Environmental Transmission of Typhoid Fever in an Urban Slum

Akullian, Adam; Ng’eno, Eric; Matheson, Alastair; Cosmas, Leonard; Macharia, Daniel; Fields, Barry S.; Bigogo, Godfrey; Mugoh, Maina; John‐Stewart, Grace; Walson, Judd L.; Wakefield, Julie; Montgomery, Joel M.

doi:10.1371/journal.pntd.0004212

Cited by 64 publications

(59 citation statements)

References 41 publications

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“…Not washing hand after toilet which is consistent with study done in Ethiopia (Getnet, 2014) and poor hygiene of house and compound which is in line with study done in Malawi (Blum et al, 2014), Malaysia (Ramani et al, 2012), Zimbabwe (Muti et al, 2014;Imanishi et al, 2014), Kenya (Akullian, 2015) remains significant factors associated with Typhoid fever contraction. During the investigation of this study, some constraint includes late starting of the investigation leading the cases to take antibiotic therapy which prevented collecting of biological samples for culture confirmation.…”

Section: Discussionsupporting

confidence: 87%

Typhoid fever outbreak investigation in Ofla Woreda, Southern Zone of Tigray Region, Ethiopia, 2016: An unmatched 1:2 case-control

Mamo¹,

Addisu²,

Marama³

2018

J. Infect. Dis. Immun.

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Typhoid fever (TF) is a systemic infection caused by the bacterium, Salmonella typhi. Globally, 22 million illnesses and 216,000 deaths occurred annually. The woreda WAS have alerted the outbreak on 27 July, 2016. The objective of this study was to investigate typhoid fever outbreak in Dera Kebele of Ofla woreda, Tigray Region, Ethiopia. Here, a suspected TF case was defined as any person with gradual onset of remittent fever in the first week, headache, arthralgia, anorexia, constipation and or abdominal pain. 45 cases were compared to 90 controls via unmatched case-control study (1:2) using pretested structured questionnaire. Cases were selected randomly. Nine blood and water samples from two sites were collected for microbiological analysis. Data were entered into Epi info 3.5.1 and analyzed using SPSS version 16; multivariate logistic regression was utilized to identify independent factors associated with TF contraction. The significance of association was constructed using odds ratio with its 95% confidence intervals. Results revealed that a total of 98 cases with one death were identified within one week (August 1 to 8, 2016). Overall, 23.2 per 1000 population attack rate with 37 per 1000 population of highest age-specific attack rate in the age group 25-44 were reported. Faecal coliforms were isolated from two water samples and all the nine blood samples were reactive for Salmonella Typhi H (Flagella) and O (somatic) antigen. Not washing hand after toilet [AOR 4.7; 95% CI (1.75-12.6)] and unhygienic house and environment [AOR 3.09; 95%CI (1.36-7.06)] were risk factors for contracting disease but not storing food for later use [AOR .28; 95 %( 0.12, 0.67)] was protective factor. Thus, not washing hand after toilet and unhygienic house and environment were risk factors; hence not storing food for later use was a protective factor. Monitoring environmental sanitation, food hygiene and hand washing practices should be promoted to prevent the disease.

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Section: Discussionsupporting

confidence: 87%

Typhoid fever outbreak investigation in Ofla Woreda, Southern Zone of Tigray Region, Ethiopia, 2016: An unmatched 1:2 case-control

Mamo¹,

Addisu²,

Marama³

2018

J. Infect. Dis. Immun.

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“…Samples were collected at points of confluence of the drainage ditches, in two areas with the highest surface flow accumulation; cluster 9 (latitude/ longitude: -1.314199/ 36.78492, altitude 1722.55) and cluster 10 (latitude/ longitude: -1.314704/ 36.78666, altitude 1722.55). There are ten geographic units referred to as clusters in the study area ( Fig 1) [15].…”

Section: Study Setting and Collection Of Surveillance Datamentioning

confidence: 99%

“…Sewage samples were collected each Monday and Wednesday. 500 mL of sewage was collected from each site during the study period (June 16 to August 26, 2014), typically a 'dry season' in Nairobi, resulting in a total of 42 samples [15] (Fig 1). (S1 File, Fig 1).…”

