typhoid Pancreatitis Presenting as Hemorrhagic Pleural Effusion Complicated by Myocarditis. Indian J Pediatr 2023; 90:210. [PMID: 36576719 DOI: 10.1007/s12098-022-04437-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 11/25/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022]
Affiliation(s)
- Arpita Chattopadhyay
- Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi, India.
| | - Sudarshan Arya
- Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi, India
| | - Suman Bisht
- Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi, India
| | - Ritu Sharma
- Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi, India
| | - Natasha Gupta
- Department of Radiology, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi, India
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Appiah GD, Le P, Prentice-Mott G, Bias M, Pratt C, Matar GM, Pindyck T, Fayad AA, Kim S, Mintz ED. Typhoid Fever in the Eastern Mediterranean Region: A Systematic Review, 1990-2021. Am J Trop Med Hyg 2023; 108:285-292. [PMID: 36538895 PMCID: PMC9896334 DOI: 10.4269/ajtmh.22-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 10/05/2022] [Indexed: 12/24/2022] Open
Abstract
The occurrence and antimicrobial resistance (AMR) of typhoid fever in the WHO Eastern Mediterranean Region (EMR) are poorly characterized. Robust surveillance data are needed to inform strategies for typhoid control and prevention in the region. We conducted a systematic review of typhoid fever occurrence, complications, and AMR patterns in EMR countries. We identified 70 studies published from 1990 to 2021, including a total of 44,541 cases with blood culture confirmed typhoid fever in 12 EMR countries, with 48 (69%) studies and 42,008 cases from Pakistan. Among 56 studies with AMR data, fluroquinolone (68% of 13,013 tested isolates), and multidrug resistance (40% of 15,765 tested isolates) were common. Forty (57%) of the 56 studies were from Pakistan, and all reports of extensively drug resistant Salmonella Typhi (48% of 9,578 tested isolates) were from studies in Pakistan. Our findings support the need for continued efforts to strengthen surveillance and laboratory capacity for blood-culture detection of typhoid fever in the region, including data from an ongoing collaboration among CDC, the American University of Beirut, and the WHO EMR office.
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Affiliation(s)
- Grace D. Appiah
- Division of Foodborne, Waterborne and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Phong Le
- Division of Foodborne, Waterborne and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Graeme Prentice-Mott
- Division of Foodborne, Waterborne and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Megan Bias
- Center for Surveillance, Epidemiology, and Laboratory Services, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Caroline Pratt
- Division of Foodborne, Waterborne and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ghassan M. Matar
- Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Talia Pindyck
- Division of Foodborne, Waterborne and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Antoine Abou Fayad
- Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Sunkyung Kim
- Division of Foodborne, Waterborne and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric D. Mintz
- Division of Foodborne, Waterborne and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Poncin M, Marembo J, Chitando P, Sreenivasan N, Makwara I, Machekanyanga Z, Nyabyenda W, Mukeredzi I, Munyanyi M, Hidle A, Chingwena F, Chigwena C, Atuhebwe P, Matzger H, Chigerwe R, Shaum A, Date K, Garone D, Chonzi P, Barak J, Phiri I, Rupfutse M, Masunda K, Gasasira A, Manangazira P. Implementation of an outbreak response vaccination campaign with typhoid conjugate vaccine – Harare, Zimbabwe, 2019. Vaccine X 2022; 12:100201. [PMID: 35983519 PMCID: PMC9379662 DOI: 10.1016/j.jvacx.2022.100201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/07/2022] [Accepted: 07/29/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Typhoid fever is a public-health problem in Harare, the capital city of Zimbabwe, with seasonal outbreaks occurring annually since 2010. In 2019, the Ministry of Health and Child Care (MOHCC) organized the first typhoid conjugate vaccination campaign in Africa in response to a recurring typhoid outbreak in a large urban setting. Method As part of a larger public health response to a typhoid fever outbreak in Harare, Gavi approved in September 2018 a MOHCC request for 340,000 doses of recently prequalified Typbar-TCV to implement a mass vaccination campaign. To select areas for the campaign, typhoid fever surveillance data from January 2016 until June 2018 was reviewed. We collected and analyzed information from the MOHCC and its partners to describe the vaccination campaign planning, implementation, feasibility, administrative coverage and financial costs. Results The campaign was conducted in nine high-density suburbs of Harare over eight days in February–March 2019 and targeted all children aged 6 months–15 years; however, the target age range was extended up to 45 years in one suburb due to the past high attack rate among adults. A total of 318,698 people were vaccinated, resulting in overall administrative coverage of 85.4 percent. More than 750 community volunteers and personnel from the MOHCC and the Ministry of Education were trained and involved in social mobilization and vaccination activities. The MOHCC used a combination of vaccination strategies (i.e., fixed and mobile immunization sites, a creche and school-based strategy, and door-to-door activities). Financial costs were estimated at US$ 2.39 per dose, including the vaccine and vaccination supplies (US$ 0.79 operational costs per dose excluding vaccine and vaccination supplies). Conclusion A mass targeted campaign in densely populated urban areas in Harare, using the recently prequalified typhoid conjugate vaccine, was feasible and achieved a high overall coverage in a short period of time.
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Affiliation(s)
- M. Poncin
- World Health Organization, Geneva, Switzerland
- Corresponding author at: Square Clair-Matin 44, 1213 Petit Lancy, Switzerland.
| | - J. Marembo
- Ministry of Health and Child Care, Harare, Zimbabwe
| | - P. Chitando
- Harare City Health Department, Harare, Zimbabwe
| | - N. Sreenivasan
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, USA
| | - I. Makwara
- Ministry of Health and Child Care, Harare, Zimbabwe
| | | | | | | | - M. Munyanyi
- Ministry of Health and Child Care, Harare, Zimbabwe
| | | | | | - C. Chigwena
- Ministry of Health and Child Care, Harare, Zimbabwe
| | - P. Atuhebwe
- World Health Organization, Brazzaville, Republic of the Congo
| | - H. Matzger
- World Health Organization, Geneva, Switzerland
| | - R. Chigerwe
- Harare City Health Department, Harare, Zimbabwe
| | | | - K. Date
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, USA
| | - D. Garone
- Médecins Sans Frontières, Brussels, Belgium
| | - P. Chonzi
- Harare City Health Department, Harare, Zimbabwe
| | - J. Barak
- United Nations Children's Fund, Harare, Zimbabwe
| | - I. Phiri
- Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - K. Masunda
- Harare City Health Department, Harare, Zimbabwe
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Birger R, Antillón M, Bilcke J, Dolecek C, Dougan G, Pollard AJ, Neuzil KM, Frost I, Laxminarayan R, Pitzer VE. Estimating the effect of vaccination on antimicrobial-resistant typhoid fever in 73 countries supported by Gavi: a mathematical modelling study. THE LANCET INFECTIOUS DISEASES 2022; 22:679-691. [PMID: 35123673 PMCID: PMC9021026 DOI: 10.1016/s1473-3099(21)00627-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/20/2021] [Accepted: 09/23/2021] [Indexed: 11/24/2022]
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Saigal K, Gupta D, Saikia D. Clinicoepidemiological Observations of Enteric Fever in Infants: Experiences From a Tertiary Care Pediatric Hospital in North India. J Infect Dis 2021; 224:S568-S572. [PMID: 35238364 PMCID: PMC8892531 DOI: 10.1093/infdis/jiab430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background There is a lack of evident data to explain the true scenario of age-specific enteric fever in India. The current study aimed to evaluate the burden and disease pattern of enteric fever among infants in a tertiary care pediatric hospital. Methods A prospective laboratory-based surveillance was conducted from April 2018 to January 2020 at a children’s hospital in North India, under the Surveillance for Enteric Fever in India study. The study included children <1 year of age in whom Salmonella serovar Typhi/Salmonella serovar Paratyphi grew in cultures from blood or sterile body fluid. The key outcome measures included disease spectrum and clinical presentation. Results Of the 10 737 blood cultures from infants, 26 were positive for S. Typhi or S. Paratyphi. The majority of cases occurred in infants aged 6–12 months, with the youngest being 1 month old. Fever with abdominal pain and diarrhea were the common symptoms, with 46% of infants requiring inpatient care. All of the isolates were susceptible to ceftriaxone. Third-generation cephalosporins were used as the first-line therapy for hospitalized infants. The average duration of fever was 8.6 days. The overall case-fatality rate among infants with enteric fever was 7.4%. Conclusions Enteric fever is a major contributor to disease and death among children. Robust surveillance studies are required to understand the true disease burden.
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Affiliation(s)
- Karnika Saigal
- Department of Microbiology and Infectious Diseases, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Deepika Gupta
- Department of Microbiology and Infectious Diseases, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Diganta Saikia
- Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, New Delhi, India
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Ryckman T, Karthikeyan AS, Kumar D, Cao Y, Kang G, Goldhaber-Fiebert JD, John J, Lo NC, Andrews JR. Comparison of Strategies for Typhoid Conjugate Vaccine Introduction in India: A Cost-Effectiveness Modeling Study. J Infect Dis 2021; 224:S612-S624. [PMID: 35238367 PMCID: PMC8892534 DOI: 10.1093/infdis/jiab150] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Typhoid fever causes substantial global mortality, with almost half occurring in India. New typhoid vaccines are highly effective and recommended by the World Health Organization for high-burden settings. There is a need to determine whether and which typhoid vaccine strategies should be implemented in India. Methods We assessed typhoid vaccination using a dynamic compartmental model, parameterized by and calibrated to disease and costing data from a recent multisite surveillance study in India. We modeled routine and 1-time campaign strategies that target different ages and settings. The primary outcome was cost-effectiveness, measured by incremental cost-effectiveness ratios (ICERs) benchmarked against India’s gross national income per capita (US$2130). Results Both routine and campaign vaccination strategies were cost-saving compared to the status quo, due to averted costs of illness. The preferred strategy was a nationwide community-based catchup campaign targeting children aged 1–15 years alongside routine vaccination, with an ICER of $929 per disability-adjusted life-year averted. Over the first 10 years of implementation, vaccination could avert 21–39 million cases and save $1.6–$2.2 billion. These findings were broadly consistent across willingness-to-pay thresholds, epidemiologic settings, and model input distributions. Conclusions Despite high initial costs, routine and campaign typhoid vaccination in India could substantially reduce mortality and was highly cost-effective.
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Affiliation(s)
- Theresa Ryckman
- Stanford Health Policy, Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University School of Medicine and the Freeman Spogli Institute, Stanford, California, USA
| | - Arun S Karthikeyan
- Wellcome Trust Research Laboratory, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dilesh Kumar
- Wellcome Trust Research Laboratory, Christian Medical College, Vellore, Tamil Nadu, India
| | - Yanjia Cao
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Gagandeep Kang
- Wellcome Trust Research Laboratory, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jeremy D Goldhaber-Fiebert
- Stanford Health Policy, Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University School of Medicine and the Freeman Spogli Institute, Stanford, California, USA
| | - Jacob John
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nathan C Lo
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
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12
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Advancement in Salmonella Detection Methods: From Conventional to Electrochemical-Based Sensing Detection. BIOSENSORS-BASEL 2021; 11:bios11090346. [PMID: 34562936 PMCID: PMC8468554 DOI: 10.3390/bios11090346] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/06/2021] [Accepted: 09/09/2021] [Indexed: 02/07/2023]
Abstract
Large-scale food-borne outbreaks caused by Salmonella are rarely seen nowadays, thanks to the advanced nature of the medical system. However, small, localised outbreaks in certain regions still exist and could possess a huge threat to the public health if eradication measure is not initiated. This review discusses the progress of Salmonella detection approaches covering their basic principles, characteristics, applications, and performances. Conventional Salmonella detection is usually performed using a culture-based method, which is time-consuming, labour intensive, and unsuitable for on-site testing and high-throughput analysis. To date, there are many detection methods with a unique detection system available for Salmonella detection utilising immunological-based techniques, molecular-based techniques, mass spectrometry, spectroscopy, optical phenotyping, and biosensor methods. The electrochemical biosensor has growing interest in Salmonella detection mainly due to its excellent sensitivity, rapidity, and portability. The use of a highly specific bioreceptor, such as aptamers, and the application of nanomaterials are contributing factors to these excellent characteristics. Furthermore, insight on the types of biorecognition elements, the principles of electrochemical transduction elements, and the miniaturisation potential of electrochemical biosensors are discussed.
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13
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Chauhan AS, Kapoor I, Rana SK, Kumar D, Gupta M, John J, Kang G, Prinja S. Cost effectiveness of typhoid vaccination in India. Vaccine 2021; 39:4089-4098. [PMID: 34120765 PMCID: PMC8256879 DOI: 10.1016/j.vaccine.2021.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/30/2021] [Accepted: 06/01/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION World Health Organization has prequalified the use of typhoid conjugate vaccine (TCV) in children over six months of age in typhoid endemic countries. We assessed the cost-effectiveness of introducing TCV separately for urban and rural areas of India. METHODS A decision analytic model was developed, using a societal perspective, to compare long-term costs and outcomes (3% discount rate) in a new-born cohort of 100,000 children immunized with or without TCV. Three vaccination scenarios were modelled, assuming the protective efficacy of TCV to last for 5, 10 and 15 years following immunization. Incidence of typhoid infection estimated under 'National Surveillance System for Enteric Fever' (NSSEFI)' was used. The prices of vaccine and cost of service delivery were included for vaccination arm. Both health system cost and out-of-pocket expenditures for treatment of typhoid illness and its complications was included. RESULTS TCV introduction in urban areas would result in prevention of 17% to 36% typhoid cases and deaths. With exclusion of indirect costs, the incremental cost per QALY gained was ₹ 151,346 (54,730-307,975), ₹ 61,710 (-5250 to 163,283) and ₹ 45,188 (-17,069 to 141,093) for scenario 1, 2 and 3 respectively. While, with inclusion of indirect costs, all 3 scenarios were cost saving. Further, in rural areas, TCV is estimated to reduce the typhoid cases and deaths by 19% to 36%, with ICER (incremental cost per QALY gained) ranging from ₹ 2340 (1316-4370) to ₹ 3574 (2057 - 6691) thousand (inclusive of indirect costs) among the 3 vaccination scenarios. CONCLUSION From a societal perspective, introduction of TCV is a cost saving strategy in urban India. Further, due to low incidence of typhoid infection, introduction of TCV is not cost-effective in rural settings of India.
