A low cost approach to track typhoid, an increasingly important disease

Typhoid is the most common infection in children in Bangladesh. If the trend of rising antibiotic resistance is not interrupted soon, mortality rates can shoot up. In this article, published in PLoS Neglected Tropical Diseases, Senjuti Saha of CHRF and her colleagues describe a low-cost and sustainable surveillance approach to monitor typhoid. The findings from such a system can aid in establishment of treatment and prevention guidelines.

Here is the author’s summary of the manuscript.

Typhoid/paratyphoid fever imposes a major global burden, specifically in low-and-middle-income countries (LMICs). However, it is challenging to implement evidence-based decisions for treatment and prevention because of lack of data from comprehensive surveillance systems, which are often expensive and difficult to sustain.

The WHO has established a global surveillance program called “Invasive Bacterial–Vaccine Preventable Diseases (IB-VPD) Surveillance” to capture sepsis, meningitis and pneumonia in under-five children in many LMICs. Data generated by this program have facilitated introduction of live-saving vaccines and development of treatment strategies. However, the program does not include typhoid/paratyphoid surveillance. We tested the feasibility and sustainability of integrating typhoid/paratyphoid surveillance into this program in two leading children’s hospitals in Bangladesh.

By monitoring all patients with signs of typhoid/paratyphoid, we captured 471 laboratory-confirmed episodes of typhoid/paratyphoid in under-five children between Jan 2012 and Dec 2016. Blood cultures results from all in-patients revealed that the proposed expanded surveillance captures 94% of hospitalized typhoid/paratyphoid cases. Thirty-six percent (170/471) of 2-59 m cases were in children <2 years. Overall, age distribution and antibiotic resistance patterns were consistent with data generated from larger, expensive and typhoid-specific surveillance programs in the region, adding credence to the proposed integration.

Adding typhoid/paratyphoid surveillance to an established invasive disease surveillance platform took advantage of existing infrastructure and resources and as such was easy and cost-effective to implement. We recommend that WHO considers similar integration in other countries; data generated from such surveillances will help countries make evidence-based decisions on introduction of upcoming vaccines and prepare for impact studies.