肯尼亚出现多起与急性感染和无症状携带相关的多重耐药伤寒菌感染。

Multiple introductions of multidrug-resistant typhoid associated with acute infection and asymptomatic carriage, Kenya.

机构信息

Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.

Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, United Kingdom.

出版信息

Elife. 2021 Sep 13;10:e67852. doi: 10.7554/eLife.67852.

BACKGROUND

Understanding the dynamics of infection and carriage of typhoid in endemic settings is critical to finding solutions to prevention and control.

METHODS

In a 3-year case-control study, we investigated typhoid among children aged <16 years (4670 febrile cases and 8549 age matched controls) living in an informal settlement, Nairobi, Kenya.

RESULTS

148 . Typhi isolates from cases and 95 from controls (stool culture) were identified; a carriage frequency of 1 %. Whole-genome sequencing showed 97% of cases and 88% of controls were genotype 4.3.1 (Haplotype 58), with the majority of each (76% and 88%) being multidrug-resistant strains in three sublineages of the H58 genotype (East Africa 1 (EA1), EA2, and EA3), with sequences from cases and carriers intermingled.

CONCLUSIONS

The high rate of multidrug-resistant H58 . Typhi, and the close phylogenetic relationships between cases and controls, provides evidence for the role of carriers as a reservoir for the community spread of typhoid in this setting.

FUNDING

National Institutes of Health (R01AI099525); Wellcome Trust (106158/Z/14/Z); European Commission (TyphiNET No 845681); National Institute for Health Research (NIHR); Bill and Melinda Gates Foundation (OPP1175797).

背景

了解在流行地区伤寒感染和携带的动态对于寻找预防和控制解决方案至关重要。

方法

在一项为期 3 年的病例对照研究中，我们调查了内罗毕肯尼亚一个非正规住区中<16 岁的儿童（4670 例发热病例和 8549 例年龄匹配对照）中的伤寒。

结果

从病例和 95 例对照（粪便培养）中鉴定出 148 株伤寒杆菌分离株；携带率为 1%。全基因组测序显示，97%的病例和 88%的对照均为基因型 4.3.1（Haplotype 58），其中每种基因型（76%和 88%）的大多数均为 H58 基因型的三个亚系（东非 1（EA1）、EA2 和 EA3）中的多药耐药菌株，病例和携带者的序列相互混合。