Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Lagankhel, Kathmandu, Nepal.
PLoS One. 2010 Nov 15;5(11):e13988. doi: 10.1371/journal.pone.0013988.
Enteric fever, caused by Salmonella enterica serovars Typhi and Paratyphi A (S. Typhi and S. Paratyphi A) remains a major public health problem in many settings. The disease is limited to locations with poor sanitation which facilitates the transmission of the infecting organisms. Efficacious and inexpensive vaccines are available for S. Typhi, yet are not commonly deployed to control the disease. Lack of vaccination is due partly to uncertainty of the disease burden arising from a paucity of epidemiological information in key locations. We have collected and analyzed data from 3,898 cases of blood culture-confirmed enteric fever from Patan Hospital in Lalitpur Sub-Metropolitan City (LSMC), between June 2005 and May 2009. Demographic data was available for a subset of these patients (n = 527) that were resident in LSMC and who were enrolled in trials. We show a considerable burden of enteric fever caused by S. Typhi (2,672; 68.5%) and S. Paratyphi A (1,226; 31.5%) at this Hospital over a four year period, which correlate with seasonal fluctuations in rainfall. We found that local population density was not related to incidence and we identified a focus of infections in the east of LSMC. With data from patients resident in LSMC we found that the median age of those with S. Typhi (16 years) was significantly less than S. Paratyphi A (20 years) and that males aged 15 to 25 were disproportionately infected. Our findings provide a snapshot into the epidemiological patterns of enteric fever in Kathmandu. The uneven distribution of enteric fever patients within the population suggests local variation in risk factors, such as contaminated drinking water. These findings are important for initiating a vaccination scheme and improvements in sanitation. We suggest any such intervention should be implemented throughout the LSMC area.
肠热病由沙门氏菌血清型 Typhi 和 Paratyphi A（S. Typhi 和 S. Paratyphi A）引起，在许多环境中仍然是一个主要的公共卫生问题。这种疾病仅限于卫生条件差的地方，因为这些地方有利于感染源的传播。针对 S. Typhi 有有效且廉价的疫苗，但并未广泛用于控制该疾病。缺乏疫苗接种部分是由于在关键地点缺乏流行病学信息，导致对疾病负担的不确定性。我们从 2005 年 6 月至 2009 年 5 月期间，在 Lalitpur 次都会城市（LSMC）的帕坦医院收集和分析了 3898 例血培养确诊肠热病病例的数据。这些患者中有一部分（n = 527）的人口统计学数据可用于分析，他们居住在 LSMC 并参加了试验。我们发现，在该医院的四年期间，S. Typhi（2672 例；68.5%）和 S. Paratyphi A（1226 例；31.5%）引起的肠热病负担相当大，这与降雨量的季节性波动有关。我们发现当地人口密度与发病率无关，并且我们确定了 LSMC 东部的一个感染中心。根据居住在 LSMC 的患者的数据，我们发现 S. Typhi（16 岁）的中位年龄明显小于 S. Paratyphi A（20 岁），且 15 至 25 岁的男性感染比例过高。我们的研究结果提供了加德满都肠热病流行病学模式的快照。肠热病患者在人群中的分布不均表明，危险因素（如污染饮用水）存在局部差异。这些发现对于启动疫苗接种计划和改善卫生条件非常重要。我们建议在整个 LSMC 地区实施任何此类干预措施。
