Multiple introductions of multidrug-resistant typhoid associated with acute infection and asymptomatic carriage, Kenya.
Multiple introductions of multidrug-resistant typhoid associated with acute infection and asymptomatic carriage, Kenya.
复制标题
肯尼亚多次传入与急性感染和无症状携带有关的多重耐药伤寒。
DOI：
10.7554/elife.67852
复制
发表时间：
2021-09-13
期刊：
影响因子：
7.7
通讯作者：
Dougan G
中科院分区：
文献类型：
--
作者：
Kariuki S;Dyson ZA;Mbae C;Ngetich R;Kavai SM;Wairimu C;Anyona S;Gitau N;Onsare RS;Ongandi B;Duchene S;Ali M;Clemens JD;Holt KE;Dougan G
了解伤寒在地方性环境中的感染和携带动态对于找到预防和控制的解决方案至关重要。在一项为期3年的病例对照研究中，我们调查了居住在肯尼亚内罗毕一个非正式定居点的16岁以下儿童（4670例发热病例和8549例年龄匹配的对照）中的伤寒。南148号从病例和95例对照（粪便培养）中鉴定出伤寒分离株;携带频率为1%。全基因组测序显示，97%的病例和88%的对照为基因型4.3.1（单倍型58），其中大多数（76%和88%）为H58基因型的三个亚系（东非1（EA 1），EA 2和EA 3）中的多药耐药菌株，病例和携带者的序列混合。高耐药率的H58 S。伤寒，病例和对照之间的密切系统发育关系，提供了证据的作用，在这种情况下，作为一个水库的伤寒社区传播的载体。美国国立卫生研究院（R 01 AI 099525）;惠康信托基金会（106158/Z/14/Z）;欧盟委员会（TyphiNET编号845681）;美国国立卫生研究院（NIHR）;比尔和梅林达·盖茨基金会（OPP 1175797）。
Understanding the dynamics of infection and carriage of typhoid in endemic settings is critical to finding solutions to prevention and control. 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. 148 S. 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. The high rate of multidrug-resistant H58 S. 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. 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).