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Affiliation(s)
- Akashdeep Singh Chauhan
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Isha Kapoor
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Saroj Kumar Rana
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Dilesh Kumar
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore 632 004, India
| | - Madhu Gupta
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Jacob John
- Department of Community Health, Christian Medical College, Vellore 632 002, India
| | - Gagandeep Kang
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore 632 004, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
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14
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Qazi SH, Yousafzai MT, Saddal NS, Dehraj IF, Thobani RS, Akhtar A, Syed JR, Kazi AM, Hotwani A, Rahman N, Mehmood J, Andrews JR, Luby SP, Garrett DO, Qamar FN. Burden of Ileal Perforations Among Surgical Patients Admitted in Tertiary Care Hospitals of Three Asian countries: Surveillance of Enteric Fever in Asia Project (SEAP), September 2016-September 2019. Clin Infect Dis 2021; 71:S232-S238. [PMID: 33258928 PMCID: PMC7705870 DOI: 10.1093/cid/ciaa1309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Typhoid fever is caused by Salmonella enterica subspecies enterica serovar Typhi (S. Typhi) and can lead to systemic illness and complications. We aimed to characterize typhoid-related ileal perforation in the context of the population-based Surveillance of Enteric Fever in Asia Project (SEAP) in Bangladesh, Nepal and Pakistan. Methods Between September 2016 and September 2019, all cases of nontraumatic ileal perforation with a clinical diagnosis of typhoid were enrolled from 4 tertiary care hospitals in Karachi, 2 pediatric hospitals in Bangladesh, and 2 hospitals in Nepal. Sociodemographic data were collected from patients or their caregivers, and clinical and outcome data were retrieved from medical records. Tissue samples were collected for histopathology and blood cultures where available. Results Of the 249 enrolled cases, 2 from Bangladesh, 5 from Nepal and 242 from Pakistan. In Pakistan, most of the cases were in the 0–15 (117/242; 48%) and 16–30 (89/242; 37%) age groups. In all countries, males were most affected: Pakistan 74.9% (180/242), Nepal 80% (4/5), and Bangladesh 100% (2/2). Blood culture was done on 76 cases; 8 (11%) were positive for S. Typhi, and all were extensively drug resistant (XDR) S. Typhi. Tissue cultures was done on 86 patients; 3 (3%) were positive for S. Typhi, and all were XDR S. Typhi, out of 86 samples tested for histopathology 4 (5%) revealed ileal perforation with necrosis. Culture or histopathology confirmed total 15 (11%) enteric fever cases with ileal perforation are similar to the clinically diagnosed cases. There were 16/242 (7%) deaths from Pakistan. Cases of ileal perforation who survived were more likely to have sought care before visiting the sentinel hospital (P = .009), visited any hospital for treatment (P = .013) compared to those who survived. Conclusions Although surveillance differed substantially by country, one reason for the higher number of ileal perforation cases in Pakistan could be the circulation of XDR strain of S. Typhi in Karachi.
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Affiliation(s)
- Saqib H Qazi
- Section of Pediatric Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Mohammad T Yousafzai
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Irum F Dehraj
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rozina S Thobani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Afshan Akhtar
- Aga Khan University Medical College, Karachi, Pakistan
| | - Jamal R Syed
- National Institute of Child Health, Karachi, Pakistan
| | - Abdul M Kazi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Aneeta Hotwani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Najeeb Rahman
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Junaid Mehmood
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Denise O Garrett
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | - Farah N Qamar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
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15
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Knoll RL, Dennebaum MS. [Fever in pediatric returning travellers]. Monatsschr Kinderheilkd 2021; 169:426-431. [PMID: 33727732 PMCID: PMC7952080 DOI: 10.1007/s00112-021-01147-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 11/24/2022]
Abstract
Management and treatment of the febrile pediatric patient returning from a tropical country is often challenging. Detailed medical and travel history with an emphasis on possible exposure (e.g. fresh water exposure, animal contact etc.) as well as a complete physical examination are essential. Considering the possible incubation period and travel destination, the number of potential differential diagnoses can often be greatly reduced. While most infections are self-limiting and run an uncomplicated course, it is crucial to recognize potentially life-threatening infections and to treat them appropriately.This article provides guidance for a rational approach and diagnostics with respect to fever in the context of differential diagnoses in tropical medicine in the pediatric patient collective.
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Affiliation(s)
- Rebecca L Knoll
- Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin, Mainz, Deutschland
| | - Martin S Dennebaum
- Institut für Mikrobiologie und Hygiene, Abteilung Infektionsmedizin, Universitätsmedizin, Langenbeckstr. 1, 55131 Mainz, Deutschland
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16
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Sajib MSI, Tanmoy AM, Hooda Y, Rahman H, Andrews JR, Garrett DO, Endtz HP, Saha SK, Saha S. Tracking the Emergence of Azithromycin Resistance in Multiple Genotypes of Typhoidal Salmonella. mBio 2021; 12:e03481-20. [PMID: 33593966 PMCID: PMC8545119 DOI: 10.1128/mbio.03481-20] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/05/2021] [Indexed: 11/29/2022] Open
Abstract
The rising prevalence of antimicrobial resistance in Salmonella enterica serovars Typhi and Paratyphi A, causative agents of typhoid and paratyphoid, have led to fears of untreatable infections. Of specific concern is the emerging resistance against azithromycin, the only remaining oral drug to treat extensively drug resistant (XDR) typhoid. Since the first report of azithromycin resistance from Bangladesh in 2019, cases have been reported from Nepal, India, and Pakistan. The genetic basis of this resistance is a single point mutation in the efflux pump AcrB (R717Q/L). Here, we report 38 additional cases of azithromycin-resistant (AzmR) Salmonella Typhi and Paratyphi A isolated in Bangladesh between 2016 and 2018. Using genomic analysis of 56 AzmR isolates from South Asia with AcrB-R717Q/L, we confirm that this mutation has spontaneously emerged in different Salmonella Typhi and Paratyphi A genotypes. The largest cluster of AzmR Typhi belonged to genotype 4.3.1.1; Bayesian analysis predicts the mutation to have emerged sometime in 2010. A travel-related Typhi isolate with AcrB-R717Q belonging to 4.3.1.1 was isolated in the United Kingdom, increasing fears of global spread. For real-time detection of AcrB-R717Q/L, we developed an extraction-free, rapid, and low-cost mismatch amplification mutation assay (MAMA). Validation of MAMA using 113 AzmR and non-AzmR isolates yielded >98% specificity and sensitivity versus phenotypic and whole-genome sequencing assays currently used for azithromycin resistance detection. With increasing azithromycin use, AcrB-R717Q/L is likely to be acquired by XDR strains. The proposed tool for active detection and surveillance of this mutation may detect pan-oral drug resistance early, giving us a window to intervene.IMPORTANCE In the early 1900s, with mortality of ∼30%, typhoid and paratyphoid ravaged parts of the world; with improved water, sanitation, and hygiene in resource-rich countries and the advent of antimicrobials, mortality dwindled to <1%. Today, the burden rests disproportionately on South Asia, where the primary means for combatting the disease is antimicrobials. However, prevalence of antimicrobial resistance is rising and, in 2016, an extensively drug resistant Typhi strain triggered an ongoing outbreak in Pakistan, leaving only one oral drug, azithromycin, to treat it. Since the description of emergence of azithromycin resistance, conferred by a point mutation in acrB (AcrB-R717Q/L) in 2019, there have been increasing numbers of reports. Using genomics and Bayesian analysis, we illustrate that this mutation emerged in approximately 2010 and has spontaneously arisen multiple times. Emergence of pan-oral drug resistant Salmonella Typhi is imminent. We developed a low-cost, rapid PCR tool to facilitate real-time detection and prevention policies.
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Affiliation(s)
- Mohammad S I Sajib
- Child Health Research Foundation, Dhaka, Bangladesh
- Institute of Biodiversity, Animal Health, and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Arif M Tanmoy
- Child Health Research Foundation, Dhaka, Bangladesh
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Yogesh Hooda
- Child Health Research Foundation, Dhaka, Bangladesh
- MRC-Laboratory Molecular Biology, Cambridge, United Kingdom
| | | | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | | | - Hubert P Endtz
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
- Fondation Mérieux and Centre International de Recherche en Infectiologie, INSERM, Lyon, France
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
- Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
- Bangladesh Institute of Child Health, Dhaka, Bangladesh
| | - Senjuti Saha
- Child Health Research Foundation, Dhaka, Bangladesh
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17
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Longley AT, Hemlock C, Date K, Luby SP, Andrews JR, Saha SK, Bogoch II, Yousafzai MT, Garrett DO, Qamar FN. Illness Severity and Outcomes Among Enteric Fever Cases From Bangladesh, Nepal, and Pakistan: Data From the Surveillance for Enteric Fever in Asia Project, 2016-2019. Clin Infect Dis 2020; 71:S222-S231. [PMID: 33258929 PMCID: PMC7705875 DOI: 10.1093/cid/ciaa1320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Enteric fever can lead to prolonged hospital stays, clinical complications, and death. The Surveillance for Enteric Fever in Asia Project (SEAP), a prospective surveillance study, characterized the burden of enteric fever, including illness severity, in selected settings in Bangladesh, Nepal, and Pakistan. We assessed disease severity, including hospitalization, clinical complications, and death among SEAP participants. METHODS We analyzed clinical and laboratory data from blood culture-confirmed enteric fever cases enrolled in SEAP hospitals and associated network laboratories from September 2016 to September 2019. We used hospitalization and duration of hospital stay as proxies for severity. We conducted a follow-up interview 6 weeks after enrollment to ascertain final outcomes. RESULTS Of the 8705 blood culture-confirmed enteric fever cases enrolled, we identified 6 deaths (case-fatality ratio, .07%; 95% CI, .01-.13%), 2 from Nepal, 4 from Pakistan, and none from Bangladesh. Overall, 1.7% (90/5205) of patients recruited from SEAP hospitals experienced a clinical complication (Bangladesh, 0.6% [18/3032]; Nepal, 2.3% [12/531]; Pakistan, 3.7% [60/1642]). The most identified complications were hepatitis (n = 36), septic shock (n = 22), and pulmonary complications/pneumonia (n = 13). Across countries, 32% (2804/8669) of patients with hospitalization data available were hospitalized (Bangladesh, 27% [1295/4868]; Nepal, 29% [455/1595]; Pakistan, 48% [1054/2206]), with a median hospital stay of 5 days (IQR, 3-7). CONCLUSIONS While defined clinical complications and deaths were uncommon at the SEAP sites, the high proportion of hospitalizations and prolonged hospital stays highlight illness severity and the need for enteric fever control measures, including the use of typhoid conjugate vaccines.
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Affiliation(s)
- Ashley T Longley
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Caitlin Hemlock
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | - Kashmira Date
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephen P Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Jason R Andrews
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Samir K Saha
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
- Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mohammad T Yousafzai
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Denise O Garrett
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | - Farah N Qamar
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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18
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Yousafzai MT, Irfan S, Thobani RS, Kazi AM, Hotwani A, Memon AM, Iqbal K, Qazi SH, Saddal NS, Rahman N, Dehraj IF, Hunzai MJ, Mehmood J, Garrett DO, Saha SK, Andrews JR, Luby SP, Qamar FN. Burden of Culture Confirmed Enteric Fever Cases in Karachi, Pakistan: Surveillance For Enteric Fever in Asia Project (SEAP), 2016-2019. Clin Infect Dis 2020; 71:S214-S221. [PMID: 33258931 PMCID: PMC7705869 DOI: 10.1093/cid/ciaa1308] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The Surveillance for Enteric Fever in Asia Project (SEAP) is a multicenter, multicountry study conducted in Pakistan, Nepal, and Bangladesh. The objectives of the study were to characterize disease incidence among patients with enteric fever. We report the burden of enteric fever at selected sites of Karachi, Pakistan. METHODS During September 2016 to September 2019, prospective surveillance was conducted at inpatient, outpatient, surgical departments, and laboratory networks of Aga Khan University Hospital, Kharadar General Hospital, and surgery units of National Institute of Child Health and Jinnah Postgraduate Medical Centre. Socio-demographic, clinical, and laboratory data were obtained from all suspected or confirmed enteric fever cases. RESULTS Overall, 22% (2230/10 094) of patients enrolled were culture-positive for enteric fever. 94% (2093/2230) of isolates were Salmonella Typhi and 6% (137/2230) were S. Paratyphi. 15% of isolates multi-drug resistant (MDR) to first-line antibiotics and 60% were extensively drug-resistant (XDR), resistant to first-line antibiotics, fluoroquinolones and third generation cephalosporin. CONCLUSION Enteric fever cases have increased during the last 3 years with large proportion of drug resistant S. Typhi cases. However, the burden of paratyphoid is still relatively low. Strengthening the existing surveillance system for enteric fever and antimicrobial resistance at the national level is recommended in Pakistan to inform prevention measures. While typhoid vaccination can significantly decrease the burden of typhoid and may also impact antimicrobial resistance, water, sanitation, and hygiene improvement is highly recommended to prevent the spread of enteric fever.
