1
|
Nakisuyi J, Bernis M, Ndamira A, Kayini V, Mulumba R, Theophilus P, Agwu E, Lule H. Prevalence and factors associated with malaria, typhoid, and co-infection among febrile children aged six months to twelve years at kampala international university teaching hospital in western Uganda. Heliyon 2023; 9:e19588. [PMID: 37809597 PMCID: PMC10558847 DOI: 10.1016/j.heliyon.2023.e19588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 08/09/2023] [Accepted: 08/28/2023] [Indexed: 10/10/2023] Open
Abstract
Background Paediatric febrile illnesses pose diagnostic challenges in low-income countries. Western Uganda is endemic for both malaria and typhoid but the true prevalence of each individual disease, their co-infections and associated factors are poorly quantified. Objective To determine the prevalence of malaria, typhoid, their co-infection, and associated factors amongst febrile children attending the paediatrics and child health department of Kampala International University Teaching Hospital (KIU-TH) in Western Uganda. Methods Cross-sectional study used a survey questionnaire covering demographics, clinical and behavioural variables. We obtained blood for peripheral films for malaria and cultures for typhoid respectively; from 108 consecutively consented participants. Ethical approval was obtained from KIU-TH research and ethics committee (No. UG-REC-023/201,834). Multivariate regression analysis was performed using Stata 14.0 (StataCorp. 2015) at 95% confidence interval, regarding p < 0.05 as statistically significant. Results Majority of participants were males 62% (n = 67), cared for by their mothers 86.1% (n = 93). The prevalence of malaria was 25% (n = 27). The prevalence of typhoid was 3.7% (n = 4), whereas the prevalence of malaria-typhoid co-infection was 2.8% (n = 3). Using treated water from protected public taps was associated with low malaria-typhoid co-infection [p = 0.04; aOR = 0.05, 95%CI [0.003-0.87], whereas drinking unboiled water from open wells increased the risk for the co-infection [p = 0.037, cOR = 17, 95%CI (1.19-243.25)]. Conclusions The prevalence of blood culture confirmed malaria-typhoid co-infection in children was lower than previously reported in serological studies. These findings emphasize the need to use gold standard diagnostic investigations in epidemiological studies. Educational campaigns should focus on the use of safe water, hygienic hand washing, and proper waste disposal; and should target mothers who mainly take care of these children.
Collapse
Affiliation(s)
- Joanitor Nakisuyi
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University-Western Campus, P.o. Box 71, Bushenyi, Uganda
| | - Melvis Bernis
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University-Western Campus, P.o. Box 71, Bushenyi, Uganda
| | - Andrew Ndamira
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University-Western Campus, P.o. Box 71, Bushenyi, Uganda
| | - Vicent Kayini
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University-Western Campus, P.o. Box 71, Bushenyi, Uganda
| | - Richard Mulumba
- Department of Obstetrics and Gynecology, Faculty of Clinical Medicine and Dentistry, Kampala International University-Western Campus, P.o. Box 71, Bushenyi, Uganda
| | - Pius Theophilus
- Medical Laboratory Science Department, Kampala International University Western Campus, Bushenyi, Uganda
| | - Ezera Agwu
- Departments of Medical Microbiology and Clinical Immunology, Faculty of Medicine, Kabale University, Uganda
| | - Herman Lule
- Faculty of Medicine, Department of Clinical Neurosciences, Turku University Hospital and University of Turku, FI-20014, Turku, Finland
| |
Collapse
|
2
|
Robertine LF, Payne VK, Honorine NT, Mounchili S, Saturine MM, Manjuh BR, Aboubakar NN, Roland B. Trends of potential waterborne diseases at different health facilities in Bamboutos Division, West Region, Cameroon: a retrospective appraisal of routine data from 2013 to 2017. JOURNAL OF WATER AND HEALTH 2021; 19:616-628. [PMID: 34371498 DOI: 10.2166/wh.2021.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Many Cameroonian cities lack access to potable drinking water where populations rely on alternative water sources of doubtful quality. This study aimed at describing the trends and patterns of waterborne diseases (WBDs) reported in some health facilities in Bamboutos Division between 2013 and 2017 as baseline data towards understanding the profile of WBDs in this area. A retrospective review of clinical data kept on patients who visited the main health facilities in Bamboutos Division from January 2013 to December 2017 was conducted. Overall, 39.1% (n = 8,124) of total patients were positive for at least one WBD. Categories of WBDs were dysenteries (18.6%), gastroenteritis (4.2%), viral hepatitis (0.2%) and typhoid was the most preponderant (24.4%). The most affected age groups were those above 24 years but significant differences were observed only in 2013 and 2017. Distribution of potential WBDs was locality dependent. The highest prevalence of typhoid fever was recorded in Bameboro (35.4%), dysenteries in Bamedjinda (20.4%) and gastroenteritis (17.3%) in Bamekoumbou. The study shows very high overall prevalence of WBDs in some localities which could be considered as 'hotspots' of WBDs in Bamboutos. This suggests the urgent need for setting up measures to tackle the challenges of potable drinking water supply.
