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Article ; Online: Co-carriage of Staphylococcus aureus and Streptococcus pneumoniae among children younger than 2 years of age in a rural population in Pakistan

Shahira Shahid / Muhammad Imran Nisar / Fyezah Jehan / Sheraz Ahmed / Furqan Kabir / Aneeta Hotwani / Sahrish Muneer / Muhammad Farrukh Qazi / Sajid Muhammad / Asad Ali / Anita K.M. Zaidi / Najeeha T. Iqbal

Clinical Epidemiology and Global Health, Vol 21, Iss , Pp 101293- (2023)

2023

Abstract: Objectives: Staphylococcus aureus and Streptococcus pneumoniae are common colonizers of the human nasopharynx. In this study, we describe S. aureus nasopharyngeal carriage and evaluate its association with S. pneumoniae carriage post-10-valent ... ...

Abstract	Objectives: Staphylococcus aureus and Streptococcus pneumoniae are common colonizers of the human nasopharynx. In this study, we describe S. aureus nasopharyngeal carriage and evaluate its association with S. pneumoniae carriage post-10-valent pneumococcal conjugate vaccine (PCV10) introduction in Pakistan. Methods: A serial cross-sectional study was undertaken from 2014 to 2018, children <2 years were randomly selected, and nasopharyngeal swabs were collected using standard WHO guidelines. S. aureus and S. pneumoniae isolates were identified using standard methods and tested for antimicrobial susceptibility by the standard Kirby-Bauer disk-diffusion method as per Clinical & Laboratory Standards Institute (CLSI) recommendations. Regression analysis was used to determine predictors associated with S. aureus carriage. Results: We enrolled 3140 children. S. aureus carriage prevalence was 5.6% (176/3140), and 50.1% (81/176) of the isolates were methicillin-resistant S. aureus (MRSA). S. aureus carriage was higher in the absence of pneumococcus compared to isolates in which pneumococcus was present (7.5% vs 5.0%). S. aureus carriage was negatively associated with pneumococcal carriage, being in 3rd and 4th year of enrollment, and vaccination with two and three PCV10 doses, in addition, fast breathing, ≥2 outpatients visits, and rainy season were positively associated. The following resistance rates were observed: 98.9% for penicillin, 74.4% for fusidic acid, and 23.3% for gentamicin, 10.2% for erythromycin, and 8.5% for cotrimoxazole. All isolates were susceptible to amikacin. Conclusions: Overall S. aureus carriage prevalence was low, PCV10 vaccine was protective against the carriage. The proportion of MRSA carriage and antimicrobial resistance was high in this community warranting continuous monitoring for invasive infections.
Keywords	Nasopharyngeal carriage ; Pakistan ; Streptococcus pneumoniae ; Staphylococcus aureus ; MRSA ; Children ; Public aspects of medicine ; RA1-1270
Subject code	630
Language	English
Publishing date	2023-05-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Pneumococcal Carriage in Infants Post-PCV10 Introduction in Pakistan

Shahira Shahid / Amala Khan / Muhammad Imran Nisar / Farah Khalid / Muhammad Farrukh Qazi / Sheraz Ahmed / Furqan Kabir / Aneeta Hotwani / Sahrish Muneer / Syed Asad Ali / Cynthia G. Whitney / Anita K. M. Zaidi / Fyezah Jehan

Vaccines, Vol 10, Iss 971, p

Results from Serial Cross-Sectional Surveys

2022 Volume 971

Abstract: The 10-valent pneumococcal vaccine was introduced in Pakistan’s Expanded Program on Immunization (EPI) in 2013 as a 3 + 0 schedule without catchup. We conducted three annual cross-sectional surveys from 2014–2016 to measure vaccine-type (VT) carriage in ... ...

