International Vaccine Institute, SNU Research Park, Seoul, South Korea.
International Vaccine Institute, SNU Research Park, Seoul, South Korea.
Lancet Glob Health. 2017 Mar;5(3):e310-e323. doi: 10.1016/S2214-109X(17)30022-0.
Available incidence data for invasive salmonella disease in sub-Saharan Africa are scarce. Standardised, multicountry data are required to better understand the nature and burden of disease in Africa. We aimed to measure the adjusted incidence estimates of typhoid fever and invasive non-typhoidal salmonella (iNTS) disease in sub-Saharan Africa, and the antimicrobial susceptibility profiles of the causative agents.
We established a systematic, standardised surveillance of blood culture-based febrile illness in 13 African sentinel sites with previous reports of typhoid fever: Burkina Faso (two sites), Ethiopia, Ghana, Guinea-Bissau, Kenya, Madagascar (two sites), Senegal, South Africa, Sudan, and Tanzania (two sites). We used census data and health-care records to define study catchment areas and populations. Eligible participants were either inpatients or outpatients who resided within the catchment area and presented with tympanic (≥38·0°C) or axillary temperature (≥37·5°C). Inpatients with a reported history of fever for 72 h or longer were excluded. We also implemented a health-care utilisation survey in a sample of households randomly selected from each study area to investigate health-seeking behaviour in cases of self-reported fever lasting less than 3 days. Typhoid fever and iNTS disease incidences were corrected for health-care-seeking behaviour and recruitment.
Between March 1, 2010, and Jan 31, 2014, 135 Salmonella enterica serotype Typhi (S Typhi) and 94 iNTS isolates were cultured from the blood of 13 431 febrile patients. Salmonella spp accounted for 33% or more of all bacterial pathogens at nine sites. The adjusted incidence rate (AIR) of S Typhi per 100 000 person-years of observation ranged from 0 (95% CI 0-0) in Sudan to 383 (274-535) at one site in Burkina Faso; the AIR of iNTS ranged from 0 in Sudan, Ethiopia, Madagascar (Isotry site), and South Africa to 237 (178-316) at the second site in Burkina Faso. The AIR of iNTS and typhoid fever in individuals younger than 15 years old was typically higher than in those aged 15 years or older. Multidrug-resistant S Typhi was isolated in Ghana, Kenya, and Tanzania (both sites combined), and multidrug-resistant iNTS was isolated in Burkina Faso (both sites combined), Ghana, Kenya, and Guinea-Bissau.
Typhoid fever and iNTS disease are major causes of invasive bacterial febrile illness in the sampled locations, most commonly affecting children in both low and high population density settings. The development of iNTS vaccines and the introduction of S Typhi conjugate vaccines should be considered for high-incidence settings, such as those identified in this study.
Bill & Melinda Gates Foundation.
撒哈拉以南非洲侵袭性沙门氏菌病的现有发病数据稀缺。需要标准化的多国数据来更好地了解非洲疾病的性质和负担。我们旨在测量撒哈拉以南非洲的伤寒和侵袭性非伤寒性沙门氏菌（iNTS）疾病的调整发病率估计，并确定病原体的抗生素敏感性特征。
我们在 13 个有伤寒报告的非洲哨点建立了一个系统的、标准化的基于血液培养的发热性疾病监测：布基纳法索（两个地点）、埃塞俄比亚、加纳、几内亚比绍、肯尼亚、马达加斯加（两个地点）、塞内加尔、南非、苏丹和坦桑尼亚（两个地点）。我们使用人口普查数据和医疗记录来定义研究的集水区和人群。符合条件的参与者是居住在集水区内且有鼓膜（≥38.0°C）或腋窝温度（≥37.5°C）的住院或门诊患者。排除有报道的发热病史超过 72 小时的住院患者。我们还在每个研究地区随机选择的样本家庭中实施了一项医疗保健利用调查，以调查报告发热持续少于 3 天的病例的就医行为。对伤寒和 iNTS 疾病的发病率进行了校正，以反映医疗保健寻求行为和招募情况。
2010 年 3 月 1 日至 2014 年 1 月 31 日期间，从 13513 名发热患者的血液中培养出 135 株伤寒血清型 Typhi（S Typhi）和 94 株 iNTS 分离株。在九个地点，沙门氏菌属占所有细菌病原体的 33%或更多。每 100000 人年观察到的 S Typhi 调整发病率（AIR）范围为 0（95%CI 0-0）在苏丹到布基纳法索一个地点的 383（274-535）；iNTS 的 AIR 范围为 0 在苏丹、埃塞俄比亚、马达加斯加（Isotry 地点）和南非到布基纳法索的第二个地点的 237（178-316）。15 岁以下人群的 iNTS 和伤寒的 AIR 通常高于 15 岁或以上人群。在加纳、肯尼亚和坦桑尼亚（两个地点合并）分离出了耐多药 S Typhi，在布基纳法索（两个地点合并）、加纳、肯尼亚和几内亚比绍分离出了耐多药 iNTS。
伤寒和 iNTS 疾病是采样地点侵袭性细菌性发热疾病的主要原因，最常见于低和高人口密度环境中的儿童。应该考虑为高发病率地区（如本研究中确定的地区）开发 iNTS 疫苗和引入伤寒血清型结合疫苗。
比尔和梅琳达盖茨基金会。
