Background: In 2017, over half the global burden of typhoid fever was projected to have occurred in India. In the absence of contemporary population-based data, it is unclear whether declining trends of hospitalization for typhoid in India reflect increased antibiotic treatment or a true reduction in infection. Methods: We conducted weekly surveillance for acute febrile illness and measured the incidence of blood culture-confirmed typhoid fever in a prospective cohort of children 6 months to 14 years old at three urban and one rural site in India between 2017 and 2020. At an additional urban and five rural sites, we combined blood culture testing of hospitalized patients with fever with health care utilization surveys to estimate incidence in the community. Results: 24,062 children were enrolled across four cohorts, contributing 46,959 child years of observation (CYO). 299 culture-confirmed typhoid cases were recorded, with incidence per 100,000 CYO of between 576 and 1173 in urban sites, and 35 in rural Pune. The estimated incidence of typhoid fever from hospital surveillance ranged between 12 and 1622 per 100,000 CYO in children 6 months to 15 years, and between 108 and 970 per 100,000 person-years among those above 15 years, although there was more uncertainty in these estimates. S . paratyphi was isolated from 33 children, overall incidence of 68 per 100,000 CYO after adjusting for age Conclusions: The incidence of typhoid fever in urban India remains high.
Background: India started Covid-19 vaccination from January 16, 2021 after the approval of two candidate vaccines namely Covishield TM and Covaxin TM .We report antibody responses among healthcare workers following two doses of CovishieldTM vaccination in a tertiary care setting. Methods: This prospective serosurveillance study was done among healthcare workers of JMMC&RI ,vaccinated during January to March 2021. Blood samples were drawn from 170 participants after their 1st dose and from 156 participants after their 2nd dose of COVID vaccine to measure the specific antibodies against the recombinant S1 subunit of the S protein of SARS CoV 2 Results: The median level of anti SARS CoV-2 Ig G antibody 28 days after the first dose vaccination is 3.64 S/C (IQR=5.91) and 11.6 S/C (IQR= 5.97) after 14 days of second dose vaccination. Protective levels of anti SARS CoV-2 Ig G antibodies is developed by 25 participants (14.7%) after 28 days of first dose of vaccination and by 109 participants (69.9%) after 14 days of second dose. 18-44 years age group (p=0.027) and absence of comorbidities (p=0.079) are associated with protective IgG levels. Conclusions: Rise in specific Ig G is observed after vaccination. Higher antibody response is observed with younger age group and absence of comorbidities, though statistically not significant. The influence of BMI is also not significant.
Background Ileal perforation occurs in about 1% of enteric fevers as a complication, with a case fatality risk (CFR) of 20%–30% in the early 1990s that decreased to 15.4% in 2011 in South East Asia. We report nontraumatic ileal perforations and its associated CFR from a 2-year prospective enteric fever surveillance across India. Methods The Surveillance for Enteric Fever in India (SEFI) project established a multitiered surveillance system for enteric fever between December 2017 and March 2020. Nontraumatic ileal perforations were surveilled at 8 tertiary care and 6 secondary care hospitals and classified according to etiology. Results Of the 158 nontraumatic ileal perforation cases identified,126 were consented and enrolled. Enteric fever (34.7%), tuberculosis (19.0%), malignancy (5.8%), and perforation of Meckel diverticulum (4.9%) were the common etiology. In those with enteric fever ileal perforation, the CFR was 7.1%. Conclusions Enteric fever remains the most common cause of nontraumatic ileal perforation in India, followed by tuberculosis. Better modalities of establishing etiology are required to classify the illness, and frame management guidelines and preventive measures. CFR data are critical for comprehensive disease burden estimation and policymaking.
Background Lack of robust data on economic burden due to enteric fever in India has made decision making on typhoid vaccination a challenge. Surveillance for Enteric Fever network was established to address gaps in typhoid disease and economic burden. Methods Patients hospitalized with blood culture-confirmed enteric fever and nontraumatic ileal perforation were identified at 14 hospitals. These sites represent urban referral hospitals (tier 3) and smaller hospitals in urban slums, remote rural, and tribal settings (tier 2). Cost of illness and productivity loss data from onset to 28 days after discharge from hospital were collected using a structured questionnaire. The direct and indirect costs of an illness episode were analyzed by type of setting. Results In total, 274 patients from tier 2 surveillance, 891 patients from tier 3 surveillance, and 110 ileal perforation patients provided the cost of illness data. The mean direct cost of severe enteric fever was US$119.1 (95% confidence interval [CI], US$85.8–152.4) in tier 2 and US$405.7 (95% CI, 366.9–444.4) in tier 3; 16.9% of patients in tier 3 experienced catastrophic expenditure. Conclusions The cost of treating enteric fever is considerable and likely to increase with emerging antimicrobial resistance. Equitable preventive strategies are urgently needed.
Background The case-fatality ratio (CFR) for enteric fever is essential for estimating disease burden and calibrating measures that balance the likely health gains from interventions against social and economic costs. Methods We aimed to estimate the CFR for enteric fever using multiple data sources within the National Surveillance System for Enteric Fever in India. This surveillance (2017–2020) was established as a multitiered surveillance system including community cohorts (tier 1), facility-based (tier 2), and tertiary care surveillance (tier 3) for estimating the burden of enteric fever in India. The CFR was calculated after accounting for healthcare-seeking behavior for enteric fever and deaths occurring outside the hospital. Results A total of 1236 hospitalized patients with blood culture–confirmed enteric fever were enrolled, of which 9 fatal cases were identified, for an estimated hospitalized CFR of 0.73% (95% confidence interval [CI], .33%–1.38%). After adjusting for severity, healthcare-seeking behavior, and deaths occurring out-of-hospital, the CFR was estimated to be 0.16% (95% CI, .07%–.29%) for all enteric fevers. Conclusions Our estimates of the CFR are relatively lower than previously estimated, accounting for care-seeking behavior and deaths outside the hospital.
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