Collapse
Affiliation(s)
- Lontuo-Fogang Robertine
- Research Unit of Applied Biology and Ecology (URBEA), Department of Animal Biology, Faculty of Science, University of Dschang, P.O. Box 067, Dschang, Cameroon E-mail:
| | - Vincent Khan Payne
- Research Unit of Applied Biology and Ecology (URBEA), Department of Animal Biology, Faculty of Science, University of Dschang, P.O. Box 067, Dschang, Cameroon E-mail:
| | - Ntangmo Tsafack Honorine
- Research Unit of Applied Biology and Ecology (URBEA), Department of Animal Biology, Faculty of Science, University of Dschang, P.O. Box 067, Dschang, Cameroon E-mail:
| | - Souleman Mounchili
- Malaria Research Laboratory, Organisation de Coordination pour la lutte contre les Endémies en Afrique centrale (OCEAC), BP 288 Yaoundé, Cameroon
| | - Matango Murielle Saturine
- Research Unit of Applied Biology and Ecology (URBEA), Department of Animal Biology, Faculty of Science, University of Dschang, P.O. Box 067, Dschang, Cameroon E-mail:
| | - Bup Rita Manjuh
- Research Unit of Applied Biology and Ecology (URBEA), Department of Animal Biology, Faculty of Science, University of Dschang, P.O. Box 067, Dschang, Cameroon E-mail:
| | - Ngouyamsa Nsapkain Aboubakar
- Research Unit of Applied Biology and Ecology (URBEA), Department of Animal Biology, Faculty of Science, University of Dschang, P.O. Box 067, Dschang, Cameroon E-mail:
| | - Bamou Roland
- Research Unit of Applied Biology and Ecology (URBEA), Department of Animal Biology, Faculty of Science, University of Dschang, P.O. Box 067, Dschang, Cameroon E-mail: ; Malaria Research Laboratory, Organisation de Coordination pour la lutte contre les Endémies en Afrique centrale (OCEAC), BP 288 Yaoundé, Cameroon
| |
Collapse
|
3
|
Gallandat K, Kolus RC, Julian TR, Lantagne DS. A systematic review of chlorine-based surface disinfection efficacy to inform recommendations for low-resource outbreak settings. Am J Infect Control 2021; 49:90-103. [PMID: 32442652 PMCID: PMC7236738 DOI: 10.1016/j.ajic.2020.05.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 12/13/2022]
Abstract
Background Infectious diseases can be transmitted via fomites (contaminated surfaces/objects); disinfection can interrupt this transmission route. However, disinfection guidelines for low-resource outbreak settings are inconsistent and not evidence-based. Methods A systematic review of surface disinfection efficacy studies was conducted to inform low-resource outbreak guideline development. Due to variation in experimental procedures, outcomes were synthesized in a narrative summary focusing on chlorine-based disinfection against 7 pathogens with potential to produce outbreaks in low-resource settings (Mycobacterium tuberculosis, Vibrio cholerae, Salmonella spp., hepatitis A virus, rotavirus, norovirus, and Ebola virus). Results Data were extracted from 89 laboratory studies and made available, including 20 studies on relevant pathogens used in combination with surrogate data to determine minimum target concentration × time (“CT”) factors. Stainless steel (68%) and chlorine-based disinfectants (56%) were most commonly tested. No consistent trend was seen in the influence of chlorine concentration and exposure time on disinfection efficacy. Disinfectant application mode; soil load; and surface type were frequently identified as influential factors in included studies. Conclusions This review highlights that surface disinfection efficacy estimates are strongly influenced by each study's experimental conditions. We therefore recommend laboratory testing to be followed by field-based testing/monitoring to ensure effectiveness is achieved in situ.
Collapse
Affiliation(s)
- Karin Gallandat
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK; Department of Civil and Environmental Engineering, Tufts University, Medford, MA.
| | - Riley C Kolus
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA; School of Medicine, Boston University, Boston, MA
| | - Timothy R Julian
- Department of Environmental Microbiology, Eawag, Swiss Federal Institute of Aquatic Science and Technology, Duebendorf, Switzerland; Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Daniele S Lantagne
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA
| |
Collapse
|
4
|
Acosta-Alonzo CB, Erovenko IV, Lancaster A, Oh H, Rychtář J, Taylor D. High endemic levels of typhoid fever in rural areas of Ghana may stem from optimal voluntary vaccination behaviour. Proc Math Phys Eng Sci 2020; 476:20200354. [PMID: 33071586 DOI: 10.1098/rspa.2020.0354] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/04/2020] [Indexed: 01/24/2023] Open
Abstract
Typhoid fever has long established itself endemically in rural Ghana despite the availability of cheap and effective vaccines. We used a game-theoretic model to investigate whether the low vaccination coverage in Ghana could be attributed to rational human behaviour. We adopted a version of an epidemiological model of typhoid fever dynamics, which accounted not only for chronic life-long carriers but also for a short-cycle transmission in the immediate environment and a long-cycle transmission via contamination of the water supply. We calibrated the model parameters based on the known incidence data. We found that unless the (perceived) cost of vaccination is negligible, the individually optimal population vaccination rate falls significantly short of the societally optimal population vaccination rate needed to reach herd immunity. We expressed both the herd immunity and the optimal equilibrium vaccination rates in terms of only a few observable parameters such as the incidence rate, demographics, vaccine waning rate and the perceived cost of vaccination relative to the cost of infection. This allowed us not to rely on other uncertain epidemiological model parameters and, in particular, to bypass uncertainties about the role of the carriers in the transmission.
