Epidemiology of typhoid and paratyphoid: implications for vaccine policy

Saha, S. et al. (2019) Epidemiology of typhoid and paratyphoid: implications for vaccine policy. Clinical Infectious Diseases, 68(Suppl2), S117-S123. (doi: 10.1093/cid/ciy1124) (PMID:30845325) (PMCID:PMC6405278)

Abstract

Background: Typhoid and paratyphoid remain the most common bloodstream infections in many resource-poor settings. The World Health Organization recommends typhoid conjugate vaccines for country-specific introduction, but questions regarding typhoid and paratyphoid epidemiology persist, especially regarding their severity in young children. Methods: We conducted enteric fever surveillance in Bangladesh from 2004 through 2016 in the inpatient departments of 2 pediatric hospitals and the outpatient departments of 1 pediatric hospital and 1 private consultation clinic. Blood cultures were conducted at the discretion of the treating physicians; cases of culture-confirmed typhoid/paratyphoid were included. Hospitalizations and durations of hospitalizations were used as proxies for severity in children <12 years old. Results: We identified 7072 typhoid and 1810 paratyphoid culture-confirmed cases. There was no increasing trend in the proportion of paratyphoid over the 13 years. The median age in the typhoid cases was 60 months, and 15% of the cases occurred in children <24 months old. The median age of the paratyphoid cases was significantly higher, at 90 months (P < .001); 9.4% were in children <24 months old. The proportion of children (<12 years old) hospitalized with typhoid and paratyphoid (32% and 21%, respectively) decreased with age; there was no significant difference in durations of hospitalizations between age groups. However, children with typhoid were hospitalized for longer than those with paratyphoid. Conclusions: Typhoid and paratyphoid fever are common in Dhaka, including among children under 2 years old, who have equivalent disease severity as older children. Early immunization with typhoid conjugate vaccines could avert substantial morbidity, but broader efforts are required to reduce the paratyphoid burden.

• Item Type: Articles
• Additional Information: The work presented here was supported by the Gavi, the Vaccine Alliance, through the World health Organizationsupported Invasive Bacterial Vaccine Preventable Diseases study (grant numbers 201588766, 201233523, 201022732, 200749550) and through the Pneumococcal Vaccines Accelerated Development and Introduction Plan (PneumoADIP) and by the Child Health Research Foundation.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Sajib, Mohammad Saiful Islam
• Authors: Saha, S., Islam, M. S., Sajib, M. S. I., Saha, S., Uddin, M. J., Hooda, Y., Hasan, M., Amin, M. R., Hanif, M., Shahidullah, M., Islam, M., Luby, S. P., Andrews, J. R., and Saha, S. K.
• College/School: College of Medical Veterinary and Life Sciences
• Journal Name: Clinical Infectious Diseases
• Publisher: Oxford University Press
• ISSN: 1058-4838
• ISSN (Online): 1537-6591
• Copyright Holders: Copyright © 2019 The Authors
• First Published: First published in Clinical Infectious Diseases 68(Suppl 2):S117-S123
• Publisher Policy: Reproduced under a Creative Commons License