article · The Lancet Global Health
Typhoid fever causes substantial illness and death across low-income regions, yet accurate data on disease burden across sub-Saharan Africa remain limited. Through hybrid hospital-based surveillance and population healthcare surveys across Burkina Faso, the Democratic Republic of the Congo, Ethiopia, Ghana, Madagascar, and Nigeria, clinical fever cases were screened to assess disease frequency. Blood cultures identified clinically significant bacterial pathogens, isolating hundreds of Salmonella enterica serovar Typhi cases. Adjusted population incidence exceeded one hundred cases per one hundred thousand person-years across four nations, reaching the highest levels in the Democratic Republic of the Congo. Additionally, a notable proportion of tested isolates demonstrated reduced susceptibility to ciprofloxacin. These findings highlight high rates of typhoid hospital admissions and antimicrobial resistance, confirming the necessity of introducing typhoid conjugate vaccines alongside water, sanitation, and hygiene improvements.
Typhoid fever poses severe health risks in low-income settings, frequently causing hospitalisations and complications. By providing reliable estimates of infection rates and uncovering resistance to ciprofloxacin, this research pinpoints communities in urgent need of interventions. It offers crucial evidence to help public health authorities and international bodies prioritise vaccination campaigns, improve healthcare access, and enhance water, sanitation, and hygiene infrastructure in high-risk African regions.
The findings directly inform the deployment and targeting of novel typhoid conjugate vaccines by public health agencies, international funders, and vaccine manufacturers. The study represents applied epidemiological research providing near-market and implementation-ready data to identify populations requiring vaccine rollout. While not developing a commercial product directly, it establishes market demand, sizing, and geographical targets for preventative vaccines and diagnostics in sub-Saharan African healthcare settings.
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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 (≥37·5°C axillary or ≥38·0°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 (33·8%) of 82 491 participants who met inclusion criteria were recruited. Blood cultures were performed for 27 544 (98·8%) of enrolled participants. Clinically significant organisms were detected in 2136 (7·7%) of these cultures, and 346 (16·2%) 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 (16·4%) 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.
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DOI: 10.1016/s2214-109x(24)00007-x
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