Abstract	The 10-valent pneumococcal vaccine was introduced in Pakistan’s Expanded Program on Immunization (EPI) in 2013 as a 3 + 0 schedule without catchup. We conducted three annual cross-sectional surveys from 2014–2016 to measure vaccine-type (VT) carriage in infants from a rural part of Pakistan. Nasopharyngeal specimens were collected by random sampling of infants from two union councils of Matiari. Samples were then transported to the Infectious Disease Research Laboratory (IDRL) at the Aga Khan University within 6–8 h of collection. Serotypes were established using sequential multiplex PCR. Of the 665 children enrolled across three surveys, 547 were culture-positive for pneumococcus. VT carriage decreased from 21.8% in 2014 to 12.7% in 2016 ( p -value for trend <0.001). Those who were not vaccinated or partially vaccinated were found to be at higher risk of carrying a VT serotype ((aOR 2.53, 95% CI 1.39, 4.63 for non-vaccinated) and (aOR 3.35, 95% CI 1.82, 6.16 for partially vaccinated)). On the other hand, being enrolled in the most recent survey was negatively associated with VT carriage (aOR 0.51, 95% CI 0.28, 0.93). We found that PCV10 was effective in decreasing the carriage of vaccine-type serotypes in Pakistani infants.
Keywords	streptococcus pneumoniae ; 10-valent pneumococcal conjugate vaccine ; Pakistan ; Medicine ; R
Language	English
Publishing date	2022-06-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
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Article ; Online: Methods for estimating the direct and indirect effect of 10 valent pneumococcal vaccine on nasopharyngeal carriage in children under 2 years in Matiari, Pakistan

Muhammad Imran Nisar / Fyezah Jehan / Shahira Shahid / Sadia Shakoor / Furqan Kabir / Aneeta Hotwani / Sahrish Muneer / Sheraz Ahmed / Cynthia Whitney / Asad Ali / Anita KM Zaidi / Saad B Omer / Najeeha Iqbal

MethodsX, Vol 8, Iss , Pp 101357- (2021)

2021

Abstract: Pneumonia is the leading cause of morbidity and mortality in children worldwide. The ten valent pneumococcal vaccine (PCV10) was introduced in Pakistan's Expanded Program on Immunization (EPI) in 2012 as a 3 + 0 schedule without catchup immunization. ... ...

Abstract	Pneumonia is the leading cause of morbidity and mortality in children worldwide. The ten valent pneumococcal vaccine (PCV10) was introduced in Pakistan's Expanded Program on Immunization (EPI) in 2012 as a 3 + 0 schedule without catchup immunization. Nasopharyngeal carriage is taken as a surrogate marker to measure the impact of pneumococcal vaccine on populations. Carriage surveys are necessary to monitor the persistence of Vaccine Type (VT) serotypes, the emergence of Non-Vaccine Type (NVT) serotypes, and their role in both transmission and disease. This article describes various troubleshooting measures which we undertook to adopt the protocol to our setting. We also used an innovative approach to describe various epidemiological parameters of vaccine effectiveness against carriage. It is important to publish these methods to allow for valid regional and temporal comparisons of results in different settings. Thus, in this article, we describe the following methods for isolating upper airway pneumococcal carriage: • Methods for the collection, transport, and storage of nasopharyngeal samples. • Methods for identification and serotyping of pneumococci. • Methods for estimation of the direct and indirect effects of pneumococcal vaccines on nasopharyngeal carriage.
Keywords	Streptococcus pneumoniae ; Pneumococcal vaccines ; Herd immunity ; Nasopharyngeal carriage ; Surveillance ; Pakistan ; Science ; Q
Subject code	310
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Impact of 10-valent Pneumococcal Conjugate Vaccine (PCV10) on nasopharyngeal carriage in children 2 years of age

Muhammad Imran Nisar / Shahira Shahid / Sajid Muhammad / Farah Khalid / Amjad Hussain / Sheraz Ahmed / Sadia Shakoor / Furqan Kabir / Aneeta Hotwani / Asad Ali / Anita KM Zaidi / Saad B Omer / Fyezah Jehan / Najeeha Iqbal

Data in Brief, Vol 35, Iss , Pp 106828- (2021)

Data from a four-year time series cross-sectional study from Pakistan

2021

Abstract: The dataset described in this paper was collected for a time-series cross-sectional study exploring the impact of 10-valent Pneumococcal Conjugate Vaccine (PCV10) on nasopharyngeal (NP) carriage in children under 2 years of age from a rural population in ...