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Affiliation(s)
- Mohammad T Yousafzai
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Seema Irfan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Rozina S Thobani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Abdul M Kazi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Aneeta Hotwani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Ashraf M Memon
- Clinical Laboratory, Kharadar General Hospital, Karachi, Pakistan
| | - Khalid Iqbal
- Clinical Laboratory, Kharadar General Hospital, Karachi, Pakistan
| | - Saqib H Qazi
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | | | - Najeeb Rahman
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Irum F Dehraj
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Mohammed J Hunzai
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Junaid Mehmood
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Denise O Garrett
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | - Samir K Saha
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu (Children) Hospital, Bangladesh
| | - Jason R Andrews
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Stephen P Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Farah N Qamar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
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19
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Marchello CS, Birkhold M, Crump JA. Complications and mortality of typhoid fever: A global systematic review and meta-analysis. J Infect 2020; 81:902-910. [PMID: 33144193 PMCID: PMC7754788 DOI: 10.1016/j.jinf.2020.10.030] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/29/2020] [Indexed: 01/17/2023]
Abstract
Complications and death are considerable among hospitalized patients with typhoid fever. Case fatality ratio of typhoid fever was higher in Africa compared to Asia. Among studies in Africa, 20% of patients with typhoid intestinal perforation died. Delays in care were correlated with increased typhoid case fatality ratio in Asia.
Objectives Updated estimates of the prevalence of complications and case fatality ratio (CFR) among typhoid fever patients are needed to understand disease burden. Methods Articles published in PubMed and Web of Science from 1 January 1980 through 29 January 2020 were systematically reviewed for hospital or community-based non-surgical studies that used cultures of normally sterile sites, and hospital surgical studies of typhoid intestinal perforation (TIP) with intra- or post-operative findings suggestive of typhoid. Prevalence of 21 pre-selected recognized complications of typhoid fever, crude and median (interquartile range) CFR, and pooled CFR estimates using a random effects meta-analysis were calculated. Results Of 113 study sites, 106 (93.8%) were located in Asia and Africa, and 84 (74.3%) were non-surgical. Among non-surgical studies, 70 (83.3%) were hospital-based. Of 10,355 confirmed typhoid patients, 2,719 (26.3%) had complications. The pooled CFR estimate among non-surgical patients was 0.9% for the Asia region and 5.4% for the Africa region. Delay in care was significantly correlated with increased CFR in Asia (r = 0.84; p<0.01). Among surgical studies, the median CFR of TIP was 15.5% (6.7–24.1%) per study. Conclusions Our findings identify considerable typhoid-associated illness and death that could be averted with prevention measures, including typhoid conjugate vaccine introduction.
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Affiliation(s)
- Christian S Marchello
- Centre for International Health, University of Otago, PO Box 56, Dunedin 9016, New Zealand
| | - Megan Birkhold
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - John A Crump
- Centre for International Health, University of Otago, PO Box 56, Dunedin 9016, New Zealand.
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20
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Kim S, Lee KS, Pak GD, Excler JL, Sahastrabuddhe S, Marks F, Kim JH, Mogasale V. Spatial and Temporal Patterns of Typhoid and Paratyphoid Fever Outbreaks: A Worldwide Review, 1990-2018. Clin Infect Dis 2020; 69:S499-S509. [PMID: 31665782 PMCID: PMC6821269 DOI: 10.1093/cid/ciz705] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Analyses of the global spatial and temporal distribution of enteric fever outbreaks worldwide are important factors to consider in estimating the disease burden of enteric fever disease burden. METHODS We conducted a global literature review of enteric fever outbreak data by systematically using multiple databases from 1 January 1990 to 31 December 2018 and classified them by time, place, diagnostic methods, and drug susceptibility, to illustrate outbreak characteristics including spatial and temporal patterns. RESULTS There were 180 940 cases in 303 identified outbreaks caused by infection with Salmonella enterica serovar Typhi (S. Typhi) and Salmonella enterica serovar Paratyphi A or B (S. Paratyphi). The size of outbreak ranged from 1 to 42 564. Fifty-one percent of outbreaks occurred in Asia, 15% in Africa, 14% in Oceania, and the rest in other regions. Forty-six percent of outbreaks specified confirmation by blood culture, and 82 outbreaks reported drug susceptibility, of which 54% had multidrug-resistant pathogens. Paratyphoid outbreaks were less common compared to typhoid (22 vs 281) and more prevalent in Asia than Africa. Risk factors were multifactorial, with contaminated water being the main factor. CONCLUSIONS Enteric fever outbreak burden remains high in endemic low- and middle-income countries and, despite its limitations, outbreak data provide valuable contemporary evidence in prioritizing resources, public health policies, and actions. This review highlights geographical locations where urgent attention is needed for enteric fever control and calls for global action to prevent and contain outbreaks.
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Affiliation(s)
- Samuel Kim
- International Vaccine Institute, Seoul, Republic of Korea.,Imperial College London, United Kingdom
| | - Kang Sung Lee
- International Vaccine Institute, Seoul, Republic of Korea
| | - Gi Deok Pak
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea.,Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
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21
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Generation and Characterization of Typhoid Toxin-Neutralizing Human Monoclonal Antibodies. Infect Immun 2020; 88:IAI.00292-20. [PMID: 32661121 DOI: 10.1128/iai.00292-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/06/2020] [Indexed: 11/20/2022] Open
Abstract
Typhoid toxin is a virulence factor of Salmonella enterica serovar Typhi, the causative agent of typhoid fever, and is thought to be responsible for the symptoms of severe disease. This toxin has a unique A2B5 architecture with two active subunits, the ADP ribosyl transferase PltA and the DNase CdtB, linked to a pentameric B subunit, which is alternatively made of PltB or PltC. Here, we describe the generation and characterization of typhoid toxin-neutralizing human monoclonal antibodies by immunizing genetically engineered mice that have a full set of human immunoglobulin variable region genes. We identified several monoclonal antibodies with strong in vitro and in vivo toxin-neutralizing activity and different mechanisms of toxin neutralization. These antibodies could serve as the basis for the development of novel therapeutic strategies against typhoid fever.
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22
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Purcell R, Pollard AJ. Elimination of typhoid: Possibility or pipe dream? J Paediatr Child Health 2020; 56:1340-1342. [PMID: 32767815 DOI: 10.1111/jpc.15088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/06/2020] [Indexed: 11/28/2022]
Abstract
The elimination of typhoid would have a substantial impact on the health of millions of people living in South and Southeast Asia and sub-Saharan Africa. Like many diseases before it, there are significant challenges to elimination, including access to safe drinking water and adequate sanitation practices, the availability of a vaccine, the identification and management of chronic carriers and the emergence of anti-microbial resistance. While provision of clean water and adequate sanitation must remain the ultimate goal, in the short term, required to cornerstone elimination in endemic areas, is an efficacious vaccine. Recent evidence of effectiveness with a tetanus-toxoid conjugate vaccine offers an opportunity for an immunogenic and safe vaccine able to be delivered to young children. Shown to be efficacious in Nepal, where infection is endemic, it may be a viable option in public health programmes moving towards elimination.
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Affiliation(s)
- Rachael Purcell
- Department of Infection and Immunity, Monash Children's Hospital, Melbourne, Victoria, Australia.,Infectious Diseases Unit, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Andrew J Pollard
- NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom.,Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
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Theiss-Nyland K, Shakya M, Colin-Jones R, Voysey M, Smith N, Karkey A, Dongol S, Pant D, Farooq YG, Neuzil KM, Shrestha S, Basnyat B, Pollard AJ. Assessing the Impact of a Vi-polysaccharide Conjugate Vaccine in Preventing Typhoid Infections Among Nepalese Children: A Protocol for a Phase III, Randomized Control Trial. Clin Infect Dis 2020; 68:S67-S73. [PMID: 30845329 PMCID: PMC6405280 DOI: 10.1093/cid/ciy1106] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Enteric fever is estimated to affect 11–20 million people worldwide each year. Morbidity and mortality from enteric fever primarily occur in lower-income countries, with children under 5 years of age experiencing a significant portion of the burden. Over the last few decades, the control of enteric fever has focused primarily on improved water and sanitation, with the available vaccines unsuitable for children and primarily used by travelers. A new typhoid conjugate vaccine (Vi-TCV), prequalified by the World Health Organization (WHO) and highly immunogenic in children under 5, has the potential to reduce the typhoid burden in endemic countries. Methods This study is a double-blinded, randomized, controlled trial with a 2-year follow-up to assess the protective impact of the Vi-TCV vaccine, compared with a control vaccine, in children from 9 months to 16 years of age. The primary outcome of interest is the reduction in the number of culture-confirmed typhoid cases attributable to Vi-TCV. Approximately 20 000 children living in the Lalitpur district, within the Kathmandu valley, will be enrolled in the study and followed to measure both safety and efficacy data, which will include adverse events, hospitalizations, antibiotic use, and fever frequency. Results Both the intervention and control vaccines are WHO prequalified vaccines, which provide a health benefit to all participants. Children have been chosen to participate because they bear a substantial burden of both typhoid morbidity and mortality in this population. The results of this study will be disseminated through a series of published articles. The findings will also be made available to the participants and the broader community, as well as local stakeholders, within Nepal. Conclusions This is the first large-scale, individually randomized, controlled trial of Vi-TCV in children in an endemic setting, and will provide new data on Vi-TCV field efficacy. With Vi-TCV introduction being considered in high-burden countries, this study will support important policy decisions. Clinical Trials Registration The trial is registered on the ISRCTN registry (for details, see https://doi.org/10.1186/ISRCTN43385161; registry number: ISRCTN 43385161).
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Affiliation(s)
| | - Mila Shakya
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - Rachel Colin-Jones
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - Merryn Voysey
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - Nicola Smith
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - Abhilasha Karkey
- Oxford University Clinical Research Unit-Nepal, Patan Hospital, Kathmandu
| | - Sabina Dongol
- Oxford University Clinical Research Unit-Nepal, Patan Hospital, Kathmandu
| | - Dikshya Pant
- Oxford University Clinical Research Unit-Nepal, Patan Hospital, Kathmandu
| | - Yama G Farooq
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health at the University of Maryland, Baltimore, MD
| | | | - Buddha Basnyat
- Oxford University Clinical Research Unit-Nepal, Patan Hospital, Kathmandu
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
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24
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Kaufhold S, Yaesoubi R, Pitzer VE. Predicting the Impact of Typhoid Conjugate Vaccines on Antimicrobial Resistance. Clin Infect Dis 2020; 68:S96-S104. [PMID: 30845324 PMCID: PMC6405272 DOI: 10.1093/cid/ciy1108] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Empiric prescribing of antimicrobials in typhoid-endemic settings has increased selective pressure on the development of antimicrobial-resistant Salmonella enterica serovar Typhi. The introduction of typhoid conjugate vaccines (TCVs) in these settings may relieve this selective pressure, thereby reducing resistant infections and improving health outcomes. Methods A deterministic transmission dynamic model was developed to simulate the impact of TCVs on the number and proportion of antimicrobial-resistant typhoid infections and chronic carriers. One-way sensitivity analyses were performed to ascertain particularly impactful model parameters influencing the proportion of antimicrobial-resistant infections and the proportion of cases averted over 10 years. Results The model simulations suggested that increasing vaccination coverage would decrease the total number of antimicrobial-resistant typhoid infections but not affect the proportion of cases that were antimicrobial resistant. In the base-case scenario with 80% vaccination coverage, 35% of all typhoid infections were antimicrobial resistant, and 44% of the total cases were averted over 10 years by vaccination. Vaccination also decreased both the total number and proportion of chronic carriers of antimicrobial-resistant infections. The prevalence of chronic carriers, recovery rates from infection, and relative fitness of resistant strains were identified as crucially important parameters. Conclusions Model predictions for the proportion of antimicrobial resistant infections and number of cases averted depended strongly on the relative fitness of the resistant strain(s), prevalence of chronic carriers, and rates of recovery without treatment. Further elucidation of these parameter values in real-world typhoid-endemic settings will improve model predictions and assist in targeting future vaccination campaigns and treatment strategies.
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Affiliation(s)
- Samantha Kaufhold
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut
- Present address: Analysis Group, 31 Menlo Park, CA 94025
| | - Reza Yaesoubi
- Department of Health Policy and Management, Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut
- Correspondence: V. E. Pitzer, Yale School of Public Health, P.O. Box 208034, New Haven, CT 06520-8034 ()
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25
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Theiss-Nyland K, Qadri F, Colin-Jones R, Zaman K, Khanam F, Liu X, Voysey M, Khan A, Hasan N, Ashher F, Farooq YG, Pollard AJ, Clemens JD. Assessing the Impact of a Vi-polysaccharide Conjugate Vaccine in Preventing Typhoid Infection Among Bangladeshi Children: A Protocol for a Phase IIIb Trial. Clin Infect Dis 2020; 68:S74-S82. [PMID: 30845333 PMCID: PMC6405281 DOI: 10.1093/cid/ciy1107] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Typhoid fever illnesses are responsible for more than 100 000 deaths worldwide each year. In Bangladesh, typhoid fever is endemic, with incidence rates between 292–395 per 100 000 people annually. While considerable effort has been made to improve access to clean water and sanitation services in the country, there is still a significant annual typhoid burden, which particularly affects children. A typhoid conjugate vaccine (Vi-TCV) was recently prequalified by the World Health Organization and recommended for use, and offers the potential to greatly reduce the typhoid burden in Bangladesh. Methods This study is a double-blind, cluster-randomized, controlled trial of Vi-TCV in a geographically defined area in Dhaka, Bangladesh. At least 32 500 children from 9 months to <16 years of age will be vaccinated and followed for 2 years to assess the effectiveness and safety of Vi-TCV in a real-world setting. All cluster residents will also be followed to measure the indirect effect of Vi-TCV in this community. Ethics and Dissemination This protocol has been approved by the International Centre for Diarrhoeal Disease Research, Bangladesh; a University of Oxford research review; and both ethical review committees. Informed written consent and assent will be obtained before enrollment. Vi-TCV has been shown to be safe and effective in previous, smaller-scale studies. The results of this study will be shared through a series of peer-reviewed journal articles. The findings will also be disseminated to the local government, stakeholders within the community, and the population within which the study was conducted. Conclusions This trial is the largest and only cluster-randomized control trial of Vi-TCV ever conducted, and will describe the effectiveness of Vi-TCV in an endemic population. The results of this trial may provide important evidence to support the introduction of TCVs in countries with a high burden of typhoid. Clinical Trials Registration ISRCTN11643110.
