Download This Paper
Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.
The Severe Typhoid in Africa Program: Incidences Of Typhoid Fever in Burkina Faso, Democratic Republic of Congo, Ethiopia, Ghana, Madagascar, And Nigeria
20 Pages Posted: 7 Dec 2022
More...Abstract
Background: The Severe Typhoid in Africa program evaluated the burden of symptomatic typhoid infections and characterized the clinical severity of this disease in six countries - Burkina Faso, the Democratic Republic of the Congo, Ethiopia, Ghana, Madagascar, and Nigeria.
Methods: A hybrid, hospital-based prospective surveillance was implemented following a standard protocol. Patients presenting with fever (≥37·5°C axillary or ≥38·0°C tympanic) or reporting fever for three consecutive days within the previous seven days were invited to participate in this study. Disease incidence at the population level was estimated using a Bayesian mixture model.
Findings: A total of 27,866 participants were recruited. Blood cultures were performed for 27,540(99%) of enrolled participants. Clinically significant organisms were detected in 2,055(7%) of these cultures, and 346(17%) Salmonella Typhi were isolated. The overall adjusted incidence per 100,000 person-years of observation (PYO) were highest in Nioko/Polesgo, Burkina Faso (1,189; 95% Confidence Interval [CI], 490–2,490), Kavuaya/Nkandu-1, DRC (348; 95% CI, 259-553) and Imerintsiatosika, Madagascar (168; 95% CI, 135–233), and lowest in Sodo, Ethiopia (23; 95% CI, 10–67). Overall, 46 of 280 (16%) tested isolates showed ciprofloxacin non-susceptibility.
Interpretation: The circulation of resistant isolates and the high incidence of infection (defined as equal or higher than 100 per 100,000 PYO) in five of the six African countries evaluated, indicates the need for rapid dispatch and implementation of effective typhoid conjugate vaccines along with measures designed to improve clean water, sanitation, and hygiene practices.
Funding Information: This research was funded by the Bill & Melinda Gates Foundation [OPP1127988]. INO was an African Research Leader supported by the UK Medical Research Council (MR/L00464X/1).
Declaration of Interests: The authors report no potential conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
Ethics Approval Statement: The study was approved by the International Vaccine Institute Institutional Review Board (IRB No. 2015-006); Institute of Tropical Medicine Antwerp Institutional Review Board, Belgium; Universiteit Antwerpen, Comite voor Medische Ethiek, Belgium; Ministère de la Santé du Burkina Faso, Comité d’Ethique pour la Recherche en Santé, Burkina Faso; Comité d’Ethique de l’Ecole de Santé Publique de l’Université de Kinshasa, Democratic Republic of Congo (No ESP/CE/011/2017); AHRI-ALERT Ethics Review Committee (AAERC), National Health Research Ethics Review Committee (NRERC) of Ethiopia; Kwame Nkrumah University of Science and Technology, School of Medical Sciences, Komfo Anokye Teaching Hospital, Committee on Human Research, Publication and Ethics, Ghana; Ministère de la Santé du Repoblikan’l Madagaskar, Comité d’Ethique, Madagascar; University of Ibadan, University College Hospital Ethics Committee (No. UI/EC/16/0369), Ibadan, Nigeria; Ethics Committee, Our Lady of Apostles Catholic Hospital Oluyoro (OLA) (No. OCH/EC/17/05), Ibadan, Nigeria; Oyo State Ethics Review Committee (AD13/479/665A), Nigeria. Ethical review boards reviewed the study annually to ensure continued compliance with the ethical principles and guidelines based on the WHO (2009), the Council for International Organizations of Medical Sciences (2016) and the Declaration of Helsinki (World Medical Association Declaration of Helsinki, 2013).
Written informed consent was obtained from all eligible participants or their legal guardians. The informed consent process included an explanation by study staff about the study purpose, expectations from participants, duration of participation, risks and benefits for participation, confidentiality, right to decline or withdraw from the study, and contact information of study investigators. Participants were asked to sign a statement of consent if they agreed to join the study. If the participant was an infant or child, his or her parent/guardian was asked to sign or thumbprint the statement of consent. If the participant was an adolescent, both the participant and the parent/guardian were asked to sign or thumbprint the statement of consent. If the participant was illiterate, an independent literate witness (where possible, this person should be selected by the participant and had no connection to the study team) was asked to sign or thumbprint the statement of consent..
Keywords: typhoid fever, invasive salmonellosis, sub-saharan Africa, incidence, surveillance, S. Typhi, antimicrobial resistance
Suggested Citation: Suggested Citation