Abstract	The dataset described in this paper was collected for a time-series cross-sectional study exploring the impact of 10-valent Pneumococcal Conjugate Vaccine (PCV10) on nasopharyngeal (NP) carriage in children under 2 years of age from a rural population in Sindh, Pakistan. The study was carried out in two union councils of Matiari - Khyber and Shah Alam Shah Jee Wasi (Latitude 25.680298 / Longitude 68.502711). Data was collected on socio-demographics, clinical characteristics and vaccination status using android phone-based application. NP samples were collected using standard World Health Organisation (WHO) techniques, culture and serotyping was done using sequential Multiplex PCR described by Centre for Disease Control, USA. We looked at the carriage rate of vaccine type (VT) and non-vaccine type (NVT) serotypes over time in vaccinated and unvaccinated children. We additionally looked at the predictors for pneumococcal carriage. The uploaded dataset, available on Mendeley data repository (Nisar, Muhammad Imran (2021), “Impact of PCV10 on nasopharyngeal carriage in children in Pakistan”, Mendeley Data, V1, doi:10.17632/t79h6g97gr.1), has 3140 observations in CSV format. Additional files uploaded include a data dictionary and the set of questionnaires. The dataset and accompanying files can be used by other interested researchers to replicate our analysis, carry similar analysis under varying set of assumptions or perform additional exploratory or metanalysis
Keywords	Streptococcus pneumoniae ; Pneumococcal Vaccines ; Herd Immunity ; Nasopharyngeal carriage ; Surveillance ; Pakistan ; Computer applications to medicine. Medical informatics ; R858-859.7 ; Science (General) ; Q1-390
Subject code	360
Language	English
Publishing date	2021-04-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Serotype-specific effectiveness against pneumococcal carriage and serotype replacement after ten-valent Pneumococcal Conjugate Vaccine (PCV10) introduction in Pakistan.

Muhammad Imran Nisar / Fyezah Jehan / Shahira Shahid / Sheraz Ahmed / Sadia Shakoor / Furqan Kabir / Aneeta Hotwani / Sahrish Muneer / Farah Khalid / Sajid Muhammad / Benjamin M Althouse / Hao Hu / Cynthia G Whitney / Asad Ali / Anita K M Zaidi / Saad B Omer / Najeeha Iqbal

PLoS ONE, Vol 17, Iss 1, p e

2022 Volume 0262466

Abstract: Objective Pakistan was one of the first South-Asian countries to introduce the ten-valent pneumococcal conjugate vaccine (PCV10) at the national level, using a 3+0 schedule without catchup, in 2013. Methods From 2014-18, fifteen children <2 years old ... ...

Abstract	Objective Pakistan was one of the first South-Asian countries to introduce the ten-valent pneumococcal conjugate vaccine (PCV10) at the national level, using a 3+0 schedule without catchup, in 2013. Methods From 2014-18, fifteen children <2 years old were recruited every week in Matiari, Sindh, and nasopharyngeal swabs were collected. The samples were cultured, and pneumococcus was further serotyped through multiplex PCR at the Aga Khan University Hospital as per the method described by the Centers for Disease Control and Prevention, USA. Results Pneumococcus was detected in 2370/3140 (75%) children. Vaccine type (VT) and non-vaccine type (NVT) serotypes were carried by 379 and 1990 children. There was a significant decline in VT carriage (by 40.3%, p-value <0.001), whereas overall NVT carriage remained the same. The prevalence of VT serotypes 6B, 9V/9A, and 19F showed a significant decline by 58.8%, 79.3%, and 56%, respectively. The prevalence of NVT serotypes 19A, 21, and 10A increased by 70%, 33.3%, and 65.6%, respectively, whereas serotypes 13 and 9N/9L decreased by 53.4% and 51.8%, respectively. Serotype-specific vaccine effectiveness estimates that reached statistical significance were for 9V/9A (VE = 65.0, 95% CI 26.0-83.5%), 19F (VE = 55.3, 95% CI 15.5-76.4%) and for the vaccine related serotype 6A (VE = 28.4, 95% CI 0.9-48.2%). Conclusion The emergence of NVT serotypes, primarily 19A replacing VT serotypes in this rural community, necessitates continuous monitoring of serotypes in the carriage and invasive disease to evaluate the utility of existing vaccine formulations.
Keywords	Medicine ; R ; Science ; Q
Subject code	630
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Gut integrity and duodenal enteropathogen burden in undernourished children with environmental enteric dysfunction.

Zehra Jamil / Najeeha Talat Iqbal / Romana Idress / Zubair Ahmed / Kamran Sadiq / Indika Mallawaarachchi / Junaid Iqbal / Sana Syed / Aneeta Hotwani / Furqan Kabir / Kumail Ahmed / Sheraz Ahmed / Fayaz Umrani / Jennie Z Ma / Fatima Aziz / Adil Kalam / Sean R Moore / Syed Asad Ali

PLoS Neglected Tropical Diseases, Vol 15, Iss 7, p e

2021 Volume 0009584

Abstract: Environmental enteric dysfunction (EED) is a subclinical condition of intestinal inflammation, barrier dysfunction and malabsorption associated with growth faltering in children living in poverty. This study explores association of altered duodenal ... ...