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Affiliation(s)
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research-Bangladesh, Dhaka
| | - Rachel Colin-Jones
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - K Zaman
- International Centre for Diarrhoeal Disease Research-Bangladesh, Dhaka
| | - Farhana Khanam
- International Centre for Diarrhoeal Disease Research-Bangladesh, Dhaka
| | - Xinxue Liu
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - Merryn Voysey
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - Arifuzzaman Khan
- International Centre for Diarrhoeal Disease Research-Bangladesh, Dhaka
| | - Nazmul Hasan
- International Centre for Diarrhoeal Disease Research-Bangladesh, Dhaka
| | - Fahim Ashher
- International Centre for Diarrhoeal Disease Research-Bangladesh, Dhaka
| | - Yama G Farooq
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - John D Clemens
- International Centre for Diarrhoeal Disease Research-Bangladesh, Dhaka
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26
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Sahastrabuddhe S, Saluja T. Overview of the Typhoid Conjugate Vaccine Pipeline: Current Status and Future Plans. Clin Infect Dis 2020; 68:S22-S26. [PMID: 30767002 PMCID: PMC6376107 DOI: 10.1093/cid/ciy884] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Typhoid fever remains a common and serious disease in populations that live in low- and middle-income countries. Treatment usually consists of antibiotics, but problems with drug-resistant strains have been increasing in endemic countries, making treatment prolonged and costly. Improved sanitation and food hygiene have been effective in controlling the disease in the industrialized world, but these steps are associated with socioeconomic progress that has been slow in most of the affected areas. Therefore, vaccination is an effective way to prevent the disease for the short to medium term. Oral typhoid vaccine and Vi polysaccharide typhoid vaccine (Vi polysaccharide) have been available for many years, yet a large population, in particular infants and children aged <2 years, remains at higher risk. Recently, with the availability of Vi polysaccharide–based conjugate vaccines and funding to support vaccination from the Gavi alliance, there is great momentum for typhoid prevention efforts. Supply of the vaccine will be critical, and there are multiple efforts to make new typhoid vaccines accessible and available to populations that desperately need them.
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Affiliation(s)
| | - Tarun Saluja
- International Vaccine Institute, Seoul, Republic of Korea
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27
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Cruz Espinoza LM, McCreedy E, Holm M, Im J, Mogeni OD, Parajulee P, Panzner U, Park SE, Toy T, Haselbeck A, Seo HJ, Jeon HJ, Kim JH, Kwon SY, Kim JH, Parry CM, Marks F. Occurrence of Typhoid Fever Complications and Their Relation to Duration of Illness Preceding Hospitalization: A Systematic Literature Review and Meta-analysis. Clin Infect Dis 2019; 69:S435-S448. [PMID: 31665781 PMCID: PMC6821330 DOI: 10.1093/cid/ciz477] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Complications from typhoid fever disease have been estimated to occur in 10%-15% of hospitalized patients, with evidence of a higher risk in children and when delaying the implementation of effective antimicrobial treatment. We estimated the prevalence of complications in hospitalized patients with culture-confirmed typhoid fever and the effects of delaying the implementation of effective antimicrobial treatment and age on the prevalence and risk of complications. METHODS A systematic review and meta-analysis were performed using studies in the PubMed database. We rated risk of bias and conducted random-effects meta-analyses. Days of disease at hospitalization (DDA) was used as a surrogate for delaying the implementation of effective antimicrobial treatment. Analyses were stratified by DDA (DDA <10 versus ≥10 mean/median days of disease) and by age (children versus adults). Differences in risk were assessed using odds ratios (ORs) and 95% confidence intervals (CIs). Heterogeneity and publication bias were evaluated with the I2 value and funnel plot analysis, respectively. RESULTS The pooled prevalence of complications estimated among hospitalized typhoid fever patients was 27% (95% CI, 21%-32%; I2 = 90.9%, P < .0001). Patients with a DDA ≥ 10 days presented higher prevalence (36% [95% CI, 29%-43%]) and three times greater risk of severe disease (OR, 3.00 [95% CI, 2.14-4.17]; P < .0001) than patients arriving earlier (16% [95% CI, 13%- 18%]). Difference in prevalence and risk by age groups were not significant. CONCLUSIONS This meta-analysis identified a higher overall prevalence of complications than previously reported and a strong association between duration of symptoms prior to hospitalization and risk of serious complications.
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Affiliation(s)
| | - Ellen McCreedy
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island
| | - Marianne Holm
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Justin Im
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Ondari D Mogeni
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Prerana Parajulee
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Ursula Panzner
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Se Eun Park
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Trevor Toy
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Andrea Haselbeck
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Hye Jin Seo
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Hyon Jin Jeon
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
- Department of Medicine, University of Cambridge, United Kingdom, United Kingdom
| | - Jong-Hoon Kim
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Soo Young Kwon
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Jerome H Kim
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | | | - Florian Marks
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
- Department of Medicine, University of Cambridge, United Kingdom, United Kingdom
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28
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Park SE, Toy T, Cruz Espinoza LM, Panzner U, Mogeni OD, Im J, Poudyal N, Pak GD, Seo H, Chon Y, Schütt-Gerowitt H, Mogasale V, Ramani E, Dey A, Park JY, Kim JH, Seo HJ, Jeon HJ, Haselbeck A, Conway Roy K, MacWright W, Adu-Sarkodie Y, Owusu-Dabo E, Osei I, Owusu M, Rakotozandrindrainy R, Soura AB, Kabore LP, Teferi M, Okeke IN, Kehinde A, Popoola O, Jacobs J, Lunguya Metila O, Meyer CG, Crump JA, Elias S, Maclennan CA, Parry CM, Baker S, Mintz ED, Breiman RF, Clemens JD, Marks F. The Severe Typhoid Fever in Africa Program: Study Design and Methodology to Assess Disease Severity, Host Immunity, and Carriage Associated With Invasive Salmonellosis. Clin Infect Dis 2019; 69:S422-S434. [PMID: 31665779 PMCID: PMC6821161 DOI: 10.1093/cid/ciz715] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Invasive salmonellosis is a common community-acquired bacteremia in persons residing in sub-Saharan Africa. However, there is a paucity of data on severe typhoid fever and its associated acute and chronic host immune response and carriage. The Severe Typhoid Fever in Africa (SETA) program, a multicountry surveillance study, aimed to address these research gaps and contribute to the control and prevention of invasive salmonellosis. METHODS A prospective healthcare facility-based surveillance with active screening of enteric fever and clinically suspected severe typhoid fever with complications was performed using a standardized protocol across the study sites in Burkina Faso, the Democratic Republic of Congo (DRC), Ethiopia, Ghana, Madagascar, and Nigeria. Defined inclusion criteria were used for screening of eligible patients for enrollment into the study. Enrolled patients with confirmed invasive salmonellosis by blood culture or patients with clinically suspected severe typhoid fever with perforation were eligible for clinical follow-up. Asymptomatic neighborhood controls and immediate household contacts of each case were enrolled as a comparison group to assess the level of Salmonella-specific antibodies and shedding patterns. Healthcare utilization surveys were performed to permit adjustment of incidence estimations. Postmortem questionnaires were conducted in medically underserved areas to assess death attributed to invasive Salmonella infections in selected sites. RESULTS Research data generated through SETA aimed to address scientific knowledge gaps concerning the severe typhoid fever and mortality, long-term host immune responses, and bacterial shedding and carriage associated with natural infection by invasive salmonellae. CONCLUSIONS SETA supports public health policy on typhoid immunization strategy in Africa.
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Affiliation(s)
- Se Eun Park
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Trevor Toy
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | | | - Ursula Panzner
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Ondari D Mogeni
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Justin Im
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Nimesh Poudyal
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
- Department of Microbiology and Infectious Disease, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Gi Deok Pak
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Hyeongwon Seo
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Yun Chon
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Heidi Schütt-Gerowitt
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
- Institute of Medical Microbiology, University of Cologne, Germany
| | - Vittal Mogasale
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Enusa Ramani
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Ayan Dey
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Ju Yeong Park
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Jong-Hoon Kim
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Hye Jin Seo
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Hyon Jin Jeon
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
- Department of Medicine, Cambridge University, United Kingdom
| | - Andrea Haselbeck
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | | | | | - Yaw Adu-Sarkodie
- School of Public Health, and, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ellis Owusu-Dabo
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaac Osei
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Michael Owusu
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Abdramane Bassiahi Soura
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | | | - Mekonnen Teferi
- Armauer Hansen Research Institute, ALERT Campus, Addis Ababa, Ethiopia
| | | | - Aderemi Kehinde
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Ibadan
- Department of Medical Microbiology and Parasitology, University College Hospital
| | - Oluwafemi Popoola
- Department of Community Medicine, College of Medicine, University of Ibadan
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - Jan Jacobs
- Department of Microbiology and Immunology, KU Leuven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Octavie Lunguya Metila
- Institut National de Recherche Biomedicales, Kinshasa
- Service de Microbiologie, Cliniques Universitaires de Kinshasa, Democratic Republic of Congo
| | - Christian G Meyer
- Institute of Tropical Medicine, Eberhard-Karls University of Tübingen, Germany
- Duy Tan University, Da Nang, Vietnam
| | - John A Crump
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Division of Infectious Diseases and International Health, Duke University Medical Center
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Sean Elias
- Jenner Institute, University of Oxford, United Kingdom
| | | | | | - Stephen Baker
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Department of Medicine, Cambridge University, United Kingdom
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Eric D Mintz
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - John D Clemens
- icddr,b, Dhaka, Bangladesh
- Fielding School of Public Health, University of California, Los Angeles
| | - Florian Marks
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
- Department of Medicine, Cambridge University, United Kingdom
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Yu AT, Amin N, Rahman MW, Gurley ES, Rahman KM, Luby SP. Case-Fatality Ratio of Blood Culture-Confirmed Typhoid Fever in Dhaka, Bangladesh. J Infect Dis 2019; 218:S222-S226. [PMID: 30304448 PMCID: PMC6226771 DOI: 10.1093/infdis/jiy543] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/10/2018] [Indexed: 02/03/2023] Open
Abstract
With impending rollout of new conjugate typhoid vaccines, better estimates of typhoid case-fatality ratio are needed for countries to set priorities for public health programs. We enrolled 1425 patients of all ages with blood culture-confirmed Salmonella Typhi from laboratory networks serving inpatients and outpatients in Dhaka, Bangladesh. Participants were asked about symptoms and complications including death experienced over a median 3-month period following blood culture diagnosis. Four fatal cases were identified (case-fatality ratio of 0.3% [95% confidence interval, .05%-.55%]). Applying this case-fatality ratio to global typhoid burden estimates would reduce deaths by 70%.