Collapse
Affiliation(s)
- Carmen B Acosta-Alonzo
- Department of Mathematics and Computer Science, Bennett College, Greensboro, NC 27401, USA
| | - Igor V Erovenko
- Department of Mathematics and Statistics, University of North Carolina at Greensboro, Greensboro, NC 27402, USA
| | - Aaleah Lancaster
- Department of Mathematics and Computer Science, Bennett College, Greensboro, NC 27401, USA
| | - Hyunju Oh
- Division of Mathematics and Computer Science, University of Guam, Mangilao, Guam 96923, USA
| | - Jan Rychtář
- Department of Mathematics and Applied Mathematics, Virginia Commonwealth University, Richmond, VA 23284-2014, USA
| | - Dewey Taylor
- Department of Mathematics and Applied Mathematics, Virginia Commonwealth University, Richmond, VA 23284-2014, USA
| |
Collapse
|
5
|
Pak GD, Haselbeck AH, Seo HW, Osei I, Amuasi J, Breiman RF, Cruz Espinosa LM, Holm M, Im J, Jang GH, Jeon HJ, Luby SP, Lunguya-Metila O, MacWright W, Mogeni OD, Okeke IN, Owusu-Dabo E, Park JK, Park SE, Popoola O, Seo HJ, Soura AB, Teferi M, Toy T, Chon Y, Rafindrakalia M, Rakotozandrindrainy R, Meyer CG, Marks F, Panzner U. The HPAfrica protocol: Assessment of health behaviour and population-based socioeconomic, hygiene behavioural factors - a standardised repeated cross-sectional study in multiple cohorts in sub-Saharan Africa. BMJ Open 2018; 8:e021438. [PMID: 30573477 PMCID: PMC6303690 DOI: 10.1136/bmjopen-2017-021438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 08/31/2018] [Accepted: 10/11/2018] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION The objective of the Health Population Africa (HPAfrica) study is to determine health behaviour and population-based factors, including socioeconomic, ethnographic, hygiene and sanitation factors, at sites of the Severe Typhoid Fever in Africa (SETA) programme. SETA aims to investigate healthcare facility-based fever surveillance in Burkina Faso, the Democratic Republic of the Congo, Ethiopia, Ghana, Madagascar and Nigeria. Meaningful disease burden estimates require adjustment for health behaviour patterns, which are assumed to vary among a study population. METHODS AND ANALYSIS For the minimum sample size of household interviews required, the assumptions of an infinite population, a design effect and age-stratification and sex-stratification are considered. In the absence of a population sampling frame or household list, a spatial approach will be used to generate geographic random points with an Aeronautical Reconnaissance Coverage Geographic Information System tool. Printouts of Google Earth Pro satellite imagery visualise these points. Data of interest will be assessed in different seasons by applying population-weighted stratified sampling. An Android-based application and a web service will be developed for electronic data capturing and synchronisation with the database server in real time. Sampling weights will be computed to adjust for possible differences in selection probabilities. Descriptive data analyses will be performed in order to assess baseline information of each study population and age-stratified and sex-stratified health behaviour. This will allow adjusting disease burden estimates. In addition, multivariate analyses will be applied to look into associations between health behaviour, population-based factors and the disease burden as determined in the SETA study. ETHICS AND DISSEMINATION Ethic approvals for this protocol were obtained by the Institutional Review Board of the International Vaccine Institute (No. 2016-0003) and by all collaborating institutions of participating countries. It is anticipated to disseminate findings from this study through publication on a peer-reviewed journal.
Collapse
Affiliation(s)
- Gi Deok Pak
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
| | | | - Hyeong Won Seo
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
| | - Isaac Osei
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Ghana, Africa
| | - John Amuasi
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Ghana, Africa
- School of Public Health, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Robert F Breiman
- Global Health Institute, Emory University, Atlanta, Georgia, USA
| | | | - Marianne Holm
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
| | - Justin Im
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
| | - Geun Hyeog Jang
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
| | - Hyon Jin Jeon
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
| | - Stephen P Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Octavie Lunguya-Metila
- Service de Microbiologie, Cliniques Universitaires de Kinshasa, Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicales, Kinshasa, Democratic Republic of the Congo
| | | | | | - Iruka N Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Ellis Owusu-Dabo
- School of Public Health, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Jin Kyung Park
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
| | - Se Eun Park
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
| | - Oluwafemi Popoola
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Hye Jin Seo
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
| | - Abdramane Bassiahi Soura
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | | | - Trevor Toy
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
| | - Yun Chon
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
| | | | | | - Christian G Meyer
- Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
- Institute of Tropical Medicine, Eberhard Karls University, Tübingen, Germany
| | - Florian Marks
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
- The Department of Medicine, The University of Cambridge, Cambridge, UK
| | - Ursula Panzner
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
- Swiss Tropical and Public HealthInstitute (Swiss TPH), Basel, Switzerland
- University of Basel, Basel, Switzerland
| |
Collapse
|
6
|
Bennett SD, Lowther SA, Chingoli F, Chilima B, Kabuluzi S, Ayers TL, Warne TA, Mintz E. Assessment of water, sanitation and hygiene interventions in response to an outbreak of typhoid fever in Neno District, Malawi. PLoS One 2018; 13:e0193348. [PMID: 29474394 PMCID: PMC5825105 DOI: 10.1371/journal.pone.0193348] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 02/09/2018] [Indexed: 11/19/2022] Open
Abstract
On May 2, 2009 an outbreak of typhoid fever began in rural villages along the Malawi-Mozambique border resulting in 748 illnesses and 44 deaths by September 2010. Despite numerous interventions, including distribution of WaterGuard (WG) for in-home water treatment and education on its use, cases of typhoid fever continued. To inform response activities during the ongoing Typhoid outbreak information on knowledge, attitudes, and practices surrounding typhoid fever, safe water, and hygiene were necessary to plan future outbreak interventions. In September 2010, a survey was administered to female heads in randomly selected households in 17 villages in Neno District, Malawi. Stored household drinking water was tested for free chlorine residual (FCR) levels using the N,N diethyl-p-phenylene diamine colorimetric method (HACH Company, Loveland, CO, USA). Attendance at community-wide educational meetings was reported by 56% of household respondents. Respondents reported that typhoid fever is caused by poor hygiene (77%), drinking unsafe water (49%), and consuming unsafe food (25%), and that treating drinking water can prevent it (68%). WaterGuard, a chlorination solution for drinking water treatment, was observed in 112 (56%) households, among which 34% reported treating drinking water. FCR levels were adequate (FCR ≥ 0.2 mg/L) in 29 (76%) of the 38 households who reported treatment of stored water and had stored water available for testing and an observed bottle of WaterGuard in the home. Soap was observed in 154 (77%) households, among which 51% reported using soap for hand washing. Educational interventions did not reach almost one-half of target households and knowledge remains low. Despite distribution and promotion of WaterGuard and soap during the outbreak response, usage was low. Future interventions should focus on improving water, sanitation and hygiene knowledge, practices, and infrastructure. Typhoid vaccination should be considered.