Abstract	Environmental enteric dysfunction (EED) is a subclinical condition of intestinal inflammation, barrier dysfunction and malabsorption associated with growth faltering in children living in poverty. This study explores association of altered duodenal permeability (lactulose, rhamnose and their ratio) with higher burden of enteropathogen in the duodenal aspirate, altered histopathological findings and higher morbidity (diarrhea) that is collectively associated with linear growth faltering in children living in EED endemic setting. In a longitudinal birth cohort, 51 controls (WHZ > 0, HAZ > -1.0) and 63 cases (WHZ< -2.0, refractory to nutritional intervention) were recruited. Anthropometry and morbidity were recorded on monthly bases up to 24 months of age. Dual sugar assay of urine collected after oral administration of lactulose and rhamnose was assessed in 96 children from both the groups. Duodenal histopathology (n = 63) and enteropathogen analysis of aspirate via Taqman array card (n = 60) was assessed in only cases. Giardia was the most frequent pathogen and was associated with raised L:R ratio (p = 0.068). Gastric microscopy was more sensitive than duodenal aspirate in H. pylori detection. Microscopically confirmed H. pylori negatively correlated with HAZ at 24 months (r = -0.313, p = 0.013). Regarding histopathological parameters, goblet cell reduction significantly correlated with decline in dual sugar excretion (p< 0.05). Between cases and controls, there were no significant differences in the median (25th, 75th percentile) of urinary concentrations (μg/ml) of lactulose [27.0 (11.50, 59.50) for cases vs. 38.0 (12.0, 61.0) for controls], rhamnose [66.0 (28.0, 178.0) vs. 86.5 (29.5, 190.5)] and L:R ratio [0.47 (0.24, 0.90) vs. 0.51 (0.31, 0.71)] respectively. In multivariable regression model, 31% of variability in HAZ at 24 months of age among cases and controls was explained by final model including dual sugars. In conclusion, enteropathogen burden is associated with altered histopathological ...
Keywords	Arctic medicine. Tropical medicine ; RC955-962 ; Public aspects of medicine ; RA1-1270
Subject code	610
Language	English
Publishing date	2021-07-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Investigation of Japanese encephalitis virus as a cause of acute encephalitis in southern Pakistan, April 2015-January 2018.

Tazeen Fatima / Abida Rais / Erum Khan / Susan L Hills / Trudy V Chambers / Aneeta Hotwani / Shahida Qureshi / Saad Shafquat / Saima Malik / Farah Qamar / Fatima Mir / Anthony A Marfin / Anita Zaidi / Asif Raza Khowaja / Sadia Shakoor

PLoS ONE, Vol 15, Iss 6, p e

2020 Volume 0234584

Abstract: Background Japanese encephalitis (JE) occurs in fewer than 1% of JE virus (JEV) infections, often with catastrophic sequelae including death and neuropsychiatric disability. JEV transmission in Pakistan was documented in 1980s and 1990s, but recent ... ...

Abstract	Background Japanese encephalitis (JE) occurs in fewer than 1% of JE virus (JEV) infections, often with catastrophic sequelae including death and neuropsychiatric disability. JEV transmission in Pakistan was documented in 1980s and 1990s, but recent evidence is lacking. Our objective was to investigate JEV as a cause of acute encephalitis in Pakistan. Methods Persons aged ≥1 month with possible JE admitted to two acute care hospitals in Karachi, Pakistan from April 2015 to January 2018 were enrolled. Cerebrospinal fluid (CSF) or serum samples were tested for JEV immunoglobulin M (IgM) using the InBios JE DetectTM assay. Positive or equivocal samples had confirmatory testing using plaque reduction neutralization tests. Results Among 227 patients, testing was performed on CSF in 174 (77%) and on serum in 53 (23%) patients. Six of eight patient samples positive or equivocal for JEV IgM had sufficient volume for confirmatory testing. One patient had evidence of recent West Nile virus (WNV) neurologic infection based on CSF testing. One patient each had recent dengue virus (DENV) infection and WNV infection based on serum results. Recent flavivirus infections were identified in two persons, one each based on CSF and serum results. Specific flaviviruses could not be identified due to serologic cross-reactivity. For the sixth person, JEV neutralizing antibodies were confirmed in CSF but there was insufficient volume for further testing. Conclusions Hospital-based JE surveillance in Karachi, Pakistan could not confirm or exclude local JEV transmission. Nonetheless, Pakistan remains at risk for JE due to presence of the mosquito vector, amplifying hosts, and rice irrigation. Laboratory surveillance for JE should continue among persons with acute encephalitis. However, in view of serological cross-reactivity, confirmatory testing of JE IgM positive samples at a reference laboratory is essential.
Keywords	Medicine ; R ; Science ; Q
Subject code	616
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Investigation of an extensive outbreak of HIV infection among children in Sindh, Pakistan

