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

Keddy, Karen H.; Smith, Anthony M.; Sooka, Arvinda; Tau, Nomsa P.; Ngomane, Hlengiwe M; Radhakrishnan, Amruta; Als, Daina; Benson, F.G.

doi:10.4269/ajtmh.18-0182

Cited by 16 publications

(14 citation statements)

References 26 publications

(49 reference statements)

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“…The majority of our cases were from low socio-economic classes, The youngest patient in our study was 9 months old. Most of the cases belonged to the age group 2-4 years which is similar to the study by previous studies [10] . Fever was seen in 100% cases which was continuous and high grade associated with chills and rigors in almost 60% of cases.…”

Section: Discussionsupporting

confidence: 90%

“…Water borne outbreaks occur due to poor sanitation and direct faecal oral spread due to poor personal hygiene, unsatisfactory sanitary facilities and unpredictable supply of safe drinking water. The infected person during acute stages of illness excrete 10 6 -10 9 salmonellae per gram of stools which is the main source of contamination of food or water [5][6][7][8][9][10] .…”

Section: Epidemiologymentioning

confidence: 99%

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A study on changing trends in the management of Entric fever

Nasreen¹

2019

Int. J. Paediatrics Geriatrics

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Aim and Objective: To study the changing profile of enteric fever with reference to clinical features and complications and also study the response of enteric fever to various drugs. Methodology: The present study was carried out of 75 cases of enteric fever and admitted to the paediatric department of Dr VRK Womens hospital and Princess Durru Shehvar Hospital from March 2018 to September 2018, Cases diagnosed as enteric fever. In all cases, a detailed Clinical history, complete physical examination, family history, history of Contact with patient of enteric fever, the type of water supply, post immunisation Status of enteric fever were asked. Only those cases with a rising litre by slide agglutination or Positive tube agglutination more than 1:80 or Positive blood culture reports were included in this study to know the clinical profile. Children between the ages of 0-12 years were selected for the study. Results: 75 cases of enteric fever in children up to 12 years of age formed the study group. 67% were boys and 33% were girls. The youngest patient in our study was 9 months old. Fever was seen in all cases. The fever was high grade, continuous in 60% and intermittent in 40% cases. General malaise and weakness were seen in all cases. Tongue coating was noticed in all cases. Splenomegaly was seen in 82.4% cases and hepatomegaly was seen in 58.4% cases. The widal agglutination by slide method showed rising titers in 49 cases. The tube agglutination was positive in 26 cases. Cases which showed positive results with both slide agglutination test and tube agglutination were 10. Blood culture was positive in 5 cases. The initial treatment started was amoxycillin in 27 cases. Amoxycillin was changed to cipro floxacillin in 11 cases and it was changed to ceftriaxone in 6 cases and amoxycillin was changed to chloramphenicol in 2 cases. Conclusion:Finally concluded that, this study on enteric fever shows the changing trends in the clinical features and management. Ceftriaxone and Cipro floxacillin were found to be very effective.

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Section: Discussionsupporting

confidence: 90%

Section: Epidemiologymentioning

confidence: 99%

A study on changing trends in the management of Entric fever

Nasreen¹

2019

Int. J. Paediatrics Geriatrics

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“…Our forest plots do not include a vertical bar to indicate this clinical threshold, but once resistance is 20% and above, this specific antimicrobial regimen is considered ineffective and unsafe and should no longer be used for empirical treatment in this setting. Conversely, the lack of data from South America and South Africa is consistent with a low incidence of enteric fever as consequence of economic progress and improvements in water safety over the last decades [115, 116], therefore not currently fitting the definition of an endemic region [117].…”

Section: Discussionmentioning

confidence: 99%

Drug-resistant enteric fever worldwide, 1990 to 2018: a systematic review and meta-analysis