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Affiliation(s)
| | - Nuhu Amin
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka
| | | | - Emily S Gurley
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kazi Mizanur Rahman
- Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
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Stanaway JD, Reiner RC, Blacker BF, Goldberg EM, Khalil IA, Troeger CE, Andrews JR, Bhutta ZA, Crump JA, Im J, Marks F, Mintz E, Park SE, Zaidi AKM, Abebe Z, Abejie AN, Adedeji IA, Ali BA, Amare AT, Atalay HT, Avokpaho EFGA, Bacha U, Barac A, Bedi N, Berhane A, Browne AJ, Chirinos JL, Chitheer A, Dolecek C, El Sayed Zaki M, Eshrati B, Foreman KJ, Gemechu A, Gupta R, Hailu GB, Henok A, Hibstu DT, Hoang CL, Ilesanmi OS, Iyer VJ, Kahsay A, Kasaeian A, Kassa TD, Khan EA, Khang YH, Magdy Abd El Razek H, Melku M, Mengistu DT, Mohammad KA, Mohammed S, Mokdad AH, Nachega JB, Naheed A, Nguyen CT, Nguyen HLT, Nguyen LH, Nguyen NB, Nguyen TH, Nirayo YL, Pangestu T, Patton GC, Qorbani M, Rai RK, Rana SM, Ranabhat CL, Roba KT, Roberts NLS, Rubino S, Safiri S, Sartorius B, Sawhney M, Shiferaw MS, Smith DL, Sykes BL, Tran BX, Tran TT, Ukwaja KN, Vu GT, Vu LG, Weldegebreal F, Yenit MK, Murray CJL, Hay SI. The global burden of typhoid and paratyphoid fevers: a systematic analysis for the Global Burden of Disease Study 2017. THE LANCET. INFECTIOUS DISEASES 2019; 19:369-381. [PMID: 30792131 PMCID: PMC6437314 DOI: 10.1016/s1473-3099(18)30685-6] [Citation(s) in RCA: 384] [Impact Index Per Article: 76.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/17/2018] [Accepted: 11/01/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Efforts to quantify the global burden of enteric fever are valuable for understanding the health lost and the large-scale spatial distribution of the disease. We present the estimates of typhoid and paratyphoid fever burden from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, and the approach taken to produce them. METHODS For this systematic analysis we broke down the relative contributions of typhoid and paratyphoid fevers by country, year, and age, and analysed trends in incidence and mortality. We modelled the combined incidence of typhoid and paratyphoid fevers and split these total cases proportionally between typhoid and paratyphoid fevers using aetiological proportion models. We estimated deaths using vital registration data for countries with sufficiently high data completeness and using a natural history approach for other locations. We also estimated disability-adjusted life-years (DALYs) for typhoid and paratyphoid fevers. FINDINGS Globally, 14·3 million (95% uncertainty interval [UI] 12·5-16·3) cases of typhoid and paratyphoid fevers occurred in 2017, a 44·6% (42·2-47·0) decline from 25·9 million (22·0-29·9) in 1990. Age-standardised incidence rates declined by 54·9% (53·4-56·5), from 439·2 (376·7-507·7) per 100 000 person-years in 1990, to 197·8 (172·0-226·2) per 100 000 person-years in 2017. In 2017, Salmonella enterica serotype Typhi caused 76·3% (71·8-80·5) of cases of enteric fever. We estimated a global case fatality of 0·95% (0·54-1·53) in 2017, with higher case fatality estimates among children and older adults, and among those living in lower-income countries. We therefore estimated 135·9 thousand (76·9-218·9) deaths from typhoid and paratyphoid fever globally in 2017, a 41·0% (33·6-48·3) decline from 230·5 thousand (131·2-372·6) in 1990. Overall, typhoid and paratyphoid fevers were responsible for 9·8 million (5·6-15·8) DALYs in 2017, down 43·0% (35·5-50·6) from 17·2 million (9·9-27·8) DALYs in 1990. INTERPRETATION Despite notable progress, typhoid and paratyphoid fevers remain major causes of disability and death, with billions of people likely to be exposed to the pathogens. Although improvements in water and sanitation remain essential, increased vaccine use (including with typhoid conjugate vaccines that are effective in infants and young children and protective for longer periods) and improved data and surveillance to inform vaccine rollout are likely to drive the greatest improvements in the global burden of the disease. FUNDING Bill & Melinda Gates Foundation.
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Rudolph ME, McArthur MA, Magder LS, Barnes RS, Chen WH, Sztein MB. Age-Associated Heterogeneity of Ty21a-Induced T Cell Responses to HLA-E Restricted Salmonella Typhi Antigen Presentation. Front Immunol 2019; 10:257. [PMID: 30886613 PMCID: PMC6409365 DOI: 10.3389/fimmu.2019.00257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 01/29/2019] [Indexed: 01/15/2023] Open
Abstract
Human-restricted Salmonella enterica serovar Typhi (S. Typhi) is the causative agent of typhoid fever—a life-threatening disease of great global health significance, particularly in the developing world. Ty21a is an oral live-attenuated vaccine that protects against the development of typhoid disease in part by inducing robust T cell responses, among which multifunctional CD8+ cytotoxic T lymphocytes (CTL) play an important role. Following Ty21a vaccination, a significant component of adult CTL have shown to be targeted to S. Typhi antigen presented by the conserved major histocompatibility complex (MHC) class Ib molecule, human leukocyte antigen-E (HLA-E). S. Typhi challenge studies have shown that baseline, multifunctional HLA-E responsive T cells are associated with protection from, and delayed onset of, typhoid disease. However, despite the overwhelming burden of typhoid fever in school-aged children, and due to limited availability of pediatric samples, incomplete information is available regarding these important HLA-E-restricted responses in children, even though studies have shown that younger children may be less likely to develop protective cell mediated immune (CMI) responses than adults following vaccination. To address this gap, we have studied this phenomenon in depth by using mass cytometry to analyze pediatric and adult T cell responses to HLA-E-restricted S. Typhi antigen presentation, before and after Ty21a vaccination. Herein, we show variable responses in all age strata following vaccination among T effector memory (TEM) and T effector memory CD45RA+ (TEMRA) cells based on conventional gating analysis. However, by utilizing the dimensionality reduction tool tSNE (t-distributed Stochastic Neighbor Embedding), we are able to identify diverse, highly multifunctional gut-homing- TEM and TEMRA clusters of cells which are more abundant in adult and older pediatric participants than in younger children. These findings highlight a potential age-associated maturation of otherwise conserved HLA-E restricted T cell responses. Such insights, coupled with the marked importance of multifunctional T cell responses to combat infection, may better inform future pediatric vaccination strategies against S. Typhi and other infectious diseases.
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Affiliation(s)
- Mark E Rudolph
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States.,Molecular Microbiology and Immunology Department, University of Maryland Graduate Program in Life Sciences, Baltimore, MD, United States
| | - Monica A McArthur
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Laurence S Magder
- Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Robin S Barnes
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Wilbur H Chen
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Marcelo B Sztein
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States.,Molecular Microbiology and Immunology Department, University of Maryland Graduate Program in Life Sciences, Baltimore, MD, United States.,Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, United States.,Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
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Parry CM, Ribeiro I, Walia K, Rupali P, Baker S, Basnyat B. Multidrug resistant enteric fever in South Asia: unmet medical needs and opportunities. BMJ 2019; 364:k5322. [PMID: 30670452 PMCID: PMC6340381 DOI: 10.1136/bmj.k5322] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Investments in newer diagnostics and antimicrobial treatments are critical to improve management of enteric fever in South Asia, say Christopher Parry and colleagues
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Affiliation(s)
- Christopher M Parry
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- School of Tropical Medicine and Global Health, Nagasaki University, Japan
| | - Isabela Ribeiro
- Dynamic Portfolio Unit, Drugs for Neglected Diseases initiative, Geneva, Switzerland
| | - Kamini Walia
- Department of Medical Microbiology, Institute of Medical Education and Research, Chandigarh, India
| | - Priscilla Rupali
- Department of Medicine, Christian Medical College, Vellore, India
| | - Stephen Baker
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Buddha Basnyat
- Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
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Capeding MR, Teshome S, Saluja T, Syed KA, Kim DR, Park JY, Yang JS, Kim YH, Park J, Jo SK, Chon Y, Kothari S, Yang SY, Ham DS, Ryu JH, Hwang HS, Mun JH, Lynch JA, Kim JH, Kim H, Excler JL, Sahastrabuddhe S. Safety and immunogenicity of a Vi-DT typhoid conjugate vaccine: Phase I trial in Healthy Filipino adults and children. Vaccine 2018; 36:3794-3801. [PMID: 29776750 PMCID: PMC6005168 DOI: 10.1016/j.vaccine.2018.05.038] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/03/2018] [Accepted: 05/07/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Typhoid fever remains a major public health problem in low- and middle-income countries where children aged 2-14 years bear the greatest burden. Vi polysaccharide is poorly immunogenic in children <2 years of age, and protection in adults is modest. The limitations of Vi polysaccharide vaccines can be overcome by conjugation of the Vi to a carrier protein. A typhoid conjugate vaccine composed of Vi polysaccharide conjugated to diphtheria toxoid (Vi-DT) has been developed. The Phase I study results are presented here. METHODS This was a randomized, observer-blinded Phase I study to assess the safety and immunogenicity of Vi-DT compared to Vi polysaccharide vaccine, conducted in Manila, Philippines. Participants enrolled in an age de-escalation manner (18-45, 6-17 and 2-5 years) were randomized between Test (Vi-DT, 25 µg) administered at 0 and 4 weeks and Comparator (Vi polysaccharide, Typhim Vi® and Vaxigrip®, Sanofi Pasteur) vaccines. RESULTS A total of 144 participants were enrolled (48 by age strata, 24 in Test and Comparator groups each). No serious adverse event was reported in either group. Solicited and unsolicited adverse events were mild or moderate in both groups with the exception of a 4-year old girl in Test group with grade 3 fever which resolved without sequelae. All participants in Test group seroconverted after first and second doses of Vi-DT while the proportions in the Comparator group were 97.1% and 97.2%, after first dose of Typhim Vi® and second dose of Vaxigrip®, respectively. Vi-DT showed 4-fold higher Geometric Mean Titers (GMT) compared to Typhim Vi® (adjusted for age strata, p < 0.001). No further increase of GMT was detected after the second dose of Vi-DT. Anti-DT IgG seroresponse rates were 81.2% and 84.5% post first and second Vi-DT doses, respectively. CONCLUSIONS Vi-DT vaccine was safe, well-tolerated and immunogenic in participants aged 2-45 years. ClinicalTrials.gov registration number: NCT02645032.
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Affiliation(s)
| | - Samuel Teshome
- International Vaccine Institute, Seoul, Republic of Korea
| | - Tarun Saluja
- International Vaccine Institute, Seoul, Republic of Korea.
| | | | - Deok Ryun Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Ju Yeon Park
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jae Seung Yang
- International Vaccine Institute, Seoul, Republic of Korea
| | - Yang Hee Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jiwook Park
- International Vaccine Institute, Seoul, Republic of Korea
| | - Sue-Kyoung Jo
- International Vaccine Institute, Seoul, Republic of Korea
| | - Yun Chon
- International Vaccine Institute, Seoul, Republic of Korea
| | - Sudeep Kothari
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | | | | | | | - Julia A Lynch
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Hun Kim
- SK Chemicals, Seoul, Republic of Korea
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Andrews JR, Baker S, Marks F, Alsan M, Garrett D, Gellin BG, Saha SK, Qamar FN, Yousafzai MT, Bogoch II, Antillon M, Pitzer VE, Kim JH, John J, Gauld J, Mogasale V, Ryan ET, Luby SP, Lo NC. Typhoid conjugate vaccines: a new tool in the fight against antimicrobial resistance. THE LANCET. INFECTIOUS DISEASES 2018; 19:e26-e30. [PMID: 30170987 DOI: 10.1016/s1473-3099(18)30350-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 05/10/2018] [Accepted: 05/17/2018] [Indexed: 10/28/2022]
Abstract
Typhoid fever is an acute systemic infectious disease responsible for an estimated 12-20 million illnesses and over 150 000 deaths annually. In March, 2018, a new recommendation was issued by WHO for the programmatic use of typhoid conjugate vaccines in endemic countries. Health economic analyses of typhoid vaccines have informed funding decisions and national policies regarding vaccine rollout. However, by focusing only on averted typhoid cases and their associated costs, traditional cost-effectiveness analyses might underestimate crucial benefits of typhoid vaccination programmes, because the potential effect of typhoid vaccines on the treatment of patients with non-specific acute febrile illnesses is not considered. For every true case of typhoid fever, three to 25 patients without typhoid disease are treated with antimicrobials unnecessarily, conservatively amounting to more than 50 million prescriptions per year. Antimicrobials for suspected typhoid might therefore be an important selective pressure for the emergence and spread of antimicrobial resistance globally. We propose that large-scale, more aggressive typhoid vaccination programmes-including catch-up campaigns in children up to 15 years of age, and vaccination in lower incidence settings-have the potential to reduce the overuse of antimicrobials and thereby reduce antimicrobial resistance in many bacterial pathogens. Funding bodies and national governments must therefore consider the potential for broad reductions in antimicrobial use and resistance in decisions related to the rollout of typhoid conjugate vaccines.
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Affiliation(s)
- Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Stephen Baker
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Florian Marks
- Department of Medicine, University of Cambridge, Cambridge, UK; Epidemiology Unit, International Vaccine Institute, Seoul, South Korea
| | - Marcella Alsan
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | | | | | - Samir K Saha
- Department of Microbiology, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Farah Naz Qamar
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Marina Antillon
- Center for Health Economics Research and Modeling Infectious Diseases, University of Antwerp, Belgium
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Jong-Hoon Kim
- Epidemiology Unit, International Vaccine Institute, Seoul, South Korea
| | - Jacob John
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Vittal Mogasale
- Policy and Economic Research Department, Development and Delivery Unit, International Vaccine Institute, Seoul, South Korea
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Nathan C Lo
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Radhakrishnan A, Als D, Mintz ED, Crump JA, Stanaway J, Breiman RF, Bhutta ZA. Introductory Article on Global Burden and Epidemiology of Typhoid Fever. Am J Trop Med Hyg 2018; 99:4-9. [PMID: 30047370 PMCID: PMC6128367 DOI: 10.4269/ajtmh.18-0032] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This article is the introduction to a 12-paper supplement on global trends in typhoid fever. The Tackling Typhoid (T2) project was initiated in 2015 to synthesize the existing body of literature on typhoidal salmonellae and study national and regional typhoid fever trends. In addition to a global systematic review, eight case studies were undertaken to examine typhoid and paratyphoid fever trends in endemic countries alongside changes in relevant contextual factors. Incidence variations exist both within and between regions with large subnational differences as well, suggesting that public health changes impacting typhoid and paratyphoid fevers in one setting may not have similar impacts in another. This supplement also brings to light the lack of national typhoid fever surveillance systems, inconsistencies in diagnostics, and the lack of typhoid fever associated morbidity and mortality data in many countries, making it difficult to accurately quantify and track burden of disease. To better understand typhoid fever there is a need for more high-quality data from resource-poor settings. The implementation of typhoid surveillance systems alongside the transition to blood-culture confirmation of cases, where possible, would aid in the improvement of data quality in low-income settings. The following supplement includes the results of our global systematic review, eight-country case study articles, a qualitative article informed by semistructured interviews, and a conclusion article on potential ways forward for typhoid control.