Victoria Simms / Rashida Ferrand / Baseer Achakzai / Amna R Siddiqui / Apsara Ali Nathwani / Syed H Abidi / Syed Faisal Mahmood / Sobiya Sawani / Abdul M Kazi / Aneeta Hotwani / Sikander Ali Memon / Jamila Soomro / Saqib Ali Shaikh / Quaid Saeed / Palwasha Khan / Fatima Mir

BMJ Open, Vol 10, Iss

protocol for a matched case–control study

2020 Volume 3

Abstract: IntroductionIn April 2019, 14 children were diagnosed with HIV infection by a private healthcare provider in Larkana district, Sindh province, Pakistan. Over the next 3 months, 930 individuals were diagnosed with HIV, >80% below 16 years, the largest ... ...

Abstract	IntroductionIn April 2019, 14 children were diagnosed with HIV infection by a private healthcare provider in Larkana district, Sindh province, Pakistan. Over the next 3 months, 930 individuals were diagnosed with HIV, >80% below 16 years, the largest ever outbreak of HIV in children in Pakistan. In this protocol paper, we describe research methods for assessing likely modes of HIV transmission in this outbreak and investigate spatial and molecular epidemiology.Methods and analysisA matched case–control study will be conducted with 406 cases recruited. Cases will be children aged below 16 years registered for care at the HIV treatment centre at Shaikh Zayed Children Hospital in Larkana City. Controls will be children who are HIV-uninfected (confirmed by a rapid HIV test) matched 1:1 by age (within 1 year), sex and neighbourhood. Following written informed consent from the guardian, a structured questionnaire will be administered to collect data on sociodemographic indices and exposure to risk factors for parenteral, vertical and sexual (only among those aged above 10 years) HIV transmission. A blood sample will be collected for hepatitis B and C serology (cases and controls) and HIV lineage studies (cases only). Mothers of participants will be tested for HIV to investigate the possibility of mother-to-child transmission. Conditional logistic regression will be used to investigate the association of a priori defined risk factors with HIV infection. Phylogenetic analyses will be conducted. Global positioning system coordinates of participants’ addresses will be collected to investigate concordance between the genetic and spatial epidemiology.Ethics and disseminationEthical approval was granted by the Ethics Review Committee of the Aga Khan University, Karachi. Study results will be shared with Sindh and National AIDS Control Programs, relevant governmental and non-governmental organisations, presented at national and international research conferences and published in international peer-reviewed scientific journals.
Keywords	Medicine ; R
Subject code	360
Language	English
Publishing date	2020-03-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Association of maternal prenatal selenium concentration and preterm birth

Anisur Rahman / Ana Alfirevic / Kenneth Maleta / Ulla Ashorn / Per Ashorn / Kelli K Ryckman / Stephen H Kennedy / Monjur Rahman / Jesmin Pervin / Cathrine Hoyo / Rasheda Khanam / James A Litch / Aneeta Hotwani / Daniel E Roth / Ge Zhang / Abdullah Al Mahmud / Mikko Hallman / Huan Xu / Zarko Alfirevic /

Jeffrey C Murray / Bellington Vwalika / Susan Murphy / Patrick Musonda / Nagendra Monangi / Angharad Care / Waqasuddin Khan / Joan T Price / Yuemei Fan / Thanh Q Le / Julio A Landero / Gerald F Combs / Elizabeth Belling / Joanne Chappell / Fansheng Kong / Criag Lacher / Nabidul Haque Chowdhury / Furqan Kabir / Imran Nisar / Ambreen Nizar / Javairia Khalid / Said Ali / Mohammed Hamad Juma / Md Munirul Islam / Laura Goodfellow / Juhi K Gupta / Larry Rand / Courtney Baruch-Gravett / Abdullah Baqui / Jane Hirst / Laura L Jelliffe-Pawlowski / Jeffrey Stringer / Louis Muglia

