Incidence of invasive salmonella disease in sub-Saharan Africa: a multicentre population-based surveillance study.

Marks, Florian and von Kalckreuth, Vera and Aaby, Peter and Adu-Sarkodie, Yaw and El Tayeb, Muna Ahmed and Ali, Mohammad and Aseffa, Abraham and Baker, Stephen and Biggs, Holly M and Bjerregaard-Andersen, Morten and Breiman, Robert F and Campbell, James I and Cosmas, Leonard and Crump, John A and Espinoza, Ligia Maria Cruz and Deerin, Jessica Fung and Dekker, Denise Myriam and Fields, Barry S and Gasmelseed, Nagla and Hertz, Julian T and Van Minh Hoang, Nguyen and Im, Justin and Jaeger, Anna and Jeon, Hyon Jin and Kabore, Leon Parfait and Keddy, Karen H and Konings, Frank and Krumkamp, Ralf and Ley, Benedikt and Løfberg, Sandra Valborg and May, Jürgen and Meyer, Christian G and Mintz, Eric D and Montgomery, Joel M and Niang, Aissatou Ahmet and Nichols, Chelsea and Olack, Beatrice and Pak, Gi Deok and Panzner, Ursula and Park, Jin Kyung and Park, Se Eun and Rabezanahary, Henintsoa and Rakotozandrindrainy, Raphaël and Raminosoa, Tiana Mirana and Razafindrabe, Tsiriniaina Jean Luco and Sampo, Emmanuel and Schütt-Gerowitt, Heidi and Sow, Amy Gassama and Sarpong, Nimako and Seo, Hye Jin and Sooka, Arvinda and Soura, Abdramane Bassiahi and Tall, Adama and Teferi, Mekonnen and Thriemer, Kamala and Warren, Michelle R and Yeshitela, Biruk and Clemens, John D and Wierzba, Thomas F (2017) Incidence of invasive salmonella disease in sub-Saharan Africa: a multicentre population-based surveillance study. The Lancet. Global health, 5 (3). e310-e323. ISSN 2214-109X


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BACKGROUND Available incidence data for invasive salmonella disease in sub-Saharan Africa are scarce. Standardised, multicountry data are required to better understand the nature and burden of disease in Africa. We aimed to measure the adjusted incidence estimates of typhoid fever and invasive non-typhoidal salmonella (iNTS) disease in sub-Saharan Africa, and the antimicrobial susceptibility profiles of the causative agents. METHODS We established a systematic, standardised surveillance of blood culture-based febrile illness in 13 African sentinel sites with previous reports of typhoid fever: Burkina Faso (two sites), Ethiopia, Ghana, Guinea-Bissau, Kenya, Madagascar (two sites), Senegal, South Africa, Sudan, and Tanzania (two sites). We used census data and health-care records to define study catchment areas and populations. Eligible participants were either inpatients or outpatients who resided within the catchment area and presented with tympanic (≥38·0°C) or axillary temperature (≥37·5°C). Inpatients with a reported history of fever for 72 h or longer were excluded. We also implemented a health-care utilisation survey in a sample of households randomly selected from each study area to investigate health-seeking behaviour in cases of self-reported fever lasting less than 3 days. Typhoid fever and iNTS disease incidences were corrected for health-care-seeking behaviour and recruitment. FINDINGS Between March 1, 2010, and Jan 31, 2014, 135 Salmonella enterica serotype Typhi (S Typhi) and 94 iNTS isolates were cultured from the blood of 13 431 febrile patients. Salmonella spp accounted for 33% or more of all bacterial pathogens at nine sites. The adjusted incidence rate (AIR) of S Typhi per 100 000 person-years of observation ranged from 0 (95% CI 0-0) in Sudan to 383 (274-535) at one site in Burkina Faso; the AIR of iNTS ranged from 0 in Sudan, Ethiopia, Madagascar (Isotry site), and South Africa to 237 (178-316) at the second site in Burkina Faso. The AIR of iNTS and typhoid fever in individuals younger than 15 years old was typically higher than in those aged 15 years or older. Multidrug-resistant S Typhi was isolated in Ghana, Kenya, and Tanzania (both sites combined), and multidrug-resistant iNTS was isolated in Burkina Faso (both sites combined), Ghana, Kenya, and Guinea-Bissau. INTERPRETATION Typhoid fever and iNTS disease are major causes of invasive bacterial febrile illness in the sampled locations, most commonly affecting children in both low and high population density settings. The development of iNTS vaccines and the introduction of S Typhi conjugate vaccines should be considered for high-incidence settings, such as those identified in this study. FUNDING Bill & Melinda Gates Foundation.

Item Type: Article
Subjects: R Medicine > RA Public aspects of medicine
R Medicine > RC Internal medicine
Depositing User: Moneeb Hassan
Date Deposited: 10 Jan 2018 05:01
Last Modified: 10 Jan 2018 05:01

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