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Affiliation(s)
| | - Daina Als
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Eric D Mintz
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Jefferey Stanaway
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada.,Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Als D, Radhakrishnan A, Arora P, Gaffey MF, Campisi S, Velummailum R, Zareef F, Bhutta ZA. Global Trends in Typhoidal Salmonellosis: A Systematic Review. Am J Trop Med Hyg 2018; 99:10-19. [PMID: 30047364 PMCID: PMC6128363 DOI: 10.4269/ajtmh.18-0034] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Typhoid and paratyphoid fever continue to significantly contribute to global morbidity and mortality. Disease burden is higher in low-and middle-income settings where surveillance programs are rare and little systematic information exists at population level. This review evaluates national, regional, and global trends in the incidence of typhoid fever and of related morbidity and mortality. A literature search in Medline, Embase, and Web of Science was conducted in June 2016, followed by screening and data extraction in duplicate. Studies reporting blood culture estimates of typhoid or paratyphoid morbidity and mortality were included in the analysis. Our search yielded 5,563 unique records, of which 1978 were assessed for relevance with 219 records meeting the eligibility criteria. Salmonella enterica serotype Typhi was the most commonly reported organism (91%), with the occurrence of typhoidal Salmonella (either incidence or prevalence) being the most commonly reported outcome (78%), followed by typhoid fever mortality, ileal perforation morbidity, and perforation mortality, respectively. Fewer than 50% of studies stratified outcomes by age or urban/rural locality. Surveillance data were available from 29 countries and patient-focused studies were available from 32 countries. Our review presents a mixed picture with declines reported in many regions and settings but with large gaps in surveillance and published data. Regional trends show generally high incidence rates in South Asia, sub-Saharan Africa, and East Asia and Pacific where the disease is endemic in many countries. Significant increases have been reported in certain countries but should be explored in the context of long-term trends and underlying at-risk populations.
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Affiliation(s)
- Daina Als
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | | | - Paul Arora
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Michelle F Gaffey
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Susan Campisi
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | | | - Farhana Zareef
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada.,Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Abstract
BACKGROUND Typhoid fever and paratyphoid fever continue to be important causes of illness and death, particularly among children and adolescents in south-central and southeast Asia. Two typhoid vaccines are widely available, Ty21a (oral) and Vi polysaccharide (parenteral). Newer typhoid conjugate vaccines are at varying stages of development and use. The World Health Organization has recently recommended a Vi tetanus toxoid (Vi-TT) conjugate vaccine, Typbar-TCV, as the preferred vaccine for all ages. OBJECTIVES To assess the effects of vaccines for preventing typhoid fever. SEARCH METHODS In February 2018, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, and mRCT. We also searched the reference lists of all included trials. SELECTION CRITERIA Randomized and quasi-randomized controlled trials (RCTs) comparing typhoid fever vaccines with other typhoid fever vaccines or with an inactive agent (placebo or vaccine for a different disease) in adults and children. Human challenge studies were not eligible. DATA COLLECTION AND ANALYSIS Two review authors independently applied inclusion criteria and extracted data, and assessed the certainty of the evidence using the GRADE approach. We computed vaccine efficacy per year of follow-up and cumulative three-year efficacy, stratifying for vaccine type and dose. The outcome addressed was typhoid fever, defined as isolation of Salmonella enterica serovar Typhi in blood. We calculated risk ratios (RRs) and efficacy (1 - RR as a percentage) with 95% confidence intervals (CIs). MAIN RESULTS In total, 18 RCTs contributed to the quantitative analysis in this review: 13 evaluated efficacy (Ty21a: 5 trials; Vi polysaccharide: 6 trials; Vi-rEPA: 1 trial; Vi-TT: 1 trial), and 9 reported on adverse events. All trials but one took place in typhoid-endemic countries. There was no information on vaccination in adults aged over 55 years of age, pregnant women, or travellers. Only one trial included data on children under two years of age.Ty21a vaccine (oral vaccine, three doses)A three-dose schedule of Ty21a vaccine probably prevents around half of typhoid cases during the first three years after vaccination (cumulative efficacy 2.5 to 3 years: 50%, 95% CI 35% to 61%, 4 trials, 235,239 participants, moderate-certainty evidence). These data include patients aged 3 to 44 years.Compared with placebo, this vaccine probably does not cause more vomiting, diarrhoea, nausea or abdominal pain (2 trials, 2066 participants; moderate-certainty evidence), headache, or rash (1 trial, 1190 participants; moderate-certainty evidence); however, fever (2 trials, 2066 participants; moderate-certainty evidence) is probably more common following vaccination.Vi polysaccharide vaccine (injection, one dose)A single dose of Vi polysaccharide vaccine prevents around two-thirds of typhoid cases in the first year after vaccination (year 1: 69%, 95% CI 63% to 74%; 3 trials, 99,979 participants; high-certainty evidence). In year 2, trial results were more variable, with the vaccine probably preventing between 45% and 69% of typhoid cases (year 2: 59%, 95% CI 45% to 69%; 4 trials, 194,969 participants; moderate-certainty evidence). These data included participants aged 2 to 55 years of age.The three-year cumulative efficacy of the vaccine may be around 55% (95% CI 30% to 70%; 11,384 participants, 1 trial; low-certainty evidence). These data came from a single trial conducted in South Africa in the 1980s in participants aged 5 to 15 years.Compared with placebo, this vaccine probably did not increase the incidence of fever (3 trials, 132,261 participants; moderate-certainty evidence) or erythema (3 trials, 132,261 participants; low-certainty evidence); however, swelling (3 trials, 1767 participants; moderate-certainty evidence) and pain at the injection site (1 trial, 667 participants; moderate-certainty evidence) were more common in the vaccine group.Vi-rEPA vaccine (two doses)Administration of two doses of the Vi-rEPA vaccine probably prevents between 50% and 96% of typhoid cases during the first two years after vaccination (year 1: 94%, 95% CI 75% to 99%; year 2: 87%, 95% CI 56% to 96%, 1 trial, 12,008 participants; moderate-certainty evidence). These data came from a single trial with children two to five years of age conducted in Vietnam.Compared with placebo, both the first and the second dose of this vaccine increased the risk of fever (1 trial, 12,008 and 11,091 participants, low-certainty evidence) and the second dose increase the incidence of swelling at the injection site (one trial, 11,091 participants, moderate-certainty evidence).Vi-TT vaccine (two doses)We are uncertain of the efficacy of administration of two doses of Vi-TT (PedaTyph) in typhoid cases in children during the first year after vaccination (year 1: 94%, 95% CI -1% to 100%, 1 trial, 1625 participants; very low-certainty evidence). These data come from a single cluster-randomized trial in children aged six months to 12 years and conducted in India. For single dose Vi-TT (Typbar-TCV), we found no efficacy trials evaluating the vaccine with natural exposure.There were no reported serious adverse effects in RCTs of any of the vaccines studied. AUTHORS' CONCLUSIONS The licensed Ty21a and Vi polysaccharide vaccines are efficacious in adults and children older than two years in endemic countries. The Vi-rEPA vaccine is just as efficacious, although data is only available for children. The new Vi-TT vaccine (PedaTyph) requires further evaluation to determine if it provides protection against typhoid fever. At the time of writing, there were only efficacy data from a human challenge setting in adults on the Vi-TT vaccine (Tybar), which clearly justify the ongoing field trials to evaluate vaccine efficacy.
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Affiliation(s)
- Rachael Milligan
- Liverpool School of Tropical MedicineCochrane Infectious Diseases GroupPembroke PlaceLiverpoolUKL3 5QA
| | - Mical Paul
- Rambam Health Care CampusDivision of Infectious DiseasesHa‐aliya 8 StHaifaIsrael33705
| | - Marty Richardson
- Liverpool School of Tropical MedicineCochrane Infectious Diseases GroupPembroke PlaceLiverpoolUKL3 5QA
| | - Ami Neuberger
- Rambam Health Care Campus and The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of TechnologyDivision of Infectious DiseasesTel AvivIsrael
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Khatun H, Islam SB, Naila NN, Islam SA, Nahar B, Alam NH, Ahmed T. Clinical profile, antibiotic susceptibility pattern of bacterial isolates and factors associated with complications in culture-proven typhoid patients admitted to an urban hospital in Bangladesh. Trop Med Int Health 2018; 23:359-366. [PMID: 29432657 DOI: 10.1111/tmi.13037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Typhoid fever is one of the major causes of morbidity and mortality in typhoid endemic countries like Bangladesh. However, data on the clinical and microbiological profile as well as factors associated with complications of typhoid in Bangladesh are scarce. We intended to characterise the clinical and microbiological profile of culture-proven typhoid fever and to identify factors associated with complications. METHODOLOGY Retrospective analysis of clinical data from 431 patients with culture-confirmed typhoid fever admitted to Dhaka hospital of International Centre for Diarrhoeal Disease Research, Bangladesh, between January 2010 and December 2014. Clinical and microbiological profiles of the patients including age, sex, and duration of illness prior to hospital admission, haematological parameters and the antimicrobial resistance profile of the infecting isolate, duration of hospital stay and defervescence time were examined by logistic regression to identify the factors associated with complications. RESULT About one of three patients were children under 5 years, and 21.5% of them were severely malnourished. During hospitalisation, 17.4% patients developed complications; mainly encephalopathy (6.7%), ileus (6.5%) and pneumonia (3.5%). Among culture-positive cases, 28.3% isolates showed multidrug resistant (MDR) and more than 90% of isolates were resistant to nalidixic acid and had intermediate sensitivity to ciprofloxacin. Five isolates were resistant to azithromycin; all isolates were sensitive to cefixime and ceftriaxone. Complication was independently associated with duration of fever before admission (adjusted odds ratio: 0.85; 95% CI: 0.074-0.97; P < 0.05), thrombocytopenia on admission (AOR: 2.84; 95% CI: 01.06-7.57; P < 0.05), duration of hospital stay (AOR: 1.34; 95% CI: 1.15-1.57; P < 0.01) and defervescence time (AOR: 0.83; 95% CI: 0.70-0.99; P < 0.05). CONCLUSION The high prevalence of typhoid fever among under-five children and complications among hospitalised patients are matters of concern. Sensitivity of Salmonella Typhi to ceftriaxone and cefixime was better than to other conventional antibiotics. Shorter duration of fever and thrombocytopenia on admission can be considered as early signs of complications.
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Affiliation(s)
- Halima Khatun
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shoeb Bin Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nurun Nahar Naila
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Syed Aminul Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Baitun Nahar
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nur Haque Alam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.,James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Kuijpers LMF, Phe T, Veng CH, Lim K, Ieng S, Kham C, Fawal N, Fabre L, Le Hello S, Vlieghe E, Weill FX, Jacobs J, Peetermans WE. The clinical and microbiological characteristics of enteric fever in Cambodia, 2008-2015. PLoS Negl Trop Dis 2017; 11:e0005964. [PMID: 28931025 PMCID: PMC5624643 DOI: 10.1371/journal.pntd.0005964] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 10/02/2017] [Accepted: 09/14/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Enteric fever remains a major public health problem in low resource settings and antibiotic resistance is increasing. In Asia, an increasing proportion of infections is caused by Salmonella enterica serovar Paratyphi A, which for a long time was assumed to cause a milder clinical syndrome compared to Salmonella enterica serovar Typhi. METHODOLOGY A retrospective chart review study was conducted of 254 unique cases of blood culture confirmed enteric fever who presented at a referral adult hospital in Phnom Penh, Cambodia between 2008 and 2015. Demographic, clinical and laboratory data were collected from clinical charts and antibiotic susceptibility testing was performed. Whole genome sequence analysis was performed on a subset of 121 isolates. RESULTS One-hundred-and-ninety unique patients were diagnosed with Salmonella Paratyphi A and 64 with Salmonella Typhi. In the period 2008-2012, Salmonella Paratyphi A comprised 25.5% of 47 enteric fever cases compared to 86.0% of 207 cases during 2013-2015. Presenting symptoms were identical for both serovars but higher median leukocyte counts (6.8 x 109/L vs. 6.3 x 109/L; p = 0.035) and C-reactive protein (CRP) values (47.0 mg/L vs. 36 mg/L; p = 0.034) were observed for Salmonella Typhi infections. All but one of the Salmonella Typhi isolates belonged to haplotype H58 associated with multidrug resistance (MDR) (i.e. resistance to ampicillin, chloramphenicol and co-trimoxazole).;42.9% actually displayed MDR compared to none of the Salmonella Paratyphi A isolates. Decreased ciprofloxacin susceptibility (DCS) was observed in 96.9% (62/64) of Salmonella Typhi isolates versus 11.5% (21/183) of Salmonella Paratyphi A isolates (all but one from 2015). All isolates were susceptible to azithromycin and ceftriaxone. CONCLUSIONS In Phnom Penh, Cambodia, Salmonella Paratyphi A now causes the majority of enteric fever cases and decreased susceptibility against ciprofloxacin is increasing. Overall, Salmonella Typhi was significantly more associated with MDR and DCS compared to Salmonella Paratyphi A.