Collapse
Affiliation(s)
- Sarah D. Bennett
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Sara A. Lowther
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Benson Chilima
- Community Health Services Unit, Ministry of Health, Lilongwe, Malawi
| | - Storn Kabuluzi
- Community Health Services Unit, Ministry of Health, Lilongwe, Malawi
| | - Tracy L. Ayers
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Thomas A. Warne
- Division of Global HIV AIDS, Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Eric Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| |
Collapse
|
7
|
Environmental Survey of Drinking Water Sources in Kampala, Uganda, during a Typhoid Fever Outbreak. Appl Environ Microbiol 2017; 83:AEM.01706-17. [PMID: 28970225 DOI: 10.1128/aem.01706-17] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 08/30/2017] [Indexed: 11/20/2022] Open
Abstract
In 2015, a typhoid fever outbreak began in downtown Kampala, Uganda, and spread into adjacent districts. In response, an environmental survey of drinking water source types was conducted in areas of the city with high case numbers. A total of 122 samples was collected from 12 source types and tested for Escherichia coli, free chlorine, and conductivity. An additional 37 grab samples from seven source types and 16 paired large volume (20 liter) samples from wells and springs were also collected and tested for the presence of Salmonella enterica serovar Typhi. Escherichia coli was detected in 60% of kaveras (drinking water sold in plastic bags) and 80% of refilled water bottles; free chlorine was not detected in either source type. Most jerry cans (68%) contained E. coli and had free chlorine residuals below the WHO-recommended level of 0.5 mg/liter during outbreaks. Elevated conductivity readings for kaveras, refilled water bottles, and jerry cans (compared to treated surface water supplied by the water utility) suggested that they likely contained untreated groundwater. All unprotected springs and wells and more than 60% of protected springs contained E. coli Water samples collected from the water utility were found to have acceptable free chlorine levels and no detectable E. coli While S Typhi was not detected in water samples, Salmonella spp. were detected in samples from two unprotected springs, one protected spring, and one refilled water bottle. These data provided clear evidence that unregulated vended water and groundwater represented a risk for typhoid transmission.IMPORTANCE Despite the high incidence of typhoid fever globally, relatively few outbreak investigations incorporate drinking water testing. During waterborne disease outbreaks, measurement of physical-chemical parameters, such as free chlorine residual and electrical conductivity, and of microbiological parameters, such as the presence of E. coli or the implicated etiologic agent, in drinking water samples can identify contaminated sources. This investigation indicated that unregulated vended water and groundwater sources were contaminated and were therefore a risk to consumers during the 2015 typhoid fever outbreak in Kampala. Identification of contaminated drinking water sources and sources that do not contain adequate disinfectant levels can lead to rapid targeted interventions.
Collapse
|
8
|
Ali E, Bergh RVD, D'hondt R, Kuma-Kuma D, Weggheleire AD, Baudot Y, Lambert V, Hunter P, Zachariah R, Maes P. Localised transmission hotspots of a typhoid fever outbreak in the Democratic Republic of Congo. Pan Afr Med J 2017. [PMID: 29541325 PMCID: PMC5847255 DOI: 10.11604/pamj.2017.28.179.10208] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction In a semi-urban setting in the Democratic Republic of Congo, this study aims to understand the dynamic of a typhoid fever (TF) outbreak and to assess: a) the existence of hot spots for TF transmission and b) the difference between typhoid cases identified within those hot spots and the general population in relation to socio-demographic characteristics, sanitation practice, and sources of drinking water. Methods This was a retrospective analysis of TF outbreaks in 2011 in Kikwit, DRC using microbiological analysis of water sources and a structured interview questionnaire. Results There were a total of 1430 reported TF cases. The outbreak’s epidemic curve shows earliest and highest peak attack rates (AR) in three military camps located in Kikwit (Ebeya 3.2%; Ngubu 3.0%; and Nsinga 2.2%) compared to an average peak AR of 0.6% in other affected areas. A total 320 cases from the military camps and the high burden health areas were interviewed. Typhoid cases in the military camps shared a latrine with more than one family (P<0.02). All tap water sources in both the military camps and general population were found to be highly contaminated with faecal coliforms. Conclusion The role of military camps in Kikwit as early hotspots of TF transmission was likely associated with lower sanitary and hygiene conditions. The proximity of camps to the general population might have been responsible for disseminating TF to the general population. Mapping of cases during an outbreak could be crucial to identify hot spots for transmission and institute corrective measures.
