在非洲和亚洲的三个城市地点的肠热病负担：一项多中心基于人群的研究。
Burden of enteric fever at three urban sites in Africa and Asia: a multicentre population-based study.
机构信息
Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal; Patan Academy of Health Sciences, Patan Hospital, Lalitpur, Nepal.
出版信息
Lancet Glob Health. 2021 Dec;9(12):e1688-e1696. doi: 10.1016/S2214-109X(21)00370-3.
BACKGROUND
Enteric fever is a serious public health concern in many low-income and middle-income countries. Numerous data gaps exist concerning the epidemiology of Salmonella enterica serotype Typhi (S Typhi) and Salmonella enterica serotype Paratyphi (S Paratyphi), which are the causative agents of enteric fever. We aimed to determine the burden of enteric fever in three urban sites in Africa and Asia.
METHODS
In this multicentre population-based study, we did a demographic census at three urban sites in Africa (Blantyre, Malawi) and Asia (Kathmandu, Nepal and Dhaka, Bangladesh) between June 1, 2016, and Sept 25, 2018. Households were selected randomly from the demographic census. Participants from within the geographical census area presenting to study health-care facilities were approached for recruitment if they had a history of fever for 72 h or more (later changed to >48 h) or temperature of 38·0°C or higher. Facility-based passive surveillance was done between Nov 11, 2016, and Dec 31, 2018, with blood-culture collection for febrile illness. We also did a community-based serological survey to obtain data on Vi-antibody defined infections. We calculated crude incidence for blood-culture-confirmed S Typhi and S Paratyphi infection, and calculated adjusted incidence and seroincidence of S Typhi blood-culture-confirmed infection.
FINDINGS
423 618 individuals were included in the demographic census, contributing 626 219 person-years of observation for febrile illness surveillance. 624 S Typhi and 108 S Paratyphi A isolates were collected from the blood of 12 082 febrile patients. Multidrug resistance was observed in 44% S Typhi isolates and fluoroquinolone resistance in 61% of S Typhi isolates. In Blantyre, the overall crude incidence of blood-culture confirmed S Typhi was 58 cases per 100 000 person-years of observation (95% CI 48-70); the adjusted incidence was 444 cases per 100 000 person-years of observation (95% credible interval [CrI] 347-717). The corresponding rates were 74 (95% CI 62-87) and 1062 (95% CrI 683-1839) in Kathmandu, and 161 (95% CI 145-179) and 1135 (95% CrI 898-1480) in Dhaka. S Paratyphi was not found in Blantyre; overall crude incidence of blood-culture-confirmed S Paratyphi A infection was 6 cases per 100 000 person-years of observation (95% CI 3-11) in Kathmandu and 42 (95% CI 34-52) in Dhaka. Seroconversion rates for S Typhi infection per 100 000 person-years estimated from anti-Vi seroconversion episodes in serological surveillance were 2505 episodes (95% CI 1605-3727) in Blantyre, 7631 (95% CI 5913-9691) in Kathmandu, and 3256 (95% CI 2432-4270) in Dhaka.
INTERPRETATION
High disease incidence and rates of antimicrobial resistance were observed across three different transmission settings and thus necessitate multiple intervention strategies to achieve global control of these pathogens.
FUNDING
Wellcome Trust and the Bill & Melinda Gates Foundation.
背景
肠热病是许多低收入和中等收入国家严重的公共卫生问题。造成肠热病的沙门氏菌 Typhi 血清型（S Typhi）和沙门氏菌 Paratyphi 血清型（S Paratyphi）的流行病学存在大量数据空白。我们旨在确定非洲和亚洲三个城市地区肠热病的负担。
方法
在这项多中心基于人群的研究中，我们在非洲的三个城市地点（马拉维布兰太尔）和亚洲的两个城市地点（尼泊尔加德满都和孟加拉国达卡）进行了人口普查，时间为 2016 年 6 月 1 日至 2018 年 9 月 25 日。从人口普查中随机选择家庭。在地理普查区域内到研究保健设施就诊且有发热 72 小时或以上（后来更改为>48 小时）或体温 38.0°C 或更高的参与者，如果有发热 72 小时或以上（后来更改为>48 小时）或体温 38.0°C 或更高的历史，可被招募参加研究。2016 年 11 月 11 日至 2018 年 12 月 31 日进行了基于设施的被动监测，对发热性疾病采集血培养。我们还进行了社区血清学调查，以获得 Vi 抗体定义的感染数据。我们计算了血培养确诊 S Typhi 和 S Paratyphi 感染的粗发病率，并计算了 S Typhi 血培养确诊感染的调整发病率和血清发病率。
结果
共有 423618 人参与了人口普查，为发热性疾病监测提供了 626219 人年的观察期。从 12082 名发热患者的血液中采集到 624 株 S Typhi 和 108 株 S Paratyphi A 分离株。44%的 S Typhi 分离株存在多药耐药性，61%的 S Typhi 分离株存在氟喹诺酮耐药性。在布兰太尔，血培养确诊 S Typhi 的总粗发病率为每 10 万人年 58 例（95%CI 48-70）；调整后的发病率为每 10 万人年 444 例（95%可信区间[CrI] 347-717）。在加德满都，相应的发病率分别为 74 例（95%CI 62-87）和 1062 例（95%CrI 683-1839），在达卡，相应的发病率分别为 161 例（95%CI 145-179）和 1135 例（95%CrI 898-1480）。在布兰太尔未发现 S Paratyphi；血培养确诊 S Paratyphi A 感染的总粗发病率为每 10 万人年 6 例（95%CI 3-11）在加德满都和 42 例（95%CI 34-52）在达卡。血清学监测中抗-Vi 血清转换事件估计的 S Typhi 感染血清转化率为布兰太尔 2505 例（95%CI 1605-3727），加德满都 7631 例（95%CI 5913-9691），达卡 3256 例（95%CI 2432-4270）。
解释
在三个不同的传播环境中观察到高发病率和抗生素耐药率，因此需要多种干预策略来实现对这些病原体的全球控制。
资金
韦尔科姆信托基金会和比尔及梅琳达·盖茨基金会。
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