Bacteremic Typhoid Fever in Children in an Urban Slum, Bangladesh

ICDDR,B Centre for Health and Population Research, Mohakhali, Dhaka 1000, Bangladesh.
Emerging infectious diseases (Impact Factor: 6.75). 03/2005; 11(2):326-9. DOI: 10.3201/eid1102.040422
Source: PubMed


We confirmed a bacteremic typhoid fever incidence of 3.9 episodes/1,000 person-years during fever surveillance in a Dhaka urban slum. The relative risk for preschool children compared with older persons was 8.9. Our regression model showed that these children were clinically ill, which suggests a role for preschool immunization.

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Available from: Robert F Breiman
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    • "We looked at the hospitalization rate in blood cultureconfirmed typhoid cases from 14 selected populationbased studies. The weighted mean hospitalization rates by regions using random effect models from eight stud- ies[9,10,13,15,17,18,21,30,33]conducted in 13 sites were presented in Fig. 3. Hospitalization rate was highest in South-Eastern and Eastern Asia region which had passive surveillance. Hospitalization was least in Southern Asia where most sites had active surveillance . "
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    ABSTRACT: Background The control of typhoid fever being an important public health concern in low and middle income countries, improving typhoid surveillance will help in planning and implementing typhoid control activities such as deployment of new generation Vi conjugate typhoid vaccines. Methods We conducted a systematic literature review of longitudinal population-based blood culture-confirmed typhoid fever studies from low and middle income countries published from 1 st January 1990 to 31 st December 2013. We quantitatively summarized typhoid fever incidence rates and qualitatively reviewed study methodology that could have influenced rate estimates. We used meta-analysis approach based on random effects model in summarizing the hospitalization rates. Results Twenty-two papers presented longitudinal population-based and blood culture-confirmed typhoid fever incidence estimates from 20 distinct sites in low and middle income countries. The reported incidence and hospitalizations rates were heterogeneous as well as the study methodology across the sites. We elucidated how the incidence rates were underestimated in published studies. We summarized six categories of under-estimation biases observed in these studies and presented potential solutions. Conclusions Published longitudinal typhoid fever studies in low and middle income countries are geographically clustered and the methodology employed has a potential for underestimation. Future studies should account for these limitations.
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    • "Countries like India, Indonesia, Bangladesh and Pakistan have been identified as high risk sites for infections caused by Salmonella spp. (Bahl et al. 2004;Brooks et al. 2005;Ochiai et al. 2008). Previous studies have indicated the prevalence of Salmonellae in surface and potable waters in India (Jyoti et al. 2010;. "

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    • "Typhoid fever is a major problem in developing countries with infants and children as well as adults being affected [1] [2] [3]. Along with improvements in water and sanitation, vaccines could play an important role in the control of the disease. "
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    ABSTRACT: Young children are very susceptible to typhoid fever, emphasizing the need for vaccination in under five age groups. The parenteral Vi polysaccharide vaccine is not immunogenic in children under 2 years and the oral Ty21a vaccine (Vivotif) available in capsular formulation is only recommended for those over 5 years. We studied immune responses to a liquid formulation of Ty21a in children 2-5 years of age. Since children in developing countries are in general hypo responsive to oral vaccines, the study was designed to determine if anti-helminthic treatment prior to vaccination, improves responses. In a pilot study in 20 children aged 4-5 years, the immune responses in plasma and in antibody in lymphocyte secretions (ALS) to the enteric coated capsule formulation of Ty21a was found to be comparable to a liquid formulation (P>0.05). Based on this, children (n=252) aged ≥2-<3 years and ≥3-<5 years were randomized to receive a liquid formulation of Ty21a with and without previous anti-helminthic treatment. The vaccine was well tolerated with only a few mild adverse events recorded in <1% of the children. De-worming did not improve immune responses and both age groups developed 32-71% IgA, IgG, and IgM responses in plasma and 63-86% IgA responses in ALS and stool specimens to a membrane preparation (MP) of Ty21a. An early MP specific proliferative T cell response was also seen. We recommend that safety and efficacy studies with a liquid formulation of the vaccine are carried out in children under five, including those less than two years of age to determine if Ty21a is protective in these age groups and applicable as a public health tool for controlling typhoid fever in high prevalence areas of typhoid fever including Bangladesh.
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