International collaboration tracks typhoid fever cases over two continents from South Africa to Australia

Smith, Anthony M.; Keddy, Karen H.; Ismail, Husna; Thomas, Juno; Grÿp, Rina van der; Manamela, Morubula J.; Huma, M.; Sooka, Arvinda; Theobald, Lisa; Mennen, Maria A.; O'Reilly, Lyn C.

doi:10.1099/jmm.0.030700-0

Cited by 15 publications

(14 citation statements)

References 4 publications

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“…Pulsed-field gel electrophoresis analysis has confirmed importation of typhoid cases from neighboring countries and overseas countries, as well as assisted in local outbreak investigations ( Supplemental Figure 2 ). 31 , 32 Representative PFGE patterns from major South African clusters have been submitted to the Global PulseNet Salmonella Typhi Database hosted by PulseNet USA. For Salmonella Paratyphi, PFGE patterns for all isolates to date ( N = 42) have been captured.…”

Section: Resultsmentioning

confidence: 99%

“… 42 , 43 Continual antimicrobial resistance monitoring has become an essential adjunct to assessing how best to control typhoid fever. 44 Molecular analyses, including PFGE and more recently WGS have confirmed that South Africa remains highly vulnerable to the introduction of multidrug-resistant typhoid fever and potential outbreaks that may result from this, 31 , 32 particularly as ongoing outbreaks of fluoroquinolone-resistant typhoid fever are reported from neighboring countries. 45 …”

Section: Discussionmentioning

confidence: 98%

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The Burden of Typhoid Fever in South Africa: The Potential Impact of Selected Interventions

Keddy

Smith

Sooka³

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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Abstract.Typhoid fever is notifiable in South Africa but clinical notification is notoriously poor. South Africa has an estimated annual incidence rate of 0.1 cases per 100,000 population of culture-confirmed typhoid fever, decreased from 17 cases per 100,000 population in the 1980s. This work was undertaken to identify the reasons for this decrease and identify potential weaknesses that may result in an increase of observed cases. Culture-confirmed cases, with additional demographic and clinical data have been collected from selected sentinel sites since 2003. Data on contextual factors (gross domestic product [GDP], sanitation, female education, and childhood diarrhea mortality) were collected. National incidence rates of culture-confirmed typhoid fever have remained constant for the past 13 years, with the exception of an outbreak in 2005: incidence was 0.4 per 100,000 population. Paratyphoid fever remains a rare disease. Antimicrobial susceptibility data suggest resistance to ciprofloxacin and azithromycin is emerging. The South African population increased from 27.5 million in 1980 to 55.0 million in 2015: urbanization increased from 50% to 65%, GDP increased from United States Dollar (USD) $2,910 to USD $6,167, access to sanitation improved from 64.4% to 70.0% in the urban population and 26.4% to 60.5% in rural areas. Female literacy levels improved from 74.8% to 92.6% over the period. Improved socioeconomic circumstances in South Africa have been temporally associated with decreasing incidence rates of typhoid fever over a 35-year period. Ongoing challenges remain including potential for large outbreaks, a large immigrant population, and emerging antimicrobial resistance. Continued active surveillance is mandatory.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

The Burden of Typhoid Fever in South Africa: The Potential Impact of Selected Interventions

Keddy

Smith

Sooka³

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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“…Typhoid fever remains an important public health challenge in South Africa [18–20]. Incidence rates of culture-confirmed typhoid fever were between 0.11 and 0.39 per 100,000 population; peaking in 2005 and 2006, due to typhoid outbreaks of over 600 clinically diagnosed cases, of which approximately 160 were culture-confirmed and captured in our surveillance [19].…”

