A Large Outbreak of Typhoid Fever Associated With a High Rate of Intestinal Perforation in Kasese District, Uganda, 2008-2009

Neil, Karen P.; Sodha, Samir V.; Lukwago, Luswa; O-Tipo, Shikanga; Mikoleit, Matthew; Simington, Sherricka D.; Mukobi, Peter; Balinandi, Stephen; Majalija, Samuel; Ayers, Joseph D.; Kagirita, Atek; Wefula, Edward; Asiimwe, Frank; Kweyamba, Vianney; Talkington, Deborah F.; Shieh, Wun‐Ju; Adem, Patricia; Batten, Brigid; Zaki, Sherif R.; Mintz, Eric D.

doi:10.1093/cid/cis025

Cited by 88 publications

(91 citation statements)

References 25 publications

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“…Based on an IP rate of 1-8% and given IP incidence previously published for this outbreak [5], the estimated incidence of typhoid varied between 296 and 2368 cases per 100,000 individuals across all age groups. The estimated incidence rate was highest among those between 15 and 19 years old, followed by those between 10 and 14 years old.…”

Section: Epidemiological Parametersmentioning

confidence: 99%

“…To estimate incidence of typhoid in Kasese and in the absence of routine, laboratory-enhanced surveillance for typhoid fever, we used published data on incidence of intestinal perforation (IP) per 5 year age-group in Kasese District [5]. Intestinal perforation is a serious complication of typhoid fever that is known to occur in 1-8% of cases [5].…”

Section: Epidemiological Parametersmentioning

confidence: 99%

“…Intestinal perforation is a serious complication of typhoid fever that is known to occur in 1-8% of cases [5]. We thus considered the IP rate for typhoid fever patients to be 1-8% across all age-groups, and calculated the total number of typhoid cases per 5 year age-groups taking into account Kasese's projected population for 2012 [5,19] [Unpublished Data: District Planner Kasese -Kasese Populations, 2008].…”

Section: Epidemiological Parametersmentioning

confidence: 99%

“…Until recently, most infections were thought to occur in Asia [2]; however, new reports suggest that parts of sub-Saharan Africa are also highly affected [1]. High rates of endemic typhoid were documented in an urban population in Kenya during 2007-2009 [3]; since 2008, severe typhoid fever outbreaks have been reported in rural areas in Malawi [4], Uganda [5], and in urban areas in Zimbabwe and Zambia [6,7].…”

Section: Introductionmentioning

confidence: 99%

“…Cost-effectiveness studies in endemic settings in Asia support the value of typhoid vaccination as a prevention and control measure, but they are not necessarily applicable in epidemic settings in Africa, where typhoid affects a wider age range and programmatic costs may differ widely given differences in health systems [4,5,14,15]. A large outbreak of typhoid fever began in Kasese District (see Appendix I), Uganda in 2008 and continued through 2011, with cases still being reported as recently as October 2012 [16] [C.D.C.…”

Section: Introductionmentioning

confidence: 99%

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Economic evaluation of typhoid vaccination in a prolonged typhoid outbreak setting: The case of Kasese district in Uganda

Carias

Wefula²,

Date

et al. 2015

Vaccine

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a b s t r a c tBackground: Vaccination has been increasingly promoted to help control epidemic and endemic typhoid fever in high-incidence areas. Despite growing recognition that typhoid incidence in some areas of subSaharan Africa is similar to high-incidence areas of Asia, no large-scale typhoid vaccination campaigns have been conducted there. We performed an economic evaluation of a hypothetical one-time, fixed-post typhoid vaccination campaign in Kasese, a rural district in Uganda where a large, multi-year outbreak of typhoid fever has been reported. Methods: We used medical cost and epidemiological data retrieved on-site and campaign costs from previous fixed-post vaccination campaigns in Kasese to account for costs from a public sector health care delivery perspective. We calculated program costs and averted disability-adjusted life years (DALYs) and medical costs as a result of vaccination, to calculate the cost of the intervention per DALY and case averted. Results: Over the 3 years of projected vaccine efficacy, a one-time vaccination campaign was estimated to avert 1768 (90%CI: 684-4431) typhoid fever cases per year and a total of 3868 (90%CI: 1353-9807) DALYs over the duration of the immunity conferred by the vaccine. The cost of the intervention per DALY averted was US$ 484 (90%CI: 18-1292) and per case averted US$ 341 (90%CI: 13-883). Conclusion: We estimated the vaccination campaign in this setting to be highly cost-effective, according to WHO's cost-effective guidelines. Results may be applicable to other African settings with similar high disease incidence estimates.

