Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
Yale Institute for Global Health, Yale University, New Haven, CT, USA.
Nat Commun. 2023 Oct 16;14(1):6502. doi: 10.1038/s41467-023-42353-9.
Since its emergence in 2016, extensively drug resistant (XDR) Salmonella enterica serovar Typhi (S. Typhi) has become the dominant cause of typhoid fever in Pakistan. The establishment of sustained XDR S. Typhi transmission in other countries represents a major public health threat. We show that the annual volume of air travel from Pakistan strongly discriminates between countries that have and have not imported XDR S. Typhi in the past, and identify a significant association between air travel volume and the rate of between-country movement of the H58 haplotype of S. Typhi from fitted phylogeographic models. Applying these insights, we analyze flight itinerary data cross-referenced with model-based estimates of typhoid fever incidence to identify the countries at highest risk of importation and sustained onward transmission of XDR S. Typhi. Future outbreaks of XDR typhoid are most likely to occur in countries that can support efficient local S. Typhi transmission and have strong travel links to regions with ongoing XDR typhoid outbreaks (currently Pakistan). Public health activities to track and mitigate the spread of XDR S. Typhi should be prioritized in these countries.
自 2016 年出现以来，广泛耐药（XDR）伤寒沙门氏菌血清型 Typhi（S. Typhi）已成为巴基斯坦伤寒的主要病因。在其他国家建立持续的 XDR S. Typhi 传播代表了一个主要的公共卫生威胁。我们表明，来自巴基斯坦的年度航空旅行量强烈区分了过去有和没有进口 XDR S. Typhi 的国家，并且在拟合系统地理学模型中，航空旅行量与 S. Typhi 的 H58 单倍型在国家间的迁移率之间存在显著关联。应用这些见解，我们分析了与基于模型的伤寒发病率估计值交叉引用的航班行程数据，以确定进口和持续传播 XDR S. Typhi 的高风险国家。XDR 伤寒的未来爆发最有可能发生在那些能够支持本地 S. Typhi 传播效率高且与正在发生 XDR 伤寒爆发的地区（目前是巴基斯坦）有密切旅行联系的国家。应优先在这些国家开展跟踪和减轻 XDR S. Typhi 传播的公共卫生活动。
