1921
Volume 99, Issue 3_Suppl
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Typhoid remains a major cause of morbidity and mortality in endemic countries. This review analyzed typhoid burden changes in Pakistan and its association with contextual factors. A retrospective cohort study on blood culture–positive typhoid and antibiotic resistance was conducted from three tertiary hospitals and contextual factor data obtained from primary household surveys. Typhi/Paratyphi positivity rates were estimated and trend analysis was carried out using positive cases out of total number of blood cultures performed. Contextual factors’ associations were determined through bivariate correlation analysis, using STATA (SataCorp, College Station, TX). We report a total of 17,387 Typhi and 8,286 Paratyphi A and B–positive specimens from 798,137 blood cultures performed. The results suggest an overall decline in typhoid incidence as Typhi positivity rates declined from 6.42% in 1992 to 1.32% in 2015 and Paratyphi (A and B) from 1.29% to 0.39%. Subgroup analysis suggests higher Typhi prevalence in adults older than 18 years, whereas Paratyphi is greater in children aged 5–18 years. The relative contribution of Paratyphi to overall confirmed cases increased from 16.8% in 1992 to 23% in 2015. The analysis suggests high burden of fluoroquinolone resistance and multidrug-resistant Typhi strains. Statistically significant associations of water, sanitation indicators, and literacy rates were observed with typhoid positivity. Despite some progress, typhoid remains endemic and a strong political will is required for targeted typhoid control strategies. A multipronged approach of improving water, sanitation and hygiene in combination with large-scale immunization in endemic settings of Pakistan could help reduce burden and prevent epidemics.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.18-0145
2018-07-25
2019-11-12
Loading full text...

Full text loading...

/deliver/fulltext/14761645/99/3_Suppl/tpmd180145.html?itemId=/content/journals/10.4269/ajtmh.18-0145&mimeType=html&fmt=ahah