Section: Sample Collections Storage and Shipmentmentioning

confidence: 99%

Pathogen surveillance in the informal settlement, Kibera, Kenya, using a metagenomics approach

et al. 2019

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BackgroundWorldwide, the number of emerging and re-emerging infectious diseases is increasing, highlighting the importance of global disease pathogen surveillance. Traditional population-based methods may fail to capture important events, particularly in settings with limited access to health care, such as urban informal settlements. In such environments, a mixture of surface water runoff and human feces containing pathogenic microorganisms could be used as a surveillance surrogate.MethodWe conducted a temporal metagenomic analysis of urban sewage from Kibera, an urban informal settlement in Nairobi, Kenya, to detect and quantify bacterial and associated antimicrobial resistance (AMR) determinants, viral and parasitic pathogens. Data were examined in conjunction with data from ongoing clinical infectious disease surveillance.ResultsA large variation of read abundances related to bacteria, viruses, and parasites of medical importance, as well as bacterial associated antimicrobial resistance genes over time were detected. Significant increased abundances were observed for a number of bacterial pathogens coinciding with higher abundances of AMR genes. Vibrio cholerae as well as rotavirus A, among other virus peaked in several weeks during the study period whereas Cryptosporidium spp. and Giardia spp, varied more over time.ConclusionThe metagenomic surveillance approach for monitoring circulating pathogens in sewage was able to detect putative pathogen and resistance loads in an urban informal settlement. Thus, valuable if generated in real time to serve as a comprehensive infectious disease agent surveillance system with the potential to guide disease prevention and treatment. The approach may lead to a paradigm shift in conducting real-time global genomics-based surveillance in settings with limited access to health care.

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“…Despite many epidemiological studies reporting the importance of water in the transmission of S. Typhi (Vollaard et al ., ; Hosoglu et al ., ; Sur et al ., ; Wang et al ., ; Corner et al ., ; Dewan et al ., ; Akullian et al ., ), comparatively little is known about the environmental survival strategies employed by this pathogen. In this study, we determined the transcriptional response of S. Typhi BRD948 to moving into water and identified multiple genes that contribute to survival.…”

Section: Discussionmentioning

confidence: 99%

Functional analysis of Salmonella Typhi adaptation to survival in water

Kingsley

Langridge

Smith

et al. 2018

Environmental Microbiology

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SummaryContaminated water is a major risk factor associated with the transmission of Salmonella enterica serovar Typhi (S. Typhi), the aetiological agent of human typhoid. However, little is known about how this pathogen adapts to living in the aqueous environment. We used transcriptome analysis (RNA‐seq) and transposon mutagenesis (TraDIS) to characterize these adaptive changes and identify multiple genes that contribute to survival. Over half of the genes in the S. Typhi genome altered expression level within the first 24 h following transfer from broth culture to water, although relatively few did so in the first 30 min. Genes linked to central metabolism, stress associated with arrested proton motive force and respiratory chain factors changed expression levels. Additionally, motility and chemotaxis genes increased expression, consistent with a scavenging lifestyle. The viaB‐associated gene tviC encoding a glcNAc epimerase that is required for Vi polysaccharide biosynthesis was, along with several other genes, shown to contribute to survival in water. Thus, we define regulatory adaptation operating in S. Typhi that facilitates survival in water.

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Environmental Transmission of Typhoid Fever in an Urban Slum

Cited by 64 publications

References 41 publications

Typhoid fever outbreak investigation in Ofla Woreda, Southern Zone of Tigray Region, Ethiopia, 2016: An unmatched 1:2 case-control

Typhoid fever outbreak investigation in Ofla Woreda, Southern Zone of Tigray Region, Ethiopia, 2016: An unmatched 1:2 case-control

Pathogen surveillance in the informal settlement, Kibera, Kenya, using a metagenomics approach

Functional analysis of Salmonella Typhi adaptation to survival in water

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