Incidence of invasive salmonella disease in sub-Saharan Africa: a multicentre population-based surveillance study
Incidence of invasive salmonella disease in sub-Saharan Africa: a multicentre population-based surveillance study
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DOI：
10.1016/s2214-109x(17)30022-0
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发表时间：
2017-03-01
影响因子：
34.3
通讯作者：
Wierzba, Thomas F.
中科院分区：
文献类型：
--
作者：
Marks, Florian;von Kalckreuth, Vera;Wierzba, Thomas F.
撒哈拉以南非洲地区侵袭性salpingdisease的发病率数据很少。需要标准化的多国数据，以更好地了解非洲疾病的性质和负担。我们的目的是衡量调整后的发病率估计伤寒和侵袭性非伤寒沙门氏菌（iNTS）疾病在撒哈拉以南Africa，和抗菌药物的敏感性概况的病原agents.Methods我们建立了一个系统的，标准化的监测血培养为基础的发热性疾病在13个非洲哨点与以前的报告伤寒：布基纳法索（2个研究中心）、埃塞俄比亚、加纳、几内亚比绍、肯尼亚、马达加斯加（2个研究中心）、塞内加尔、南非、苏丹和坦桑尼亚（2个研究中心）。我们使用人口普查数据和卫生保健记录来定义研究集水区和人口。合格的参与者是居住在集水区内的住院患者或门诊患者，并且表现为鼓膜温度（>= 38.0摄氏度）或腋窝温度（>= 37.5摄氏度）。排除了报告有发热72小时或更长时间病史的住院患者。我们还实施了一个卫生保健利用调查的样本从每个研究领域随机选择的家庭，以调查在自我报告的发烧持续不到3天的情况下寻求健康的行为。伤寒和iNTS疾病的发病率进行了校正的医疗保健寻求行为和recruitment.Findings之间的2010年3月1日，和2014年1月31日，135沙门氏菌肠道血清型伤寒（S伤寒）和94 iNTS分离培养13 431发热患者的血液。沙门氏菌占33%或以上的所有细菌病原体在9个网站。伤寒沙门氏菌每100 000人-年观察的校正发病率（AIR）范围从苏丹的0（95% CI 0-0）到布基纳法索一个研究中心的383（274-535）; iNTS的AIR范围从苏丹、埃塞俄比亚、马达加斯加（Isotry研究中心）和南非的0到布基纳法索第二个研究中心的237（178-316）。在15岁以下的人群中，iNTS和伤寒的AIR通常高于15岁或以上的人群。多重耐药伤寒沙门氏菌在加纳、肯尼亚和坦桑尼亚（两个地点合并）被分离，多重耐药iNTS在布基纳法索（两个地点合并）、加纳、肯尼亚和几内亚比绍被分离。解释伤寒和iNTS疾病是采样地点侵袭性细菌性发热疾病的主要原因，最常见的影响儿童在低和高人口密度设置。对于高发病率的环境，如本研究中确定的环境，应考虑开发iNTS疫苗和引入伤寒沙门氏菌结合疫苗。版权所有（C）作者。由Elsevier Ltd.发布。这是CC BY许可下的开放获取文章。
Background Available incidence data for invasive salmonella disease in sub-Saharan Africa are scarce. Standardised, multicountry data are required to better understand the nature and burden of disease in Africa. We aimed to measure the adjusted incidence estimates of typhoid fever and invasive non-typhoidal salmonella (iNTS) disease in sub-Saharan Africa, and the antimicrobial susceptibility profiles of the causative agents.Methods We established a systematic, standardised surveillance of blood culture-based febrile illness in 13 African sentinel sites with previous reports of typhoid fever: Burkina Faso (two sites), Ethiopia, Ghana, Guinea-Bissau, Kenya, Madagascar (two sites), Senegal, South Africa, Sudan, and Tanzania (two sites). We used census data and health-care records to define study catchment areas and populations. Eligible participants were either inpatients or outpatients who resided within the catchment area and presented with tympanic (>= 38.0 degrees C) or axillary temperature (>= 37.5 degrees C). Inpatients with a reported history of fever for 72 h or longer were excluded. We also implemented a health-care utilisation survey in a sample of households randomly selected from each study area to investigate health-seeking behaviour in cases of self-reported fever lasting less than 3 days. Typhoid fever and iNTS disease incidences were corrected for health-care-seeking behaviour and recruitment.Findings Between March 1, 2010, and Jan 31, 2014, 135 Salmonella enterica serotype Typhi (S Typhi) and 94 iNTS isolates were cultured from the blood of 13 431 febrile patients. Salmonella spp accounted for 33% or more of all bacterial pathogens at nine sites. The adjusted incidence rate (AIR) of S Typhi per 100 000 person-years of observation ranged from 0 (95% CI 0-0) in Sudan to 383 (274-535) at one site in Burkina Faso; the AIR of iNTS ranged from 0 in Sudan, Ethiopia, Madagascar (Isotry site), and South Africa to 237 (178-316) at the second site in Burkina Faso. The AIR of iNTS and typhoid fever in individuals younger than 15 years old was typically higher than in those aged 15 years or older. Multidrug-resistant S Typhi was isolated in Ghana, Kenya, and Tanzania (both sites combined), and multidrug-resistant iNTS was isolated in Burkina Faso (both sites combined), Ghana, Kenya, and Guinea-Bissau.Interpretation Typhoid fever and iNTS disease are major causes of invasive bacterial febrile illness in the sampled locations, most commonly affecting children in both low and high population density settings. The development of iNTS vaccines and the introduction of S Typhi conjugate vaccines should be considered for high-incidence settings, such as those identified in this study. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license.