Shifts in Geographic Distribution and Antimicrobial Resistance during a Prolonged Typhoid Fever Outbreak — Bundibugyo and Kasese Districts, Uganda, 2009–2011

Autor: Nikki Maxwell, Amos Murangi, Samuel Kadivane, Matthew Mikoleit, Fred Mulabya, Issa Makumbi, Uziah Kule, Molly M. Freeman, John R. Lule, Vince Hill, Maroya Spalding Walters, Kevin Joyce, Eric D. Mintz, Caroline Ouma, Janell Routh, Denis Mubiru, Emmanuel Ejoku, Nancy Garrett, Absalom Rwantangle, Jessica L. Halpin, Ben Mbusa, Atek Kagirita, Robert Downing
Rok vydání: 2014
Předmět:
Male
Abdominal pain
Epidemiology
Global Health
Salmonella typhi
Disease Outbreaks
Feces
Cluster Analysis
Uganda
Child
Aged
80 and over
lcsh:Public aspects of medicine
Middle Aged
Anti-Bacterial Agents
Electrophoresis
Gel
Pulsed-Field
Vaccination
Blood
Infectious Diseases
Child
Preschool
Medicine
Female
Topography
Medical
Public Health
medicine.symptom
Research Article
Adult
medicine.medical_specialty
lcsh:Arctic medicine. Tropical medicine
Adolescent
lcsh:RC955-962
Perforation (oil well)
Microbial Sensitivity Tests
Microbiology
Typhoid fever
Young Adult
Antibiotic resistance
Internal medicine
Drug Resistance
Bacterial
medicine
Humans
Typhoid Fever
Biology
Aged
business.industry
Public Health
Environmental and Occupational Health
Infant
Outbreak
lcsh:RA1-1270
medicine.disease
Molecular Typing
Immunology
business
Zdroj: PLoS Neglected Tropical Diseases, Vol 8, Iss 3, p e2726 (2014)
PLoS Neglected Tropical Diseases
ISSN: 1935-2735
DOI: 10.1371/journal.pntd.0002726
Popis: Background Salmonella enterica serovar Typhi is transmitted by fecally contaminated food and water and causes approximately 22 million typhoid fever infections worldwide each year. Most cases occur in developing countries, where approximately 4% of patients develop intestinal perforation (IP). In Kasese District, Uganda, a typhoid fever outbreak notable for a high IP rate began in 2008. We report that this outbreak continued through 2011, when it spread to the neighboring district of Bundibugyo. Methodology/Principal Findings A suspected typhoid fever case was defined as IP or symptoms of fever, abdominal pain, and ≥1 of the following: gastrointestinal disruptions, body weakness, joint pain, headache, clinically suspected IP, or non-responsiveness to antimalarial medications. Cases were identified retrospectively via medical record reviews and prospectively through laboratory-enhanced case finding. Among Kasese residents, 709 cases were identified from August 1, 2009–December 31, 2011; of these, 149 were identified during the prospective period beginning November 1, 2011. Among Bundibugyo residents, 333 cases were identified from January 1–December 31, 2011, including 128 cases identified during the prospective period beginning October 28, 2011. IP was reported for 507 (82%) and 59 (20%) of Kasese and Bundibugyo cases, respectively. Blood and stool cultures performed for 154 patients during the prospective period yielded isolates from 24 (16%) patients. Three pulsed-field gel electrophoresis pattern combinations, including one observed in a Kasese isolate in 2009, were shared among Kasese and Bundibugyo isolates. Antimicrobial susceptibility was assessed for 18 isolates; among these 15 (83%) were multidrug-resistant (MDR), compared to 5% of 2009 isolates. Conclusions/Significance Molecular and epidemiological evidence suggest that during a prolonged outbreak, typhoid spread from Kasese to Bundibugyo. MDR strains became prevalent. Lasting interventions, such as typhoid vaccination and improvements in drinking water infrastructure, should be considered to minimize the risk of prolonged outbreaks in the future.
Author Summary Typhoid fever is an acute febrile illness caused by the bacteria Salmonella Typhi and transmitted through food and water contaminated with the feces of typhoid fever patients or carriers. We investigated typhoid fever outbreaks in two neighboring Ugandan districts, Kasese and Bundibugyo, where typhoid fever outbreaks began in 2008 and 2011, respectively. In Kasese from August 2009–December 2011, we documented 709 cases of typhoid fever. In Bundibugyo from January–December 2011, we documented 333 cases. Salmonella Typhi from Bundibugyo and Kasese had indistinguishable molecular fingerprints; laboratory and epidemiological evidence indicate that the outbreak spread from Kasese to Bundibugyo. Salmonella Typhi isolated during our investigation were resistant to more antibiotics than isolates obtained from Kasese in 2009. Drinking water in both districts was fecally contaminated and the likely vehicle for the outbreaks. Our investigation highlights that in unchecked typhoid fever outbreaks, illness can become geographically dispersed and outbreak strains can become increasingly resistant to antibiotics. Lasting interventions, including investments in drinking water infrastructure and typhoid vaccination, are needed to control these outbreaks and prevent future outbreaks.
Databáze: OpenAIRE
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