Collapse
Affiliation(s)
- Engy Ali
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), Luxembourg, Brussels, Belgium
| | - Rafael Van Den Bergh
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), Luxembourg, Brussels, Belgium
| | - Rob D'hondt
- Médecins Sans Frontières - Operational Centre Brussels, Kinshasa, DRC
| | - Donat Kuma-Kuma
- Ministry of Public Health, Health District Kikwit, Kikwit, Bandundu, DRC
| | | | - Yves Baudot
- Network for Application & Development of Aerospatial Remote sensing (N.A.D.A.R), Belgium
| | - Vincent Lambert
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Brussels
| | - Paul Hunter
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, United Kingdom
| | - Rony Zachariah
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), Luxembourg, Brussels, Belgium
| | - Peter Maes
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Brussels
| |
Collapse
|
9
|
Contini S. Typhoid intestinal perforation in developing countries: Still unavoidable deaths? World J Gastroenterol 2017; 23:1925-1931. [PMID: 28373758 PMCID: PMC5360633 DOI: 10.3748/wjg.v23.i11.1925] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/20/2017] [Accepted: 03/06/2017] [Indexed: 02/07/2023] Open
Abstract
Typhoid fever is a public health challenge mostly concentrated in impoverished, overcrowded areas of the developing world, with lack of safe drinking and sanitation. The most serious complication is typhoid intestinal perforation (TIP), observed in 0.8% to 39%, with a striking rate difference between high-income and low-middle-income countries. Although the mortality rate consequent to TIP in resource-poor countries is improved in the last decades, it is still fluctuating from 5% to 80%, due to surgical- and not surgical-related constraints. Huge economic costs and long timelines are required to provide a short- to middle-term solution to the lack of safe water and sanitation. Inherent limitations of the currently available diagnostic tools may lead to under-evaluation as well as over-evaluation of the disease, with consequent delayed treatment or inappropriate, excessive antibiotic use, hence increasing the likelihood of bacterial resistance. There is a need for immunization programs in populations at greatest risk, especially in sub-Saharan Africa. Uniform surgical strategies and guidelines, on the basis of sound or prospective surgical studies and adapted to the local realities, are still lacking. Major drawbacks of the surgical treatment are the frequent delays to surgery, either for late diagnosis or for difficult transports, and the unavailable appropriate intensive care units in most peripheral facilities. As a consequence, poor patient’s conditions at presentation, severe peritoneal contamination and unsuitable postoperative care are the foremost determinant of surgical morbidity and mortality.
Collapse
|
10
|
Typhoidal and non-typhoidal Salmonella infections in Africa. Eur J Clin Microbiol Infect Dis 2016; 35:1913-1922. [PMID: 27562406 DOI: 10.1007/s10096-016-2760-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 08/16/2016] [Indexed: 12/31/2022]
Abstract
Salmonella infections in humans can range from self-limiting gastroenteritis typically associated with non-typhoidal Salmonella (NTS) to typhoidal fever, which can be life-threatening. Salmonellosis causes considerable morbidity and mortality in both humans and animals, and has a significant socioeconomic impact worldwide. In Africa, it is difficult to evaluate the situation of salmonellosis due to the non-availability of facilities capable of performing the tests essential for the diagnosis of typhoidal and non-typhoidal Salmonella infections. This article reviews important work in the literature, including the epidemiology, disease burden, pathogenesis, genomics, diagnosis, treatment, emergence and tracking of multidrug-resistant (MDR) Salmonella infections and intercontinental transmission of Salmonella to Africa. Searches of PubMed and Google Scholar were completed and the retrieved list of relevant publications were further screened. The literature revealed that the most common form of the disease in Africa is gastroenteritis, with bacterial multiplication in intestinal submucosa and diarrhoea caused by the inflammatory response and, perhaps, also by toxins. In addition to the high burden of Salmonella infection in Africa, MDR Salmonella species is on the rise in the continent, which might pose difficulties in the treatment of the disease.
Collapse
|
11
|
Principi N, Esposito S. Preventing invasive salmonellosis in children through vaccination. Expert Rev Vaccines 2016; 15:897-905. [PMID: 27140662 DOI: 10.1080/14760584.2016.1183484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Vaccination is an important strategy to control endemic enteric fever (EF) and to interrupt transmission during outbreaks. The main aim of this paper is to discuss the efficacy of available EF vaccines in children and to highlight novel vaccination possibilities against EF and non-typhoid invasive salmonelloses. AREAS COVERED Two types of typhoid vaccines are presently available in the industrialized world. One of these vaccines is administered parenterally and is based on the virulence-associated (Vi) capsular polysaccaride of Salmonella typhi. The second vaccine is based on a live attenuated strain of the pathogen and is given orally. In addition, a Vi-tetanus toxoid conjugated vaccine is currently licensed in India; however, it is not available anywhere else. Expert commentary: Unfortunately, only typhoid fever is addressed by the currently licensed typhoid vaccines. Moreover, they are unsuitable for infants and remain a possible aid for reducing the risk of EF only in older subjects. They should be used in developing countries with endemic EF. New vaccines able to confer long-term protection to subjects in the first years of life and those with immature immune systems could significantly reduce incidence rates of EF in younger children. Vi-conjugate preparations are promising solutions in this regard.