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Section: Epidemiological Parametersmentioning

confidence: 99%

Section: Epidemiological Parametersmentioning

confidence: 99%

Section: Epidemiological Parametersmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Economic evaluation of typhoid vaccination in a prolonged typhoid outbreak setting: The case of Kasese district in Uganda

Carias

Wefula²,

Date

et al. 2015

Vaccine

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Rapid diagnostic tests for typhoid and paratyphoid (enteric) fever

Wijedoru

Mallett

Parry

2017

Cochrane Database of Systematic Reviews

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Background Differentiating both typhoid ( Salmonella Typhi) and paratyphoid ( Salmonella Paratyphi A) infection from other causes of fever in endemic areas is a diagnostic challenge. Although commercial point‐of‐care rapid diagnostic tests (RDTs) for enteric fever are available as alternatives to the current reference standard test of blood or bone marrow culture, or to the widely used Widal Test, their diagnostic accuracy is unclear. If accurate, they could potentially replace blood culture as the World Health Organization (WHO)‐recommended main diagnostic test for enteric fever. Objectives To assess the diagnostic accuracy of commercially available rapid diagnostic tests (RDTs) and prototypes for detecting Salmonella Typhi or Paratyphi A infection in symptomatic persons living in endemic areas. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register, MEDLINE, Embase, Science Citation Index, IndMED, African Index Medicus, LILACS, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) up to 4 March 2016. We manually searched WHO reports, and papers from international conferences on Salmonella infections. We also contacted test manufacturers to identify studies. Selection criteria We included diagnostic accuracy studies of enteric fever RDTs in patients with fever or with symptoms suggestive of enteric fever living in endemic areas. We classified the reference standard used as either Grade 1 (result from a blood culture and a bone marrow culture) or Grade 2 (result from blood culture and blood polymerase chain reaction, or from blood culture alone). Data collection and analysis Two review authors independently extracted the test result data. We used a modified QUADAS‐2 extraction form to assess methodological quality. We performed a meta‐analysis when there were sufficient studies for the test and heterogeneity was reasonable. Main results Thirty‐seven studies met the inclusion criteria and included a total of 5080 participants (range 50 to 1732). Enteric fever prevalence rates in the study populations ranged from 1% to 75% (median prevalence 24%, interquartile range (IQR) 11% to 46%). The included studies evaluated 16 different RDTs, and 16 studies compared two or more different RDTs. Only three studies used the Grade 1 reference standard, and only 11 studies recruited unselected febrile patients. Most included studies were from Asia, with five studies from sub‐Saharan Africa. All of the RDTs were designed to detect S. Typhi infection only. Most studies evaluated three RDTs and their variants: TUBEX in 14 studies; Typhidot (Typhidot, Typhidot‐M, and TyphiRapid‐Tr02) in 22 studies; and the Test‐It Typ...

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Controlling Food Safety Hazards in Root and Tuber Processing: An HACCP Approach

Obadina

Adekoya

2016

Tropical Roots and Tubers

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A Large Outbreak of Typhoid Fever Associated With a High Rate of Intestinal Perforation in Kasese District, Uganda, 2008-2009

Cited by 88 publications

References 25 publications

Economic evaluation of typhoid vaccination in a prolonged typhoid outbreak setting: The case of Kasese district in Uganda

Economic evaluation of typhoid vaccination in a prolonged typhoid outbreak setting: The case of Kasese district in Uganda

Rapid diagnostic tests for typhoid and paratyphoid (enteric) fever

Controlling Food Safety Hazards in Root and Tuber Processing: An HACCP Approach

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