Section: Discussionmentioning

confidence: 99%

Typhoid Fever in South Africa in an Endemic HIV Setting

Keddy

Sooka²,

Smith

et al. 2016

PLoS ONE

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BackgroundTyphoid fever remains an important disease in Africa, associated with outbreaks and the emerging multidrug resistant Salmonella enterica serotype Typhi (Salmonella Typhi) haplotype, H58. This study describes the incidence of, and factors associated with mortality due to, typhoid fever in South Africa, where HIV prevalence is high.Methods and FindingsNationwide active laboratory-based surveillance for culture-confirmed typhoid fever was undertaken from 2003–2013. At selected institutions, additional clinical data from patients were collected including age, sex, HIV status, disease severity and outcome. HIV prevalence among typhoid fever patients was compared to national HIV seroprevalence estimates. The national reference laboratory tested Salmonella Typhi isolates for antimicrobial susceptibility and haplotype. Unadjusted and adjusted logistic regression analyses were conducted determining factors associated with typhoid fever mortality. We identified 855 typhoid fever cases: annual incidence ranged from 0.11 to 0.39 per 100,000 population. Additional clinical data were available for 369 (46.8%) cases presenting to the selected sites. Among typhoid fever patients with known HIV status, 19.3% (29/150) were HIV-infected. In adult females, HIV prevalence in typhoid fever patients was 43.2% (19/44) versus 15.7% national HIV seroprevalence (P < .001); in adult males, 16.3% (7/43) versus 12.3% national HIV seroprevalence (P = .2). H58 represented 11.9% (22/185) of Salmonella Typhi isolates tested. Increased mortality was associated with HIV infection (AOR 10.7; 95% CI 2.3–50.3) and disease severity (AOR 9.8; 95% CI 1.6–60.0) on multivariate analysis.ConclusionsTyphoid fever incidence in South Africa was largely unchanged from 2003–2013. Typhoid fever mortality was associated disease severity. HIV infection may be a contributing factor. Interventions mandate improved health care access, including to HIV management programmes as well as patient education. Further studies are necessary to clarify relationships between HIV infection and typhoid fever in adults.

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“…Across sub-Saharan Africa in the last decade, outbreaks in Zambia, 14 Zimbabwe, 15,16 Uganda, 17,18 Malawi and Mozambique, 4 South Africa, 19,20 the Democratic Republic of Congo, 21 and the Ivory Coast, 22 have resulted in more than 8,000 suspected cases of typhoid fever, a considerable increase in both the number of outbreaks and cases of typhoid fever from the previous decade. The outbreaks in Zambia, Zimbabwe and DRC occurred primarily in low income neighborhoods of the capital city, although other areas of the country were also affected.…”

Section: Increasing Typhoid Fever Recognition In Africamentioning

confidence: 99%

Vaccination for typhoid fever in Sub-Saharan Africa

Slayton

Date

Mintz

2013

Human Vaccines & Immunotherapeutics

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Emerging data on the epidemiologic, clinical and microbiologic aspects of typhoid fever in sub-Saharan Africa call for new strategies and new resources to bring the regional epidemic under control. Areas with endemic disease at rates approaching those in south Asia have been identified; large, prolonged and severe outbreaks are occurring more frequently; and resistance to antimicrobial agents, including fluoroquinolones is increasing. Surveillance for typhoid fever is hampered by the lack of laboratory resources for rapid diagnosis, culture confirmation and antimicrobial susceptibility testing. Nonetheless, in 2010, typhoid fever was estimated to cause 725 incident cases and 7 deaths per 100,000 person years in sub-Saharan Africa. Efforts for prevention and outbreak control are challenged by limited access to safe drinking water and sanitation and by a lack of resources to initiate typhoid immunization. A comprehensive approach to typhoid fever prevention including laboratory and epidemiologic capacity building, investments in water, sanitation and hygiene and reconsideration of the role of currently available vaccines could significantly reduce the disease burden. Targeted vaccination using currently available typhoid vaccines should be considered as a short-to intermediate-term risk reduction strategy for high-risk groups across sub-Saharan Africa.

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International collaboration tracks typhoid fever cases over two continents from South Africa to Australia

Cited by 15 publications

References 4 publications

The Burden of Typhoid Fever in South Africa: The Potential Impact of Selected Interventions

The Burden of Typhoid Fever in South Africa: The Potential Impact of Selected Interventions

Typhoid Fever in South Africa in an Endemic HIV Setting

Vaccination for typhoid fever in Sub-Saharan Africa

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