BMJ Global Health, Vol 6, Iss

a multicountry meta-analysis

2021 Volume 9

Keywords	Medicine (General) ; R5-920 ; Infectious and parasitic diseases ; RC109-216
Language	English
Publishing date	2021-09-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Incidence of typhoid and paratyphoid fever in Bangladesh, Nepal, and Pakistan

Denise O Garrett, MD / Ashley T Longley, MPH / Kristen Aiemjoy, PhD / Mohammad T Yousafzai, MPH / Caitlin Hemlock, MS / Alexander T Yu, MD / Krista Vaidya, MSc / Dipesh Tamrakar, MD / Shampa Saha, MPH / Isaac I Bogoch, MD / Kashmira Date, MD / Senjuti Saha, PhD / Mohammad Shahidul Islam, MSPH / K M Ishtiaque Sayeed, MPH / Caryn Bern, MD / Sadia Shakoor, MD / Irum F Dehraj, MSc / Junaid Mehmood, MA / Mohammad S I Sajib, MSc /

Maksuda Islam, BA / Rozina S Thobani, MSc / Aneeta Hotwani, MPH / Najeeb Rahman, MSc / Seema Irfan, FCPS / Shiva R Naga, BSc / Ashraf M Memon, MD / Sailesh Pradhan, ProfMD / Khalid Iqbal, MBA / Rajeev Shrestha, ProfPhD / Hafizur Rahman, MDT / Md Mahmudul Hasan, MPH / Saqib H Qazi, FACS / Abdul M Kazi, MPH / Nasir S Saddal, FCPS / Raza Jamal, FCPS / Mohammed J Hunzai, MSc / Tanvir Hossain, MSc / Florian Marks, PhD / Alice S Carter, BA / Jessica C Seidman, PhD / Farah N Qamar, FRCP / Samir K Saha, PhD / Jason R Andrews, MD / Stephen P Luby, ProfMD

The Lancet Global Health, Vol 10, Iss 7, Pp e978-e

results of the Surveillance for Enteric Fever in Asia Project

2022 Volume 988

Abstract: Summary: Background: Precise enteric fever disease burden data are needed to inform prevention and control measures, including the use of newly available typhoid vaccines. We established the Surveillance for Enteric Fever in Asia Project (SEAP) to inform ...

Abstract	Summary: Background: Precise enteric fever disease burden data are needed to inform prevention and control measures, including the use of newly available typhoid vaccines. We established the Surveillance for Enteric Fever in Asia Project (SEAP) to inform these strategies. Methods: From September, 2016, to September, 2019, we conducted prospective clinical surveillance for Salmonella enterica serotype Typhi (S Typhi) and Paratyphi (S Paratyphi) A, B, and C at health facilities in predetermined catchment areas in Dhaka, Bangladesh; Kathmandu and Kavrepalanchok, Nepal; and Karachi, Pakistan. Patients eligible for inclusion were outpatients with 3 or more consecutive days of fever in the last 7 days; inpatients with suspected or confirmed enteric fever; patients with blood culture-confirmed enteric fever from the hospital laboratories not captured by inpatient or outpatient enrolment and cases from the laboratory network; and patients with non-traumatic ileal perforation under surgical care. We used a hybrid surveillance model, pairing facility-based blood culture surveillance with community surveys of health-care use. Blood cultures were performed for enrolled patients. We calculated overall and age-specific typhoid and paratyphoid incidence estimates for each study site. Adjusted estimates accounted for the sensitivity of blood culture, the proportion of eligible individuals who consented and provided blood, the probability of care-seeking at a study facility, and the influence of wealth and education on care-seeking. We additionally calculated incidence of hospitalisation due to typhoid and paratyphoid. Findings: A total of 34 747 patients were enrolled across 23 facilitates (six tertiary hospitals, surgical wards of two additional hospitals, and 15 laboratory network sites) during the study period. Of the 34 303 blood cultures performed on enrolled patients, 8705 (26%) were positive for typhoidal Salmonella. Adjusted incidence rates of enteric fever considered patients in the six tertiary hospitals. Adjusted ...
Keywords	Public aspects of medicine ; RA1-1270
Subject code	610
Language	English
Publishing date	2022-07-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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