Incidence of typhoid fever in Burkina Faso, Democratic Republic of the Congo, Ethiopia, Ghana, Madagascar, and Nigeria (the Severe Typhoid in Africa programme): a population-based study

Abstract

Background Typhoid Fever remains a major cause of morbidity and mortality in low-income settings. The Severe Typhoid in Africa programme was designed to address regional gaps in typhoid burden data and identify populations eligible for interventions using novel typhoid conjugate vaccines. Methods A hybrid design, hospital -based prospective surveillance with population -based health-care utilisation surveys, was implemented in six countries in sub-Saharan Africa. Patients presenting with fever (>= 37<middle dot>5 degrees C axillary or >= 38<middle dot>0 degrees C tympanic) or reporting fever for three consecutive days within the previous 7 days were invited to participate. Typhoid fever was ascertained by culture of blood collected upon enrolment. Disease incidence at the population level was estimated using a Bayesian mixture model. Findings 27 866 (33<middle dot>8%) of 82 491 participants who met inclusion criteria were recruited. Blood cultures were performed for 27 544 (98<middle dot>8%) of enrolled participants. Clinically significant organisms were detected in 2136 (7<middle dot>7%) of these cultures, and 346 (16<middle dot>2%) Salmonella enterica serovar Typhi were isolated. The overall adjusted incidence per 100 000 person -years of observation was highest in Kavuaya and Nkandu 1, Democratic Republic of the Congo (315, 95% credible interval 254-390). Overall, 46 (16<middle dot>4%) of 280 tested isolates showed ciprofloxacin non -susceptibility. Interpretation High disease incidence (ie, >100 per 100 000 person -years of observation) recorded in four countries, the prevalence of typhoid hospitalisations and complicated disease, and the threat of resistant typhoid strains strengthen 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 The Bill & Melinda Gates Foundation. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.