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Affiliation(s)
- Laura M. F. Kuijpers
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology & Immunology, KU Leuven, Leuven, Belgium
- * E-mail:
| | - Thong Phe
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
| | - Chhun H. Veng
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
| | - Kruy Lim
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
| | - Sovann Ieng
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
| | - Chun Kham
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
| | - Nizar Fawal
- Unité des Bactéries Pathogènes Entériques, Centre National de Référence des E. coli, Shigella et Salmonella, Institut Pasteur, Paris, France
| | - Laetitia Fabre
- Unité des Bactéries Pathogènes Entériques, Centre National de Référence des E. coli, Shigella et Salmonella, Institut Pasteur, Paris, France
| | - Simon Le Hello
- Unité des Bactéries Pathogènes Entériques, Centre National de Référence des E. coli, Shigella et Salmonella, Institut Pasteur, Paris, France
| | - Erika Vlieghe
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of General Internal Medicine, Infectious diseases and Tropical Medicine, University Hospital Antwerp, Antwerp, Belgium
| | - François-Xavier Weill
- Unité des Bactéries Pathogènes Entériques, Centre National de Référence des E. coli, Shigella et Salmonella, Institut Pasteur, Paris, France
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology & Immunology, KU Leuven, Leuven, Belgium
| | - Willy E. Peetermans
- Department of Internal Medicine, University Hospital Leuven, Leuven, Belgium
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Antillón M, Bilcke J, Paltiel AD, Pitzer VE. Cost-effectiveness analysis of typhoid conjugate vaccines in five endemic low- and middle-income settings. Vaccine 2017; 35:3506-3514. [PMID: 28527687 PMCID: PMC5462484 DOI: 10.1016/j.vaccine.2017.05.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 04/28/2017] [Accepted: 05/01/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Typhoid fever remains endemic in low- and middle-income countries. Programmatic use of existing vaccines is limited, but upcoming typhoid conjugate vaccines (TCVs) could warrant wider use. We evaluated the cost-effectiveness of five TCV delivery strategies in three urban areas (Delhi and Kolkata, India and Nairobi, Kenya) and two rural settings (Lwak, Kenya and Dong Thap, Vietnam) with varying incidence. METHODS AND FINDINGS We evaluated routine infant vaccination with and without catch-up campaigns among older individuals. We used a dynamic model of typhoid transmission to simulate cases, hospitalizations, deaths, disability-adjusted life-years (DALY) lost, treatment and intervention costs. We estimated cost-effectiveness (in terms of cost in international dollars (I$) per DALY averted) from the healthcare payer perspective, and assessed how it was influenced by uncertain model parameters. Compared to no vaccination, routine infant vaccination at I$1/dose was cost-saving in Delhi and Dong Thap, "very cost-effective" in Kolkata and Nairobi, and "cost-effective" in Lwak according to World Health Organization thresholds. However, routine vaccination was not the optimal strategy compared to strategies that included a catch-up campaign, which yielded the highest probability of being cost-saving in Delhi and Dong Thap and were most likely to provide a return on investment above a willingness-to-pay threshold of I$1440 in Kolkata, I$2300 in Nairobi, and I$5360 in Lwak. Vaccine price impacted the optimal strategy, and the number of doses required and rate of hospitalization were the primary sources of uncertainty. CONCLUSION Routine vaccination with TCV would be cost-effective in most settings, and additional one-time catch-up campaigns would also be economically justified.
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Affiliation(s)
- Marina Antillón
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06520-8034, USA.
| | - Joke Bilcke
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06520-8034, USA; Center for Health Economics Research and Modeling Infectious Diseases, University of Antwerp, Belgium
| | - A David Paltiel
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT 06520-8034, USA
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06520-8034, USA.
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Antillón M, Warren JL, Crawford FW, Weinberger DM, Kürüm E, Pak GD, Marks F, Pitzer VE. The burden of typhoid fever in low- and middle-income countries: A meta-regression approach. PLoS Negl Trop Dis 2017; 11:e0005376. [PMID: 28241011 PMCID: PMC5344533 DOI: 10.1371/journal.pntd.0005376] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 03/09/2017] [Accepted: 01/31/2017] [Indexed: 11/26/2022] Open
Abstract
Background Upcoming vaccination efforts against typhoid fever require an assessment of the baseline burden of disease in countries at risk. There are no typhoid incidence data from most low- and middle-income countries (LMICs), so model-based estimates offer insights for decision-makers in the absence of readily available data. Methods We developed a mixed-effects model fit to data from 32 population-based studies of typhoid incidence in 22 locations in 14 countries. We tested the contribution of economic and environmental indices for predicting typhoid incidence using a stochastic search variable selection algorithm. We performed out-of-sample validation to assess the predictive performance of the model. Results We estimated that 17.8 million cases of typhoid fever occur each year in LMICs (95% credible interval: 6.9–48.4 million). Central Africa was predicted to experience the highest incidence of typhoid, followed by select countries in Central, South, and Southeast Asia. Incidence typically peaked in the 2–4 year old age group. Models incorporating widely available economic and environmental indicators were found to describe incidence better than null models. Conclusions Recent estimates of typhoid burden may under-estimate the number of cases and magnitude of uncertainty in typhoid incidence. Our analysis permits prediction of overall as well as age-specific incidence of typhoid fever in LMICs, and incorporates uncertainty around the model structure and estimates of the predictors. Future studies are needed to further validate and refine model predictions and better understand year-to-year variation in cases. Typhoid fever is a bacterial enteric infection that continues to pose a considerable burden to the 5.5 billion people living in low- and middle-income countries (LMICs). We developed and validated a model incorporating widely available indicators of economic and social development and the environment to estimate the burden of typhoid fever across LMICs. Our analysis uses all available data to estimate the incidence of typhoid in key age groups, which is important for the design and implementation of optimal vaccination strategies, and it identifies regions of the world that have the most uncertainty in typhoid incidence. Across all LMICs, we estimated that the expected number of typhoid fever cases per year is 17.8 million (95% CI: 6.9–48.4 million). We also present the probability that incidence surpasses the criteria for low, medium, high, and very high incidence in each country, which could help guide policy in the face of uncertainty.
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Affiliation(s)
- Marina Antillón
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
- * E-mail:
| | - Joshua L. Warren
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Forrest W. Crawford
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Daniel M. Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Esra Kürüm
- Department of Statistics, University of California Riverside, Riverside, California, United States of America
| | - Gi Deok Pak
- International Vaccine Institute, Seoul, Republic of Korea
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
| | - Virginia E. Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
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Maude RR, Ghose A, Samad R, de Jong HK, Fukushima M, Wijedoru L, Hassan MU, Hossain MA, Karim MR, Sayeed AA, van den Ende S, Pal S, Zahed ASM, Rahman W, Karnain R, Islam R, Tran DTN, Ha TT, Pham AH, Campbell JI, van Doorn HR, Maude RJ, van der Poll T, Wiersinga WJ, Day NPJ, Baker S, Dondorp AM, Parry CM, Faiz MA. A prospective study of the importance of enteric fever as a cause of non-malarial febrile illness in patients admitted to Chittagong Medical College Hospital, Bangladesh. BMC Infect Dis 2016; 16:567. [PMID: 27737634 PMCID: PMC5064917 DOI: 10.1186/s12879-016-1886-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 10/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fever is a common cause of hospital admission in Bangladesh but causative agents, other than malaria, are not routinely investigated. Enteric fever is thought to be common. METHODS Adults and children admitted to Chittagong Medical College Hospital with a temperature of ≥38.0 °C were investigated using a blood smear for malaria, a blood culture, real-time PCR to detect Salmonella Typhi, S. Paratyphi A and other pathogens in blood and CSF and an NS1 antigen dengue ELISA. RESULTS We enrolled 300 febrile patients with a negative malaria smear between January and June 2012: 156 children (aged ≤15 years) and 144 adults with a median (interquartile range) age of 13 (5-31) years and median (IQR) illness duration before admission of five (2-8) days. Clinical enteric fever was diagnosed in 52 patients (17.3 %), lower respiratory tract infection in 48 (16.0 %), non-specific febrile illness in 48 (16.0 %), a CNS infection in 37 patients (12.3 %), urinary sepsis in 23 patients (7.7 %), an upper respiratory tract infection in 21 patients (7.0 %), and diarrhea or dysentery in 21 patients (7.0 %). Malaria was still suspected in seven patients despite a negative microscopy test. S. Typhi was detected in blood by culture or PCR in 34 (11.3 %) of patients. Of note Rickettsia typhi and Orientia tsutsugamushi were detected by PCR in two and one patient respectively. Twenty-nine (9 %) patients died during their hospital admission (15/160 (9.4 %) of children and 14/144 (9.7 %) adults). Two of 52 (3.8 %) patients with enteric fever, 5/48 (10.4 %) patients with lower respiratory tract infections, and 12/37 (32.4 %) patients with CNS infection died. CONCLUSION Enteric fever was confirmed in 11.3 % of patients admitted to this hospital in Bangladesh with non-malaria fever. Lower respiratory tract and CNS infections were also common. CNS infections in this location merit more detailed study due to the high mortality.
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Affiliation(s)
- Rapeephan R Maude
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Rasheda Samad
- Chittagong Medical College Hospital, Chittagong, Bangladesh
| | - Hanna K de Jong
- Department of Internal Medicine, Division of Infectious Diseases and Center for Infection and Immunity Amsterdam (CINIMA), and Center for Experimental Molecular Medicine (CEMM), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Masako Fukushima
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lalith Wijedoru
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | | | | | | | - Stannie van den Ende
- Department of Internal Medicine, Division of Infectious Diseases and Center for Infection and Immunity Amsterdam (CINIMA), and Center for Experimental Molecular Medicine (CEMM), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sujat Pal
- Chittagong Medical College Hospital, Chittagong, Bangladesh
| | - A S M Zahed
- Chittagong Medical College Hospital, Chittagong, Bangladesh
| | - Wahid Rahman
- Chittagong Medical College Hospital, Chittagong, Bangladesh
| | - Rifat Karnain
- Chittagong Medical College Hospital, Chittagong, Bangladesh
| | - Rezina Islam
- Chittagong Medical College Hospital, Chittagong, Bangladesh
| | - Dung Thi Ngoc Tran
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit (OUCRU), Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Tuyen Thanh Ha
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit (OUCRU), Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Anh Hong Pham
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit (OUCRU), Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - James I Campbell
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit (OUCRU), Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
| | - H Rogier van Doorn
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit (OUCRU), Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
| | - Richard J Maude
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
| | - Tom van der Poll
- Department of Internal Medicine, Division of Infectious Diseases and Center for Infection and Immunity Amsterdam (CINIMA), and Center for Experimental Molecular Medicine (CEMM), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - W Joost Wiersinga
- Department of Internal Medicine, Division of Infectious Diseases and Center for Infection and Immunity Amsterdam (CINIMA), and Center for Experimental Molecular Medicine (CEMM), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicholas P J Day
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
| | - Stephen Baker
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit (OUCRU), Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK.,Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Arjen M Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, Oxford University, Oxford, UK
| | - Christopher M Parry
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. .,Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. .,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
| | - Md Abul Faiz
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Malaria Research Group and Dev Care Foundation, Chittagong, Bangladesh
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Azmatullah A, Qamar FN, Thaver D, Zaidi AK, Bhutta ZA. Systematic review of the global epidemiology, clinical and laboratory profile of enteric fever. J Glob Health 2016; 5:020407. [PMID: 26649174 PMCID: PMC4672836 DOI: 10.7189/jogh.05.020407] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Children suffer the highest burden of enteric fever among populations in South Asian countries. The clinical features are non–specific, vary in populations, and are often difficult to distinguish clinically from other febrile illnesses, leading to delayed or inappropriate diagnosis and treatment. We undertook a systematic review to assess the clinical profile and laboratory features of enteric fever across age groups, economic regions, level of care and antibiotic susceptibility patterns. Methods We searched PubMed (January 1964–December 2013) for studies describing clinical features in defined cohorts of patients over varying time periods. Studies with all culture–confirmed cases or those with at least 50% culture–confirmed cases were included. 242 reports were screened out of 4398 relevant articles and 180 reports were included for final review. Results 96% of studies were from an urban location, 96% were hospital–based studies, with 41% of studies were from South Asia. Common clinical features in hospitalized children include high–grade fever, coated tongue, anaemia, nausea/vomiting, diarrhea, constipation, hepatomegaly, splenomegaly neutrophilia, abdominal distension and GI bleeding. In adults’ nausea/vomiting, thrombocytopenia and GI perforation predominate. The case–fatality rate in children under 5 years is higher than school aged children and adolescents, and is highest in Sub Saharan Africa and North Africa/Middle East regions. Multi–drug resistant enteric fever has higher rates of complications than drug sensitive enteric fever, but case fatality rates were comparable in both. Conclusions Our findings indicate variability in disease presentation in adults compared to children, in different regions and in resistant vs sensitive cases. Majority of studies are from hospitalized cases, and are not disaggregated by age. Despite higher complications in MDR enteric fever, case fatality rate is comparable to sensitive cases, with an overall hospital based CFR of 2%, which is similar to recent global estimates. This review underscores the importance of further epidemiological studies in community settings among children and adults, and the need for further preventable measures to curtail the burden of disease.
