Incidence of typhoid fever in Burkina Faso, Democratic Republic of the Congo, Ethiopia, Ghana, Madagascar, and Nigeria (the Severe Typhoid in Africa programme): a population-based study
Florian Marks, Justin Im, Se Eun Park, Gi Deok Pak, Hyon Jin Jeon, Lady Rosny Wandji Nana, Marie-France Phoba, Lisette Mbuyi-Kalonji, Ondari D Mogeni, Biruk Yeshitela, Ursula Panzner, Ligia María Cruz Espinoza, Tigist Beyene, Michael Owusu-Ansah, Sampson Twumasi-Ankrah, Melese Yeshambaw, Ashenafi Alemu, Oluwafemi J Adewusi, Olukemi Adekanmbi, Ellen Higginson, Akinlolu Adepoju, Sarah Agbi, Enoch G Cakpo, Veronica O Ogunleye, Gaëlle Nkoji Tunda, Odion O Ikhimiukor, Jules Mbuyamba, Trevor Toy, Francis Opoku Agyapong, Isaac Osei, John Amuasi, Tsiriniaina Jean Luco Razafindrabe, Tiana Mirana Raminosoa, Gabriel Nyirenda, Njariharinjakampionona Randriamampionona, Hyeong Won Seo, Hyejin Seo, Mohamadou Siribie, Megan E Carey, Michael Owusu, Christian G Meyer, Ndrainaharimira Rakotozandrindrainy, Nimarko Sarpong, Mathilde Razafindrakalia, Ravomialisoa Razafimanantsoa, Moussa Ouedraogo, Yeonseon J Kim, Jooah Lee, Raphaël M Zellweger, Sophie S Y Kang, Ju Yeon Park, John A Crump, Liselotte Hardy, Jan Jacobs, Denise O Garrett, Jason R Andrews, Nimesh Poudyal, Deok Ryun Kim, John D Clemens, Stephen G Baker, Jerome H Kim, Gordon Dougan, Jonathan D Sugimoto, Sandra Van Puyvelde, Aderemi Kehinde, Oluwafemi A Popoola, Vittal Mogasale, Robert F Breiman, William R MacWright, Abraham Aseffa, Birkneh Tilahun Tadesse, Andrea Haselbeck, Yaw Adu-Sarkodie, Mekonnen Teferi, Abdramane Soura Bassiahi, Iruka N Okeke, Octavie Lunguya-Metila, Ellis Owusu-Dabo, Raphaël Rakotozandrindrainy
SummaryBackgroundTyphoid Fever remains a major cause of morbidity and mortality in low-income settings. The Severe Typhoid in Africa programme was designed to address regional gaps in typhoid burden data and identify populations eligible for interventions using novel typhoid conjugate vaccines.MethodsA hybrid design, hospital-based prospective surveillance with population-based health-care utilisation surveys, was implemented in six countries in sub-Saharan Africa. Patients presenting with fever (≥37·5°C axillary or ≥38·0°C tympanic) or reporting fever for three consecutive days within the previous 7 days were invited to participate. Typhoid fever was ascertained by culture of blood collected upon enrolment. Disease incidence at the population level was estimated using a Bayesian mixture model.Findings27 866 (33·8%) of 82 491 participants who met inclusion criteria were recruited. Blood cultures were performed for 27 544 (98·8%) of enrolled participants. Clinically significant organisms were detected in 2136 (7·7%) of these cultures, and 346 (16·2%) Salmonella enterica serovar Typhi were isolated. The overall adjusted incidence per 100 000 person-years of observation was highest in Kavuaya and Nkandu 1, Democratic Republic of the Congo (315, 95% credible interval 254–390). Overall, 46 (16·4%) of 280 tested isolates showed ciprofloxacin non-susceptibility.InterpretationHigh disease incidence (ie, >100 per 100 000 person-years of observation) recorded in four countries, the prevalence of typhoid hospitalisations and complicated disease, and the threat of resistant typhoid strains strengthen the need for rapid dispatch and implementation of effective typhoid conjugate vaccines along with measures designed to improve clean water, sanitation, and hygiene practices.FundingThe Bill & Melinda Gates Foundation.