Collapse
Affiliation(s)
- Nicola Principi
- a Paediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Susanna Esposito
- a Paediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| |
Collapse
|
12
|
Osei-Tutu B, Anto F. Trends of reported foodborne diseases at the Ridge Hospital, Accra, Ghana: a retrospective review of routine data from 2009-2013. BMC Infect Dis 2016; 16:139. [PMID: 27013510 PMCID: PMC4807551 DOI: 10.1186/s12879-016-1472-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 03/14/2016] [Indexed: 11/13/2022] Open
Abstract
Background There are over 250 foodborne diseases and are of growing public health concern worldwide. The distribution of these diseases varies from one locality to the other. Foodborne diseases come about as a result of ingestion of food contaminated with microorganisms or chemicals. The most common clinical presentation of foodborne disease takes the form of gastrointestinal symptoms; although other systems of the body can also be affected and represents a considerable burden of disability as well as mortality. The current study was carried out with the aim of describing the trends and patterns of foodborne diseases reported at the Ridge Hospital in Accra, Ghana to serve as the first step towards understanding the profile of foodborne diseases in Accra. The study could then serve as a guide in the establishment of a sentinel site or surveillance system for foodborne diseases. Methods A retrospective review of routine data kept on patients who visited the Ridge Hospital from January 2009 to December 2013 was conducted to describe the trends and patterns of foodborne diseases reported at the facility. All available health records were reviewed and data on foodborne diseases extracted and analysed by age group, sex, season and geographical location within the catchment area of the hospital. Results The review showed significant variation in the annual reported cases of foodborne diseases [2009 = 11.5 % (118/1058); 2010 = 2.30 % (22/956); 2011 = 17.45 % (608/3485); 2012 = 7.98 % (498/6315) and 2013 = 2.56 % (345/13458)] p < 0.05. Significant seasonal variations were also observed [early dry season = 10.2 % (322/3142); late dry season = 24.4 % (909/3728); early wet season = 4.3 % (107/2494); late wet season = 6.3 % (256/4094). There were monthly variations also during the period (p < 0.001) except for the year 2010 (p = 0.428). The highest prevalence was reported during the late dry season (February–April). The most affected age group was those aged between 15 and 34 years who had significantly more infections in 2012 and 2013 than the other age groups (p < 0.001). Overall many more males than females reported of food borne diseases (p < 0.001). Conclusion The commonly reported foodborne diseases at the Ridge Hospital were: typhoid fever, dysentery, cholera and viral hepatitis. These diseases were found to be very seasonal with peaks at the onset of the rainy season. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1472-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Benjamin Osei-Tutu
- School of Public Health, University of Ghana, Legon, Accra, Ghana.,Food and Drugs Authority Accra, Accra, Ghana
| | - Francis Anto
- School of Public Health, University of Ghana, Legon, Accra, Ghana.
| |
Collapse
|
13
|
Mogasale V, Maskery B, Ochiai RL, Lee JS, Mogasale VV, Ramani E, Kim YE, Park JK, Wierzba TF. Burden of typhoid fever in low-income and middle-income countries: a systematic, literature-based update with risk-factor adjustment. LANCET GLOBAL HEALTH 2015; 2:e570-80. [PMID: 25304633 DOI: 10.1016/s2214-109x(14)70301-8] [Citation(s) in RCA: 336] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND No access to safe water is an important risk factor for typhoid fever, yet risk-level heterogeneity is unaccounted for in previous global burden estimates. Since WHO has recommended risk-based use of typhoid polysaccharide vaccine, we revisited the burden of typhoid fever in low-income and middle-income countries (LMICs) after adjusting for water-related risk. METHODS We estimated the typhoid disease burden from studies done in LMICs based on blood-culture-confirmed incidence rates applied to the 2010 population, after correcting for operational issues related to surveillance, limitations of diagnostic tests, and water-related risk. We derived incidence estimates, correction factors, and mortality estimates from systematic literature reviews. We did scenario analyses for risk factors, diagnostic sensitivity, and case fatality rates, accounting for the uncertainty in these estimates and we compared them with previous disease burden estimates. FINDINGS The estimated number of typhoid fever cases in LMICs in 2010 after adjusting for water-related risk was 11·9 million (95% CI 9·9-14·7) cases with 129 000 (75 000-208 000) deaths. By comparison, the estimated risk-unadjusted burden was 20·6 million (17·5-24·2) cases and 223 000 (131 000-344 000) deaths. Scenario analyses indicated that the risk-factor adjustment and updated diagnostic test correction factor derived from systematic literature reviews were the drivers of differences between the current estimate and past estimates. INTERPRETATION The risk-adjusted typhoid fever burden estimate was more conservative than previous estimates. However, by distinguishing the risk differences, it will allow assessment of the effect at the population level and will facilitate cost-effectiveness calculations for risk-based vaccination strategies for future typhoid conjugate vaccine.
Collapse
Affiliation(s)
| | | | | | | | | | - Enusa Ramani
- International Vaccine Institute, Seoul, South Korea
| | | | | | | |
Collapse
|
14
|
Date KA, Bentsi-Enchill A, Marks F, Fox K. Typhoid fever vaccination strategies. Vaccine 2015; 33 Suppl 3:C55-61. [PMID: 25902360 PMCID: PMC10644681 DOI: 10.1016/j.vaccine.2015.04.028] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 03/31/2015] [Accepted: 04/01/2015] [Indexed: 01/08/2023]
Abstract
Typhoid vaccination is an important component of typhoid fever prevention and control, and is recommended for public health programmatic use in both endemic and outbreak settings. We reviewed experiences with various vaccination strategies using the currently available typhoid vaccines (injectable Vi polysaccharide vaccine [ViPS], oral Ty21a vaccine, and injectable typhoid conjugate vaccine [TCV]). We assessed the rationale, acceptability, effectiveness, impact and implementation lessons of these strategies to inform effective typhoid vaccination strategies for the future. Vaccination strategies were categorized by vaccine disease control strategy (preemptive use for endemic disease or to prevent an outbreak, and reactive use for outbreak control) and vaccine delivery strategy (community-based routine, community-based campaign and school-based). Almost all public health typhoid vaccination programs used ViPS vaccine and have been in countries of Asia, with one example in the Pacific and one experience using the Ty21a vaccine in South America. All vaccination strategies were found to be acceptable, feasible and effective in the settings evaluated; evidence of impact, where available, was strongest in endemic settings and in the short- to medium-term. Vaccination was cost-effective in high-incidence but not low-incidence settings. Experience in disaster and outbreak settings remains limited. TCVs have recently become available and none are WHO-prequalified yet; no program experience with TCVs was found in published literature. Despite the demonstrated success of several typhoid vaccination strategies, typhoid vaccines remain underused. Implementation lessons should be applied to design optimal vaccination strategies using TCVs which have several anticipated advantages, such as potential for use in infant immunization programs and longer duration of protection, over the ViPS and Ty21a vaccines for typhoid prevention and control.