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Affiliation(s)
- Asma Azmatullah
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Farah Naz Qamar
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Durrane Thaver
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Anita Km Zaidi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Research Institute, The Hospital for Sick Children, Toronto, Canada ; Centre of Excellence in Women & Child Health, The Aga Khan University, Karachi, Pakistan
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Crump JA, Sjölund-Karlsson M, Gordon MA, Parry CM. Epidemiology, Clinical Presentation, Laboratory Diagnosis, Antimicrobial Resistance, and Antimicrobial Management of Invasive Salmonella Infections. Clin Microbiol Rev 2015; 28:901-37. [PMID: 26180063 PMCID: PMC4503790 DOI: 10.1128/cmr.00002-15] [Citation(s) in RCA: 640] [Impact Index Per Article: 71.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Salmonella enterica infections are common causes of bloodstream infection in low-resource areas, where they may be difficult to distinguish from other febrile illnesses and may be associated with a high case fatality ratio. Microbiologic culture of blood or bone marrow remains the mainstay of laboratory diagnosis. Antimicrobial resistance has emerged in Salmonella enterica, initially to the traditional first-line drugs chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole. Decreased fluoroquinolone susceptibility and then fluoroquinolone resistance have developed in association with chromosomal mutations in the quinolone resistance-determining region of genes encoding DNA gyrase and topoisomerase IV and also by plasmid-mediated resistance mechanisms. Resistance to extended-spectrum cephalosporins has occurred more often in nontyphoidal than in typhoidal Salmonella strains. Azithromycin is effective for the management of uncomplicated typhoid fever and may serve as an alternative oral drug in areas where fluoroquinolone resistance is common. In 2013, CLSI lowered the ciprofloxacin susceptibility breakpoints to account for accumulating clinical, microbiologic, and pharmacokinetic-pharmacodynamic data suggesting that revision was needed for contemporary invasive Salmonella infections. Newly established CLSI guidelines for azithromycin and Salmonella enterica serovar Typhi were published in CLSI document M100 in 2015.
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Affiliation(s)
- John A Crump
- Centre for International Health, University of Otago, Dunedin, Otago, New Zealand Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maria Sjölund-Karlsson
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melita A Gordon
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Christopher M Parry
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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McArthur MA, Fresnay S, Magder LS, Darton TC, Jones C, Waddington CS, Blohmke CJ, Dougan G, Angus B, Levine MM, Pollard AJ, Sztein MB. Activation of Salmonella Typhi-specific regulatory T cells in typhoid disease in a wild-type S. Typhi challenge model. PLoS Pathog 2015; 11:e1004914. [PMID: 26001081 PMCID: PMC4441490 DOI: 10.1371/journal.ppat.1004914] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/27/2015] [Indexed: 12/12/2022] Open
Abstract
Salmonella Typhi (S. Typhi), the causative agent of typhoid fever, causes significant morbidity and mortality worldwide. Currently available vaccines are moderately efficacious, and identification of immunological responses associated with protection or disease will facilitate the development of improved vaccines. We investigated S. Typhi-specific modulation of activation and homing potential of circulating regulatory T cells (Treg) by flow and mass cytometry using specimens obtained from a human challenge study. Peripheral blood mononuclear cells were obtained from volunteers pre- and at multiple time-points post-challenge with wild-type S. Typhi. We identified differing patterns of S. Typhi-specific modulation of the homing potential of circulating Treg between volunteers diagnosed with typhoid (TD) and those who were not (No TD). TD volunteers demonstrated up-regulation of the gut homing molecule integrin α4ß7 pre-challenge, followed by a significant down-regulation post-challenge consistent with Treg homing to the gut. Additionally, S. Typhi-specific Treg from TD volunteers exhibited up-regulation of activation molecules post-challenge (e.g., HLA-DR, LFA-1). We further demonstrate that depletion of Treg results in increased S. Typhi-specific cytokine production by CD8+ TEM in vitro. These results suggest that the tissue distribution of activated Treg, their characteristics and activation status may play a pivotal role in typhoid fever, possibly through suppression of S. Typhi-specific effector T cell responses. These studies provide important novel insights into the regulation of immune responses that are likely to be critical in protection against typhoid and other enteric infectious diseases.
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Affiliation(s)
- Monica A. McArthur
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Stephanie Fresnay
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Laurence S. Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Thomas C. Darton
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Claire Jones
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Claire S. Waddington
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Christoph J. Blohmke
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Gordon Dougan
- Microbial Pathogenesis Group, Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Brian Angus
- Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Myron M. Levine
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Andrew J. Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the National Institute for Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Marcelo B. Sztein
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
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46
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Qamar FN, Azmatullah A, Bhutta ZA. Challenges in measuring complications and death due to invasive Salmonella infections. Vaccine 2015; 33 Suppl 3:C16-20. [PMID: 25921727 DOI: 10.1016/j.vaccine.2015.03.103] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/26/2015] [Accepted: 03/28/2015] [Indexed: 01/08/2023]
Abstract
Despite the highest burden of Typhoid fever in children globally, exact estimates of morbidity and mortality are lacking due to scarcity of published data. Despite a high prevalence and a socioeconomic burden in developing countries, published data with morbidity and mortality figures are limited especially Africa and South American regions. Data from the community is insufficient and most case fatality estimates are extrapolations from hospital based studies that do not cover all geographical regions, and include cases which may or not be culture confirmed, MDR resistant or sensitive cases, or from mixed populations of age (adults and children). Complications of typhoid such as intestinal perforation, bone marrow suppression, and encephalopathy are dependent on MDR/Fluoroquinolone resistant Salmonella infection, comorbidities such as malnutrition, and health-care access. Data is again insufficient to estimate the true burden of Typhoid Fever in different regions and groups of populations. Although there has been a rapid decline in cases in developed countries with the advent of improved sanitization, timely and easy access to health care and laboratories, this is still not the case in the developing countries where Typhoid deaths are still occurring. The way forward is to develop rapid and cost effective point of care diagnostic tests, put in place validated clinical algorithms for suspected clinical cases, and design prospective, and community based studies in different groups, implement maintenance of electronic health records in large public sector hospitals and regions to identify populations that will benefit most from the implementation of vaccine. Policies on public health education and typhoid vaccine may help to reduce morbidity and mortality due to the disease.
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Affiliation(s)
- Farah Naz Qamar
- Department of Pediatrics and Child Health, Center of Excellence in Women and Child Health, The Aga Khan University, PO Box 3500, Karachi 74800, Pakistan.
| | - Asma Azmatullah
- Department of Pediatrics and Child Health, Center of Excellence in Women and Child Health, The Aga Khan University, PO Box 3500, Karachi 74800, Pakistan
| | - Zulfiqar A Bhutta
- Department of Pediatrics and Child Health, Center of Excellence in Women and Child Health, The Aga Khan University, PO Box 3500, Karachi 74800, Pakistan.
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47
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Luby SP, Saha S, Andrews JR. Towards sustainable public health surveillance for enteric fever. Vaccine 2015; 33 Suppl 3:C3-7. [PMID: 25912287 DOI: 10.1016/j.vaccine.2015.02.054] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/09/2015] [Accepted: 02/12/2015] [Indexed: 10/23/2022]
Abstract
Enteric fever that results from infection by the typhoidal Salmonellas (Salmonella Typhi and Salmonella Paratyphi A, B and C) is a life-threatening preventable illness. Surveillance of enteric fever is important to understand current burden of disease, to track changes in human health burden from increasing antimicrobial resistance and to assess the impact of efforts to reduce disease burden. Since enteric fever occurs predominantly in low income communities, expensive surveillance is not sustainable. Traditional hospital-based surveillance does not estimate population burden and intensive community-based cohort studies do not capture the severe disease that is crucial to policy decisions. While cohort studies have been considered the gold standard for incidence estimates, the resources required to conduct them are great; as a consequence, estimates of enteric fever burden have been highly geographically and temporally restricted. A hybrid approach combining laboratory diagnosis that is already being conducted in healthcare centers with community-based surveillance of health care facility use offers a low-cost, sustainable approach to generate policy relevant data.
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Affiliation(s)
- Stephen P Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, United States.
| | - Samir Saha
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Jason R Andrews
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, United States
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48
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A prevalence study of typhoid fever and convalescent phase asymptomatic typhoid carriers among the schoolchildren in the northern part of Tamil Nadu. J Public Health (Oxf) 2015. [DOI: 10.1007/s10389-015-0655-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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49
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Mogasale V, Desai SN, Mogasale VV, Park JK, Ochiai RL, Wierzba TF. Case fatality rate and length of hospital stay among patients with typhoid intestinal perforation in developing countries: a systematic literature review. PLoS One 2014; 9:e93784. [PMID: 24743649 PMCID: PMC3990554 DOI: 10.1371/journal.pone.0093784] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 03/08/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Typhoid fever remains a major health problem in the developing world. Intestinal perforation is a lethal complication and continues to occur in impoverished areas despite advances in preventive and therapeutic strategies. OBJECTIVES To estimate the case fatality rate (CFR) and length of hospital stay among patients with typhoid intestinal perforation in developing countries. DATA SOURCES Peer-reviewed publications listed in PubMed and Google Scholar. STUDY ELIGIBILITY The publications containing data on CFR or length of hospitalization for typhoid fever from low, lower middle and upper middle income countries based on World Bank classification. Limits are English language, human research and publication date from 1st January 1991 to 31st December 2011. PARTICIPANTS Subjects with reported typhoid intestinal perforation. INTERVENTIONS None, standard practice as reported in the publication. STUDY APPRAISAL AND SYNTHESIS METHODS Systematic literature review followed by meta-analysis after regional classification on primary data. Descriptive methods were applied on secondary data. RESULTS From 42 published reports, a total of 4,626 hospitalized typhoid intestinal perforation cases and 706 deaths were recorded (CFR = 15·4%; 95% CI; 13·0%-17·8%) with a significant regional differences. The overall mean length of hospitalization for intestinal perforation from 23 studies was 18.4 days (N = 2,542; 95% CI; 15.6-21.1). LIMITATIONS Most typhoid intestinal perforation studies featured in this review were from a limited number of countries. CONCLUSIONS The CFR estimated in this review is a substantial reduction from the 39.6% reported from a literature review for years 1960 to 1990. Aggressive resuscitation, appropriate antimicrobial coverage, and prompt surgical intervention may have contributed to decrease mortality. IMPLICATIONS The quantification of intestinal perforation outcomes and its regional disparities as presented here is valuable in prioritizing and targeting typhoid-preventive interventions to the most affected areas.
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Affiliation(s)
- Vittal Mogasale
- Policy and Economic Research Centre, Access Department, Development and Delivery Unit, International Vaccine Institute, Seoul, South Korea
| | - Sachin N. Desai
- Clinical Development and Regulatory Department, Development and Delivery Unit, International Vaccine Institute, Seoul, South Korea
| | - Vijayalaxmi V. Mogasale
- Epidemiology Department, Development and Delivery Unit, International Vaccine Institute, Seoul, South Korea
| | - Jin Kyung Park
- Biostatistics and Data Management Department, Development and Delivery Unit, International Vaccine Institute, Seoul, South Korea
| | | | - Thomas F. Wierzba
- Development and Delivery Unit, International Vaccine Institute, Seoul, South Korea
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50
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Parry CM, Thompson C, Vinh H, Chinh NT, Phuong LT, Ho VA, Hien TT, Wain J, Farrar JJ, Baker S. Risk factors for the development of severe typhoid fever in Vietnam. BMC Infect Dis 2014; 14:73. [PMID: 24512443 PMCID: PMC3923984 DOI: 10.1186/1471-2334-14-73] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 01/30/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Typhoid fever is a systemic infection caused by the bacterium Salmonella enterica serovar Typhi. Age, sex, prolonged duration of illness, and infection with an antimicrobial resistant organism have been proposed risk factors for the development of severe disease or fatality in typhoid fever. METHODS We analysed clinical data from 581 patients consecutively admitted with culture confirmed typhoid fever to two hospitals in Vietnam during two periods in 1993-1995 and 1997-1999. These periods spanned a change in the antimicrobial resistance phenotypes of the infecting organisms i.e. fully susceptible to standard antimicrobials, resistance to chloramphenicol, ampicillin and trimethoprim-sulphamethoxazole (multidrug resistant, MDR), and intermediate susceptibility to ciprofloxacin (nalidixic acid resistant). Age, sex, duration of illness prior to admission, hospital location and the presence of MDR or intermediate ciprofloxacin susceptibility in the infecting organism were examined by logistic regression analysis to identify factors independently associated with severe typhoid at the time of hospital admission. RESULTS The prevalence of severe typhoid was 15.5% (90/581) and included: gastrointestinal bleeding (43; 7.4%); hepatitis (29; 5.0%); encephalopathy (16; 2.8%); myocarditis (12; 2.1%); intestinal perforation (6; 1.0%); haemodynamic shock (5; 0.9%), and death (3; 0.5%). Severe disease was more common with increasing age, in those with a longer duration of illness and in patients infected with an organism exhibiting intermediate susceptibility to ciprofloxacin. Notably an MDR phenotype was not associated with severe disease. Severe disease was independently associated with infection with an organism with an intermediate susceptibility to ciprofloxacin (AOR 1.90; 95% CI 1.18-3.07; p = 0.009) and male sex (AOR 1.61 (1.00-2.57; p = 0.035). CONCLUSIONS In this group of patients hospitalised with typhoid fever infection with an organism with intermediate susceptibility to ciprofloxacin was independently associated with disease severity. During this period many patients were being treated with fluoroquinolones prior to hospital admission. Ciprofloxacin and ofloxacin should be used with caution in patients infected with S. Typhi that have intermediate susceptibility to ciprofloxacin.
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Affiliation(s)
- Christopher M Parry
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, Liverpool, UK
| | - Corinne Thompson
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, Churchill Hospital, Oxford, UK
| | - Ha Vinh
- Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
| | - Nguyen Tran Chinh
- Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
| | - Le Thi Phuong
- Dong Thap Provincial Hospital, Cao Lanh, Dong Thap Province, Vietnam
| | - Vo Anh Ho
- Dong Thap Provincial Hospital, Cao Lanh, Dong Thap Province, Vietnam
| | - Tran Tinh Hien
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
- Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
| | - John Wain
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
- Department of Medical Microbiology, University of East Anglia, Norwich, UK
| | - Jeremy J Farrar
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, Churchill Hospital, Oxford, UK
| | - Stephen Baker
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, Churchill Hospital, Oxford, UK
- London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
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