Child Health Research Foundation, Dhaka, Bangladesh.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Clin Infect Dis. 2020 Dec 1;71(Suppl 3):S196-S204. doi: 10.1093/cid/ciaa1356.
Enteric fever causes substantial morbidity and mortality in low- and middle-income countries. Here, we analyzed Surveillance for Enteric Fever in Asia Project (SEAP) data to estimate the burden of enteric fever hospitalization among children aged <15 years and identify risk factors for hospitalization in Bangladesh.
SEAP used hospital surveillance paired with a community-based health-care utilization assessment. In SEAP hospital surveillance, blood was obtained for culture from children aged <15 years with ≥3 days of fever. In the hospital catchment area, a health-care utilization survey (HCUS) was conducted to estimate the proportion of febrile children hospitalized at the study hospitals. We analyzed hospital surveillance and HCUS data to estimate the health care-adjusted incidence of enteric fever hospitalization, and conducted univariable and multivariable logistic regressions.
From July 2017 through June 2019, 2243 laboratory-confirmed enteric fever cases were detected in 2 study hospitals; 673 (30%) were hospitalized. The health care-adjusted incidence of enteric fever hospitalization among children <15 years old was 303/100 000 children/year (95% confidence interval [CI], 293-313). Salmonella Typhi contributed most to the enteric fever hospitalization incidence (277/100 000 children/year; 95% CI, 267-287). The incidence was highest among children aged 2 to <5 years (552/100 000 children/year; 95% CI, 522-583), followed by those aged <2 years (316/100 000 children/year; 95% CI, 288-344). Factors independently associated with enteric fever hospitalization included fever duration, diarrhea, vomiting, abdominal pain, and leukocytopenia.
We estimated a high burden of hospitalization due to enteric fever among children aged <5 years in Bangladesh. The introduction of a typhoid conjugate vaccine would protect children from typhoid and avert typhoid hospitalizations.
肠热病在中低收入国家会导致大量发病和死亡。在这里，我们分析了亚洲肠热病监测项目（SEAP）的数据，以估计 15 岁以下儿童患肠热病住院的负担，并确定孟加拉国住院的危险因素。
SEAP 采用医院监测与基于社区的医疗保健利用评估相结合的方法。在 SEAP 医院监测中，从发热≥3 天的 15 岁以下儿童中采集血液进行培养。在医院监测区，进行医疗保健利用调查（HCUS），以估计在研究医院住院的发热儿童比例。我们分析了医院监测和 HCUS 数据，以估计肠热病住院的医疗调整发病率，并进行了单变量和多变量逻辑回归。
从 2017 年 7 月至 2019 年 6 月，在 2 家研究医院共发现 2243 例实验室确诊的肠热病病例；673 例（30%）住院。15 岁以下儿童的肠热病住院的医疗调整发病率为 303/100000 儿童/年（95%置信区间[CI]，293-313）。伤寒沙门氏菌对肠热病住院发病率的贡献最大（277/100000 儿童/年；95%CI，267-287）。发病率在 2 至<5 岁的儿童中最高（552/100000 儿童/年；95%CI，522-583），其次是<2 岁的儿童（316/100000 儿童/年；95%CI，288-344）。与肠热病住院相关的独立因素包括发热持续时间、腹泻、呕吐、腹痛和白细胞减少。
我们估计孟加拉国<5 岁儿童因肠热病住院的负担很高。引入伤寒结合疫苗将保护儿童免受伤寒感染并避免伤寒住院。
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