Collapse
Affiliation(s)
- Kashmira A Date
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329-4027, USA.
| | - Adwoa Bentsi-Enchill
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization (WHO), Geneva, Switzerland
| | - Florian Marks
- International Vaccine Institute, Kwanak PO Box 14, Seoul 151-600, Republic of Korea
| | - Kimberley Fox
- World Health Organization Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines
| |
Collapse
|
15
|
Hoehn RS, Abbott DE. Beyond the bedside: A review of translational medicine in global health. World J Transl Med 2015; 4:1-10. [DOI: 10.5528/wjtm.v4.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 11/14/2014] [Accepted: 01/19/2015] [Indexed: 02/05/2023] Open
Abstract
Translational research is a broad field of medicine with several key phases moving from scientific discovery to bench research and the hospital bedside, followed by evidence-based practice and population-level policy and programming. Understanding these phases is crucial when it comes to preventing and treating illness, especially in global health. Communities around the world struggle with a variety of health problems that are at some times similar and at others quite different. Three major world health issues help to outline the phases of translational research: vaccines, human immunodeficiency virus and acquired immunodeficiency syndrome, and non-communicable diseases. Laboratory research has excelled in many of these areas and is struggling in a few. Where successful therapies have been discovered there are often problems with appropriate use or dissemination to groups in need. Also, many diseases would be better prevented from a population health approach. This review highlights successes and struggles in the arena of global health, from smallpox eradication to the impending epidemic of cardiovascular disease, in an attempt to illustrate of the various phases of translational research.
Collapse
|
16
|
Carias C, Walters MS, Wefula E, Date KA, Swerdlow DL, Vijayaraghavan M, Mintz E. Economic evaluation of typhoid vaccination in a prolonged typhoid outbreak setting: The case of Kasese district in Uganda. Vaccine 2015; 33:2079-85. [DOI: 10.1016/j.vaccine.2015.02.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 01/17/2015] [Accepted: 02/11/2015] [Indexed: 10/24/2022]
|
17
|
Date KA, Bentsi-Enchill AD, Fox KK, Abeysinghe N, Mintz ED, Khan MI, Sahastrabuddhe S, Hyde TB. Typhoid Fever surveillance and vaccine use - South-East Asia and Western Pacific regions, 2009-2013. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2014; 63:855-60. [PMID: 25275329 PMCID: PMC4584874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Typhoid fever is a serious, systemic infection resulting in nearly 22 million cases and 216,500 deaths annually, primarily in Asia. Safe water, adequate sanitation, appropriate personal and food hygiene, and vaccination are the most effective strategies for prevention and control. In 2008, the World Health Organization (WHO) recommended use of available typhoid vaccines to control endemic disease and outbreaks and strengthening of typhoid surveillance to improve disease estimates and identify high-risk populations (e.g., persons without access to potable water and adequate sanitation). This report summarizes the status of typhoid surveillance and vaccination programs in the WHO South-East Asia (SEAR) and Western Pacific regions (WPR) during 2009-2013, after the revised WHO recommendations. Data were obtained from the WHO/United Nations Children's Fund (UNICEF) Joint Reporting Form on Immunization, a supplemental survey of surveillance and immunization program managers, and published literature. During 2009-2013, 23 (48%) of 48 countries and areas of SEAR (11) and WPR (37) collected surveillance or notifiable disease data on typhoid cases, with most surveillance activities established before 2008. Nine (19%) countries reported implementation of typhoid vaccination programs or recommended vaccine use during 2009-2013. Despite the high incidence, typhoid surveillance is weak in these two regions, and vaccination efforts have been limited. Further progress toward typhoid fever prevention and control in SEAR and WPR will require country commitment and international support for enhanced surveillance, targeted use of existing vaccines and availability of newer vaccines integrated within routine immunization programs, and integration of vaccination with safe water, sanitation, and hygiene measures.
Collapse
Affiliation(s)
- Kashmira A. Date
- Global Immunization Division, Center for Global Health, CDC,Corresponding authors: Kashmira A. Date, , 404-639-8913; Adwoa D. Bentsi-Enchill, , +41 22-7911154
| | - Adwoa D. Bentsi-Enchill
- Immunization, Vaccines, and Biologicals, World Health Organization,Corresponding authors: Kashmira A. Date, , 404-639-8913; Adwoa D. Bentsi-Enchill, , +41 22-7911154
| | - Kimberley K. Fox
- Regional Office for the Western Pacific, World Health Organization
| | | | - Eric D. Mintz
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - M. Imran Khan
- Coalition Against Typhoid Secretariat, Sabin Vaccine Institute, Washington, DC
| | | | - Terri B. Hyde
- Global Immunization Division, Center for Global Health, CDC
| |
Collapse
|
18
|
Blum LS, Dentz H, Chingoli F, Chilima B, Warne T, Lee C, Hyde T, Gindler J, Sejvar J, Mintz ED. Formative investigation of acceptability of typhoid vaccine during a typhoid fever outbreak in Neno District, Malawi. Am J Trop Med Hyg 2014; 91:729-37. [PMID: 25002303 PMCID: PMC4183395 DOI: 10.4269/ajtmh.14-0067] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 05/02/2014] [Indexed: 11/07/2022] Open
Abstract
Typhoid fever affects an estimated 22 million people annually and causes 216,000 deaths worldwide. We conducted an investigation in August and September 2010 to examine the acceptability of typhoid vaccine in Neno District, Malawi where a typhoid outbreak was ongoing. We used qualitative methods, including freelisting exercises, key informant and in-depth interviews, and group discussions. Respondents associated illness with exposure to "bad wind," and transmission was believed to be airborne. Typhoid was considered extremely dangerous because of its rapid spread, the debilitating conditions it produced, the number of related fatalities, and the perception that it was highly contagious. Respondents were skeptical about the effectiveness of water, sanitation, and hygiene (WaSH) interventions. The perceived severity of typhoid and fear of exposure, uncertainty about the effectiveness of WaSH measures, and widespread belief in the efficacy of vaccines in preventing disease resulted in an overwhelming interest in receiving typhoid vaccine during an outbreak.
