No abstract

The incidence of enteric fever, an invasive bacterial infection caused by typhoidal Salmonellae, is largely unknown in regions lacking blood culture surveillance. New serologic markers have proven accurate in diagnosing enteric fever, but whether they could be used to reliably estimate population-level incidence is unknown. We collected longitudinal blood samples from blood culture-confirmed enteric fever cases enrolled from surveillance studies in Bangladesh, Nepal, Pakistan and Ghana and conducted cross-sectional sero-surveys in the catchment areas of each surveillance site. We used ELISAs to measure quantitative IgA and IgG antibody responses to Hemolysin E (HlyE) and S. Typhi lipopolysaccharide (LPS). We used Bayesian hierarchical models to fit two-phase power-function decay models to the longitudinal sero-responses among enteric fever cases and used the joint distributions of the peak antibody titers and decay rate to estimate population-level incidence rates from cross-sectional serosurveys. The longitudinal antibody kinetics for all antigen-isotypes were similar across countries and did not vary by clinical severity. The incidence of typhoidal Salmonella infection ranged between 41.2 per 100 person years (95% CI: 34.0-50.1) in Dhaka, Bangladesh to 5.8 (95% CI: 4.8-7.1) in Kavrepalanchok, Nepal and followed the same rank order as clinical incidence estimates. The approach described here has the potential to expand the geographic scope of typhoidal Salmonella surveillance and generate incidence estimates that are comparable across geographic regions and time.

Background: Typhoid and paratyphoid remain common bloodstream infections in areas with suboptimal water and sanitation infrastructure. Paratyphoid, caused by Salmonella Paratyphi A, is less prevalent than typhoid and its antimicrobial resistance (AMR) trends are less documented. Empirical treatment for paratyphoid is commonly based on the knowledge of susceptibility of Salmonella Typhi, which causes typhoid. Hence, with rising drug resistance in Salmonella Typhi, last-line antibiotics like ceftriaxone and azithromycin are prescribed for both typhoid and paratyphoid. Here, we report 23-year AMR trends of Salmonella Paratyphi A in Bangladesh. Methods: From 1999 to 2021, we conducted enteric fever surveillance in two major pediatric hospitals and three clinics in Dhaka, Bangladesh. Blood cultures were performed at the discretion of the treating physicians; cases were confirmed by culture, serological and biochemical tests. Antimicrobial susceptibility was determined following CLSI guidelines. Results: Over 23 years, we identified 2,725 blood culture-confirmed paratyphoid cases. Over 97% of the isolates were susceptible to ampicillin, chloramphenicol, and cotrimoxazole, and no isolate was resistant to all three. No resistance to ceftriaxone was recorded, and >99% of the isolates were sensitive to azithromycin. A slight increase in minimum inhibitory concentration (MIC) is noticed for ceftriaxone but current average MIC is 32-fold lower than the resistance cut-off. Over 99%, of the isolates exhibited decreased susceptibility to ciprofloxacin. Conclusions: Salmonella Paratyphi A has remained susceptible to most antibiotics, unlike Salmonella Typhi, despite widespread usage of many antibiotics in Bangladesh. The data can guide evidence-based policy decisions for empirical treatment of paratyphoid fever.

Objective: Bankers lead a sedentary and highly stressful life that often leads to developing noncommunicable diseases (NCDs) such as hypertension, diabetes, mental disorders, etc. The study aims to assess the prevalence of undiagnosed hypertension and prehypertension among bankers in Bangladesh. Methods: Data from 365 bankers from five public and private banks in Bangladesh were collected using a pretested semistructured questionnaire. Prehypertension was defined as having systolic blood pressure of 120-139 mmHg and diastolic blood pressure of 80-89 mmHg. Multivariate logistic regression models were created to investigate the factors associated with them. Results: The prevalence of undiagnosed hypertension and prehypertension were 22.5% and 55.3%, respectively. Most of the bankers were males and 35-44 years of age. The risk of hypertension and prehypertension was significantly higher among males (OR, 16.59; OR, 6.42), longer duration of services (F, 3.56), prolonged working hours (OR, 3.8; OR, 3.09), smoking (OR, 6.18; OR, 3.43), overweight (OR, 6.81; OR, 2.41) and obese (OR, 8.94; OR, 3.36) bankers, respectively. After controlling for all confounders, the predictors of hypertension were males (aOR, 12.8; CI, 2.73- 60.02), current smokers (aOR,2.87; CI, 1.03-8), overweight (aOR,5.11; CI, 1.46-17.93), and obesity (aOR, 9.59; CI, 2.41-38.22). For prehypertension, males (aOR, 9.72; CI, 3.06- 30.87) and obesity (aOR, 3.95; CI, 1.52- 10.25) were found as predictors. Conclusion: More than three fourth of bankers in Bangladesh have either undiagnosed hypertension or prehypertension associated with several contributing factors to occur. A large-scale study is recommended to understand the clear picture of the overall NCD risk factors burden among bankers in Bangladesh.