Saha Senjuti, Islam Maksuda, Uddin Mohammad J, Saha Shampa, Das Rajib C, Baqui Abdullah H, Santosham Mathuram, Black Robert E, Luby Stephen P, Saha Samir K
Child Health Research Foundation, Department of Microbiology, Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
PLoS Negl Trop Dis. 2017 Oct 26;11(10):e0005999. doi: 10.1371/journal.pntd.0005999. eCollection 2017 Oct.
Lack of surveillance systems and accurate data impede evidence-based decisions on treatment and prevention of enteric fever, caused by Salmonella Typhi/Paratyphi. The WHO coordinates a global Invasive Bacterial-Vaccine Preventable Diseases (IB-VPD) surveillance network but does not monitor enteric fever. We evaluated the feasibility and sustainability of integrating enteric fever surveillance into the ongoing IB-VPD platform.
The IB-VPD surveillance system uses WHO definitions to enroll 2-59 month children hospitalized with possible pneumonia, sepsis or meningitis. We expanded this surveillance system to additionally capture suspect enteric fever cases during 2012-2016, in two WHO sentinel hospitals of Bangladesh, by adding inclusion criteria of fever ≥102°F for ≥3 days, irrespective of other manifestations. Culture-positive enteric fever cases from in-patient departments (IPD) detected in the hospital laboratories but missed by the expanded surveillance, were also enrolled to assess completion. Costs for this integration were calculated for the additional personnel and resources required.
In the IB-VPD surveillance, 5,185 cases were enrolled; 3% (N = 171/5185) were positive for microbiological growth, of which 55% (94/171) were culture-confirmed cases of enteric fever (85 Typhi and 9 Paratyphi A). The added inclusion criteria for enteric fever enrolled an additional 1,699 cases; 22% (358/1699) were positive, of which 85% (349/358) were enteric fever cases (305 Typhi and 44 Paratyphi A). Laboratory surveillance of in-patients of all ages enrolled 311 additional enteric fever cases (263 Typhi and 48 Paratyphi A); 9% (28/311) were 2-59 m and 91% (283/311) >59 m. Altogether, 754 (94+349+311) culture-confirmed enteric fever cases were found, of which 471 were 2-59 m. Of these 471 cases, 94% (443/471) were identified through the hospital surveillances and 6% (28/471) through laboratory results. Twenty-three percent (170/754) of all cases were children <2 years. Additional cost for the integration was USD 44,974/year, a 27% increase to the IB-VPD annual expenditure.
In a setting where enteric disease is a substantial public health problem, we could integrate enteric fever surveillance into the standard IB-VPD surveillance platform at a modest cost.
缺乏监测系统和准确数据阻碍了针对伤寒沙门氏菌/副伤寒沙门氏菌引起的肠热病治疗和预防的循证决策。世界卫生组织协调了一个全球侵袭性细菌疫苗可预防疾病（IB-VPD）监测网络，但未对肠热病进行监测。我们评估了将肠热病监测纳入现行IB-VPD平台的可行性和可持续性。
IB-VPD监测系统采用世界卫生组织的定义，纳入因可能患有肺炎、败血症或脑膜炎而住院的2至59个月儿童。在2012年至2016年期间，我们在孟加拉国的两家世界卫生组织哨点医院扩大了该监测系统，通过增加发热≥102°F持续≥3天的纳入标准，无论有无其他症状，额外捕捉疑似肠热病病例。医院实验室检测到但扩大监测遗漏的住院部（IPD）培养阳性的肠热病病例也被纳入，以评估完整性。计算了整合所需的额外人员和资源成本。
在IB-VPD监测中，共纳入5185例病例；3%（N = 171/5185）微生物培养呈阳性，其中55%（94/171）为肠热病培养确诊病例（85例伤寒和9例甲型副伤寒）。新增的肠热病纳入标准又纳入了1699例病例；22%（358/1699）呈阳性，其中85%（349/358）为肠热病病例（305例伤寒和44例甲型副伤寒）。对所有年龄段住院患者的实验室监测又纳入了311例肠热病病例（263例伤寒和48例甲型副伤寒）；9%（28/311）为2至59个月大，91%（283/311）大于59个月大。总共发现754例（94 + 349 + 311）培养确诊的肠热病病例，其中471例为2至59个月大。在这471例病例中，94%（443/471）通过医院监测识别，6%（28/471）通过实验室结果识别。所有病例的23%（170/754）为2岁以下儿童。整合的额外成本为每年44974美元，比IB-VPD年度支出增加27%。
在肠道疾病是重大公共卫生问题的环境中，我们能够以适度成本将肠热病监测纳入标准的IB-VPD监测平台。