Browne

Hamadani

Kumaran

et al. 2020

BMC Med

493

401

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BackgroundAntimicrobial resistance (AMR) is an increasing threat to global health. There are > 14 million cases of enteric fever every year and > 135,000 deaths. The disease is primarily controlled by antimicrobial treatment, but this is becoming increasingly difficult due to AMR. Our objectives were to assess the prevalence and geographic distribution of AMR in Salmonella enterica serovars Typhi and Paratyphi A infections globally, to evaluate the extent of the problem, and to facilitate the creation of geospatial maps of AMR prevalence to help targeted public health intervention.MethodsWe performed a systematic review of the literature by searching seven databases for studies published between 1990 and 2018. We recategorised isolates to allow the analysis of fluoroquinolone resistance trends over the study period. The prevalence of multidrug resistance (MDR) and fluoroquinolone non-susceptibility (FQNS) in individual studies was illustrated by forest plots, and a random effects meta-analysis was performed, stratified by Global Burden of Disease (GBD) region and 5-year time period. Heterogeneity was assessed using the I2 statistics. We present a descriptive analysis of ceftriaxone and azithromycin resistance.FindingsWe identified 4557 articles, of which 384, comprising 124,347 isolates (94,616 S. Typhi and 29,731 S. Paratyphi A) met the pre-specified inclusion criteria. The majority (276/384; 72%) of studies were from South Asia; 40 (10%) articles were identified from Sub-Saharan Africa. With the exception of MDR S. Typhi in South Asia, which declined between 1990 and 2018, and MDR S. Paratyphi A, which remained at low levels, resistance trends worsened for all antimicrobials in all regions. We identified several data gaps in Africa and the Middle East. Incomplete reporting of antimicrobial susceptibility testing (AST) and lack of quality assurance were identified.InterpretationDrug-resistant enteric fever is widespread in low- and middle-income countries, and the situation is worsening. It is essential that public health and clinical measures, which include improvements in water quality and sanitation, the deployment of S. Typhi vaccination, and an informed choice of treatment are implemented. However, there is no licenced vaccine for S. Paratyphi A. The standardised reporting of AST data and rollout of external quality control assessment are urgently needed to facilitate evidence-based policy and practice.Trial registrationPROSPERO CRD42018029432.

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“…These countries included Vietnam, 15 Thailand, 14 Chile, 9 and South Africa. 13 In other settings where typhoid fever trends were more uncertain, such as Pakistan, 12 India, 10 Bangladesh, 8 and Nigeria, 11 we obtained time trend information from large reference laboratories with standardized methods and documented denominators and relevant test volumes over time.…”

Section: Methodsmentioning

confidence: 99%

Typhoid Fever: Way Forward

Bhutta

Gaffey

Crump

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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Abstract.The Tackling Typhoid supplement shows that typhoid fever continues to be a problem globally despite socioeconomic gains in certain settings. Morbidity remains high in many endemic countries, notably in sub-Saharan Africa and South Asia. In addition, antimicrobial resistance is a growing issue that poses a challenge for clinical management. The findings from this supplement revealed that outside of high-income countries, there were few reliable population-based estimates of typhoid and paratyphoid fever derived from surveillance systems. This indicates the need for monitoring systems that can also characterize the effectiveness of interventions, particularly in low- and middle-income settings. The country case studies indicated that gains in economic conditions, education, and environmental health may be associated with reductions in typhoid fever burden. Over the study period, the effect is mainly notable in countries with higher baseline levels of economic development, female literacy, and investments in public sanitation. High burden countries must continue to invest in strategies at the local level to address environmental factors such as access to safe drinking water and improved public sanitation that are known to interrupt transmission or diminish the risk of acquiring typhoid. Developing more effective vaccines and incorporating appropriate immunization strategies that target populations with the greatest risk could potentially alleviate disease burden.

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

Cited by 16 publications

References 26 publications

A study on changing trends in the management of Entric fever

A study on changing trends in the management of Entric fever

Drug-resistant enteric fever worldwide, 1990 to 2018: a systematic review and meta-analysis

Typhoid Fever: Way Forward

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