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Typhoid Fever in the Eastern Mediterranean Region: A Systematic Review, 1990–2021

Grace D. AppiahDivision of Foodborne, Waterborne and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia;

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Phong LeDivision of Foodborne, Waterborne and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia;

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Graeme Prentice-MottDivision of Foodborne, Waterborne and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia;

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Megan BiasCenter for Surveillance, Epidemiology, and Laboratory Services, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia;

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Caroline PrattDivision of Foodborne, Waterborne and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia;

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Ghassan M. MatarDepartment of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon

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Talia PindyckDivision of Foodborne, Waterborne and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia;

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Antoine Abou FayadDepartment of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon

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Sunkyung KimDivision of Foodborne, Waterborne and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia;

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Eric D. MintzDivision of Foodborne, Waterborne and Environmental Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia;

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ABSTRACT.

The occurrence and antimicrobial resistance (AMR) of typhoid fever in the WHO Eastern Mediterranean Region (EMR) are poorly characterized. Robust surveillance data are needed to inform strategies for typhoid control and prevention in the region. We conducted a systematic review of typhoid fever occurrence, complications, and AMR patterns in EMR countries. We identified 70 studies published from 1990 to 2021, including a total of 44,541 cases with blood culture confirmed typhoid fever in 12 EMR countries, with 48 (69%) studies and 42,008 cases from Pakistan. Among 56 studies with AMR data, fluroquinolone (68% of 13,013 tested isolates), and multidrug resistance (40% of 15,765 tested isolates) were common. Forty (57%) of the 56 studies were from Pakistan, and all reports of extensively drug resistant Salmonella Typhi (48% of 9,578 tested isolates) were from studies in Pakistan. Our findings support the need for continued efforts to strengthen surveillance and laboratory capacity for blood-culture detection of typhoid fever in the region, including data from an ongoing collaboration among CDC, the American University of Beirut, and the WHO EMR office.

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Author Notes

Address correspondence to Grace D. Appiah, Division of Foodborne, Waterborne and Environmental Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA 30333. E-mail: gappiah@cdc.gov

Financial support: This study was supported by funding from Gavi, the Vaccine Alliance.

Disclosures: The opinions expressed by authors contributing to this manuscript do not necessarily reflect the opinions of the CDC or the institutions with which the authors are affiliated.

Authors’ addresses: Grace D. Appiah, Phong Le, Graeme Prentice-Mott, Caroline Pratt, Talia Pindyck, Sunkyung Kim, and Eric D. Mintz, Division of Foodborne, Waterborne and Environmental Diseases, U.S. Centers for Disease Control, Atlanta, GA, E-mails: ydg3@cdc.gov, pyv8@cdc.gov, qbt1@cdc.gov, yqg5@cdc.gov, nrb1@cdc.gov, wox0@cdc.gov, and ericdmintz@gmail.com. Megan Bias, Center for Surveillance, Epidemiology, and Laboratory Services, U.S. Centers for Disease Control, Atlanta, GA, E-mail: pwj1@cdc.gov. Ghassan M. Matar and Antoine Abou Fayad, Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon, E-mails: gmatar@aub.edu.lb and aa328@aub.edu.lb.

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