References

  1. Siddiqui FJ, Rabbani F, Hasan R, Nizami SQ, Bhutta ZA, , 2006. Typhoid fever in children: some epidemiological considerations from Karachi, Pakistan. Int J Infect Dis 10: 215222. [Google Scholar]
  2. Stuart BM, Pullen RL, , 1946. Typhoid: clinical analysis of three hundred and sixty cases. Arch Intern Med (Chic) 78: 629661. [Google Scholar]
  3. Paul UK, Barik KL, Sinharay K, Banik S, Bandyopadhyay A, , 2016. Knowledge, attitude and practice of general practitioners regarding typhoid fever. Int J Sci Stud 3: 8386. [Google Scholar]
  4. Crump JA, Luby SP, Mintz ED, , 2004. The global burden of typhoid fever. Bull World Health Organ 82: 346353. [Google Scholar]
  5. World Health Organization, 2016. Typhoid: WHO. Available at: http://www.who.int/immunization/diseases/typhoid/en/. Accessed November 2, 2016.
  6. Buckle GC, Walker CL, Black RE, , 2012. Typhoid fever and paratyphoid fever: systematic review to estimate global morbidity and mortality for 2010. J Glob Health 2: 010401. [Google Scholar]
  7. Ochiai RL, Domi Typhoid Study Group , 2008. A study of typhoid fever in five Asian countries: disease burden and implications for controls. Bull World Health Organ 86: 260268. [Google Scholar]
  8. Van Basten J, Stockenbrügger R, , 1993. Typhoid perforation. A review of the literature since 1960. Trop Geogr Med 46: 336339. [Google Scholar]
  9. Clasen T, Schmidt WP, Rabie T, Roberts I, Cairncross S, , 2007. Interventions to improve water quality for preventing diarrhoea: systematic review and meta-analysis. BMJ 334: 782. [Google Scholar]
  10. Crump JA, Mintz ED, , 2010. Global trends in typhoid and paratyphoid fever. Clin Infect Dis 50: 241246. [Google Scholar]
  11. Engels EA, Falagas ME, Lau J, Bennish ML, , 1998. Typhoid fever vaccines: a meta-analysis of studies on efficacy and toxicity. BMJ 316: 110116. [Google Scholar]
  12. Rowe B, Ward LR, Threlfall EJ, , 1997. Multidrug-resistant Salmonella typhi: a worldwide epidemic. Clin Infect Dis 24 (Suppl 1): S106S109. [Google Scholar]
  13. Khan MI, 2012. Epidemiology, clinical presentation, and patterns of drug resistance of Salmonella typhi in Karachi, Pakistan. J Infect Dev Ctries 6: 704714. [Google Scholar]
  14. Hazir T, Qazi SA, Abbas KA, Khan MA, , 2002. Therapeutic re-appraisal of multiple drug resistant Salmonella typhi (MDRST) in Pakistani children. J Pak Med Assoc 52: 123127. [Google Scholar]
  15. Butt T, Ahmad RN, Salman M, Kazmi SY, , 2005. Changing trends in drug resistance among typhoid salmonellae in Rawalpindi, Pakistan. East Mediterr Health J 11: 10381044. [Google Scholar]
  16. Qamar FN, Azmatullah A, Kazi AM, Khan E, Zaidi AK, , 2014. A three-year review of antimicrobial resistance of Salmonella enterica serovars Typhi and Paratyphi A in Pakistan. J Infect Dev Ctries 8: 981986. [Google Scholar]
  17. Naeem Khan M, Shafee M, Hussain K, Samad A, Arif Awan M, Manan A, Wadood A, , 2013. Typhoid fever in paediatric patients in Quetta, Balochistan, Pakistan. Pak J Med Sci 29: 929932. [Google Scholar]
  18. Luby SP, Faizan MK, Fisher-Hoch SP, Syed A, Mintz ED, Bhutta ZA, McCormick JB, , 1998. Risk factors for typhoid fever in an endemic setting, Karachi, Pakistan. Epidemiol Infect 120: 129138. [Google Scholar]
  19. Khan MI, 2012. Risk factors associated with typhoid fever in children aged 2–16 years in Karachi, Pakistan. Epidemiol Infect 140: 665672. [Google Scholar]
  20. Khan Z, , 1993. Immunisation and infant mortality in Pakistan. Pak Dev Rev 32: 11171123. [Google Scholar]
  21. Ahmad N, Akhtar T, Roghani MT, Ilyas HM, Ahmad M, , 1999. Immunization coverage in three districts of North West Frontier Province (NWFP). J Pak Med Assoc 49: 301305. [Google Scholar]
  22. Khan MI, 2006. Lessons and implications from a mass immunization campaign in squatter settlements of Karachi, Pakistan: an experience from a cluster-randomized double-blinded vaccine trial [NCT00125047]. Trials 7: 17. [Google Scholar]
  23. Bhutta ZA, 2014. Immunogenicity and safety of the Vi-CRM197 conjugate vaccine against typhoid fever in adults, children, and infants in south and southeast Asia: results from two randomised, observer-blind, age de-escalation, phase 2 trials. Lancet Infect Dis 14: 119129. [Google Scholar]
  24. World Health Organization UNICEF, , 2016. Joint Monitoring Programme (JMP) for Water Supply and Sanitation WHO, UNICEF. Available at: https://www.wssinfo.org/. Accessed January 16, 2017.
  25. The Demographic and Health Surveys Program, 2017. Demographic and Health Surveys—Pakistan: USAID. Available at: http://dhsprogram.com/Where-We-Work/Country-Main.cfm?ctry_id=31&c=Pakistan&Country=Pakistan&cn=&r=4. Accessed January 16, 2017.
  26. Leber AL, , 2016. Clinical Microbiology Procedures Handbook Fourth Edition. Washington, DC: American Society of Microbiology.
  27. Bauer A, Kirby W, Sherris JC, Turck M, , 1966. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol 45: 493. [Google Scholar]
  28. Clinical Laboratory Standards Institute, 2018. Clinical Laboratory Standards Institute (CLSI) Guidelines. Available at: http://clsi.org/standards. Accessed April 28, 2018.
  29. Clinical Laboratory Standards Institute, 2000. Performance Standards for Antimicrobial Susceptibility Testing, 7th edition, M2 A6. Wayne, PA: Clinical and Laboratory Standards Institute.
  30. Clinical and Laboratory Standards Institute, 2012. Performance Standards for Antimicrobial Susceptibility Testing, 22nd informational supplement. Wayne, PA: Clinical and Laboratory Standards Institute.
  31. StataCorp LP, 2017. Stata Data Analysis and Statistical Software, Vol. 10. Special Edition Release, 733.
  32. Klemm EJ, 2018. Emergence of an extensively drug-resistant Salmonella enterica serovar typhi clone harboring a promiscuous plasmid encoding resistance to fluoroquinolones and third-generation cephalosporins. MBio 9: e00105e00118. [Google Scholar]
  33. Sur D, Ali M, von Seidlein L, Manna B, Deen JL, Acosta CJ, Clemens JD, Bhattacharya SK, , 2007. Comparisons of predictors for typhoid and paratyphoid fever in Kolkata, India. BMC Public Health 7: 289. [Google Scholar]
  34. Alba S, 2016. Risk factors of typhoid infection in the Indonesian archipelago. PLoS One 11: e0155286. [Google Scholar]
  35. Parande MA, Patil PC, Rayate MV, Lukde MU, , 2011. Epidemiological profile of enteric fever cases admitted in SCSMGH, Solapur. Natl J Community Med 2: 9195. [Google Scholar]
  36. Vollaard AM, Ali S, van Asten HA, Widjaja S, Visser LG, Surjadi C, van Dissel JT, , 2004. Risk factors for typhoid and paratyphoid fever in Jakarta, Indonesia. JAMA 291: 26072615. [Google Scholar]
  37. Wain J, Hendriksen RS, Mikoleit ML, Keddy KH, Ochiai RL, , 2015. Typhoid fever. Lancet 385: 11361145. [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.18-0145
Loading
/content/journals/10.4269/ajtmh.18-0145
Loading

Data & Media loading...

  • Received : 16 Feb 2018
  • Accepted : 05 May 2018
  • Published online : 25 Jul 2018

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error