Collapse
Affiliation(s)
- Lauren S Blum
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - Holly Dentz
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - Felix Chingoli
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - Benson Chilima
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - Thomas Warne
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - Carla Lee
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - Terri Hyde
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - Jacqueline Gindler
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - James Sejvar
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| | - Eric D Mintz
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia
| |
Collapse
|
19
|
Imanishi M, Kweza PF, Slayton RB, Urayai T, Ziro O, Mushayi W, Francis-Chizororo M, Kuonza LR, Ayers T, Freeman MM, Govore E, Duri C, Chonzi P, Mtapuri-Zinyowera S, Manangazira P, Kilmarx PH, Mintz E, Lantagne D. Household water treatment uptake during a public health response to a large typhoid fever outbreak in Harare, Zimbabwe. Am J Trop Med Hyg 2014; 90:945-54. [PMID: 24664784 DOI: 10.4269/ajtmh.13-0497] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Locally manufactured sodium hypochlorite (chlorine) solution has been sold in Zimbabwe since 2010. During October 1, 2011-April 30, 2012, 4,181 suspected and 52 confirmed cases of typhoid fever were identified in Harare. In response to this outbreak, chlorine tablets were distributed. To evaluate household water treatment uptake, we conducted a survey and water quality testing in 458 randomly selected households in two suburbs most affected by the outbreak. Although 75% of households were aware of chlorine solution and 85% received chlorine tablets, only 18% had reportedly treated stored water and had the recommended protective level of free chlorine residuals. Water treatment was more common among households that reported water treatment before the outbreak, and those that received free tablets during the outbreak (P < 0.01), but was not associated with chlorine solution awareness or use before the outbreak (P > 0.05). Outbreak response did not build on pre-existing prevention programs.
Collapse
Affiliation(s)
- Maho Imanishi
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Epidemiology & Laboratory Training Program, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Safe Water Systems, Population Services International-Zimbabwe, Harare, Zimbabwe; Water Sanitation and Hygiene, Welthungerhilfe-Zimbabwe, Harare, Zimbabwe; Collaborating Centre for Operational Research and Evaluation, United Nations Children's Fund-Zimbabwe, Harare, Zimbabwe; City of Harare Health Services Department, Harare, Zimbabwe; Laboratory Services, National Microbiology Reference Laboratory, Harare Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe; Centers for Disease Control and Prevention-Zimbabwe, Harare, Zimbabwe; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia; Tufts University, Medford, Massachusetts
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Strugnell RA, Scott TA, Wang N, Yang C, Peres N, Bedoui S, Kupz A. Salmonella vaccines: lessons from the mouse model or bad teaching? Curr Opin Microbiol 2014; 17:99-105. [PMID: 24440968 DOI: 10.1016/j.mib.2013.12.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 12/15/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
Abstract
Salmonella enterica subsp. enterica includes several very important human serovars including Typhi, Paratyphi, Typhimurium and Enteritidis. These bacteria cause a significant global burden of disease, typically classified into enteric fever, gastroenteritis and, more recently, invasive non-typhoidal salmonellosis (iNTS). Vaccines have been developed for one of these serovars, S. Typhi and the recent increase in iNTS cases has resulted in a push to develop new vaccines that will inhibit disease by S. Typhimurium and S. Enteritidis, the most common iNTS S. enterica serovars. The development of new human vaccines has been informed by studies in the murine model of typhoid fever based on S. Typhimurium infections of very 'sensitive' (Nramp-1(S)) mice, which has some obvious deficiencies, not the least that antibodies protect humans against S. Typhi infection but are only weakly protective in 'sensitive' mice infected with S. Typhimurium. S. Typhimurium also lacks Vi, the target of protective antibodies in typhoid fever. Notwithstanding these deficiencies, the murine model has identified a very complex series of innate and adaptive immune responses to infection that might be exploited to develop new vaccines. Equally, advances in understanding the pathogenesis of infection, through pathogenomics and more sophisticated animal models will likely contribute to the development of novel immunogens.
Collapse
Affiliation(s)
- Richard A Strugnell
- Department of Microbiology and Immunology, University of Melbourne, Parkville, VIC 3010, Australia.
| | - Timothy A Scott
- Department of Microbiology and Immunology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Nancy Wang
- Department of Microbiology and Immunology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Chenying Yang
- Department of Microbiology and Immunology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Newton Peres
- Department of Microbiology and Immunology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Sammy Bedoui
- Department of Microbiology and Immunology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Andreas Kupz
- Department of Microbiology and Immunology, University of Melbourne, Parkville, VIC 3010, Australia
| |
Collapse
|
21
|
Arya SC, Agarwal N. Vaccination for typhoid fever in Sub-Saharan Africa. Hum Vaccin Immunother 2013; 9:2316. [DOI: 10.4161/hv.25648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|