1921
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Typhoid fever is notifiable in South Africa but clinical notification is notoriously poor. South Africa has an estimated annual incidence rate of 0.1 cases per 100,000 population of culture-confirmed typhoid fever, decreased from 17 cases per 100,000 population in the 1980s. This work was undertaken to identify the reasons for this decrease and identify potential weaknesses that may result in an increase of observed cases. Culture-confirmed cases, with additional demographic and clinical data have been collected from selected sentinel sites since 2003. Data on contextual factors (gross domestic product [GDP], sanitation, female education, and childhood diarrhea mortality) were collected. National incidence rates of culture-confirmed typhoid fever have remained constant for the past 13 years, with the exception of an outbreak in 2005: incidence was 0.4 per 100,000 population. Paratyphoid fever remains a rare disease. Antimicrobial susceptibility data suggest resistance to ciprofloxacin and azithromycin is emerging. The South African population increased from 27.5 million in 1980 to 55.0 million in 2015: urbanization increased from 50% to 65%, GDP increased from United States Dollar (USD) $2,910 to USD $6,167, access to sanitation improved from 64.4% to 70.0% in the urban population and 26.4% to 60.5% in rural areas. Female literacy levels improved from 74.8% to 92.6% over the period. Improved socioeconomic circumstances in South Africa have been temporally associated with decreasing incidence rates of typhoid fever over a 35-year period. Ongoing challenges remain including potential for large outbreaks, a large immigrant population, and emerging antimicrobial resistance. Continued active surveillance is mandatory.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.18-0182
2018-09-06
2019-01-18

Full text loading...

/deliver/fulltext/14761645/99/3_Suppl/tpmd180182.html?itemId=/content/journals/10.4269/ajtmh.18-0182&mimeType=html&fmt=ahah

References

  1. Keddy KH, Sooka A, Smith AM, Musekiwa A, Tau NP, Klugman KP, Angulo FJ, Germs SA, , 2016. Typhoid fever in South Africa in an endemic HIV setting. PLoS One 11: e0164939. [Google Scholar]
  2. Keddy KH, Sooka A, Ismail H, Smith AM, Weber I, Letsoalo ME, Harris BN, , 2011. Molecular epidemiological investigation of a typhoid fever outbreak in South Africa, 2005: the relationship to a previous epidemic in 1993. Epidemiol Infect 139: 12391245. [Google Scholar]
  3. Waner S, Kfir R, Idema GK, Coetzee DJ, Rasmussen K, Koornhof HJ, Klugman KP, , 1998. Waterborne outbreak of typhoid fever in Delmas. South Afr J Epidemiol Infect 13: 5357. [Google Scholar]
  4. Klugman KP, Gilbertson IT, Koornhof HJ, Robbins JB, Schneerson R, Schulz D, Cadoz M, Armand J, , 1987. Protective activity of Vi capsular polysaccharide vaccine against typhoid fever. Lancet 2: 11651169. [Google Scholar]
  5. Hendriksen RS, 2015. Genomic signature of multidrug-resistant Salmonella enterica serovar Typhi isolates related to a massive outbreak in Zambia between 2010 and 2012. J Clin Microbiol 53: 262272. [Google Scholar]
  6. Imanishi M, Zimbabwe Typhoid Fever Outbreak Working Group 2011–2012 , 2014. Household water treatment uptake during a public health response to a large typhoid fever outbreak in Harare, Zimbabwe. Am J Trop Med Hyg 90: 945954. [Google Scholar]
  7. Lutterloh E, 2012. Multidrug-resistant typhoid fever with neurologic findings on the Malawi-Mozambique border. Clin Infect Dis 54: 11001106. [Google Scholar]
  8. Sejvar J, 2012. Neurologic manifestations associated with an outbreak of typhoid fever, Malawi–Mozambique, 2009: an epidemiologic investigation. PLoS One 7: e46099. [Google Scholar]
  9. Weber IB, , 2007. Evaluation of the Notifiable Disease Surveillance System in Gauteng Province, South Africa. Pretoria, South Africa: University of Pretoria.
  10. Tau N, Smith AM, Wain J, Tarupiwa A, Coulibaly K, Keddy KH, , 2016. Development and evaluation of a multiple-locus varable number tandem repeats analysis assay for subtyping Salmonella typhi strains from sub-Saharan Africa. J Med Microbiol 66: 937945. [Google Scholar]
  11. Smith AM, Tau N, Sooka A, Keddy KH, GERMS-SA Surveillance Network; , 2015. Microbiological characterization of Salmonella enterica serotype Paratyphi, South Africa, 2003–2014. J Med Microbiol 64: 14501453. [Google Scholar]
  12. Küstner HGV, , 1979. Trends in four major communicable diseases. S Afr Med J 55: 460473. [Google Scholar]
  13. National Department of Health SA, 1995. Typhoid fever in South Africa 1919–1994. Epidemiol Comments 22: 2438. [Google Scholar]
  14. Azmatullah A, Qamar FN, Thaver D, Zaidi AK, Bhutta ZA, , 2015. Systematic review of the global epidemiology, clinical and laboratory profile of enteric fever. J Glob Health 5: 020407. [Google Scholar]
  15. Khan M, Coovadia Y, Connolly C, Sturm AW, , 2000. Risk factors predicting complications in blood culture-proven typhoid fever in adults. Scand J Infect Dis 32: 201205. [Google Scholar]
  16. Qamar FN, Azmatullah A, Bhutta ZA, , 2015. Challenges in measuring complications and death due to invasive Salmonella infections. Vaccine 33 (Suppl 3): C16C20. [Google Scholar]
  17. Jacobs MR, Koornhof HJ, Crisp SI, Palmhert HL, Fitzstephens A, , 1978. Enteric fever caused by Salmonella paratyphi C in South and south west Africa. S Afr Med J 54: 434438. [Google Scholar]
  18. Actuarial Society of South Africa, 2011. ASSA Provincial Output_110216. Available at: www.actuarialsociety.org.za. Accessed August 1, 2012.
  19. South African Human Rights Commission, 2014. Report on the Right to Access Sufficient Water and Decent Sanitation in South Africa: 2014. Johannesburg, South Africa: South African Human Rights Commission.
  20. National Department of Health SA, 2007. Foodstuffs, Cosmetics and Disinfectants Amendment Act. 39 of 2007. South Africa. Available at: https://www.gov.za/st/documents/foodstuffs-cosmetics-and-disinfectants-amendment-act. Accessed September 26, 2016.
  21. National Department of Health SA, 2014. Regulations Governing Microbiological Standards for Foodstuffs and Related Matters. South Africa. Available at: http://www.health.gov.za/index.php/2014-03-17-09-09-38/legislation/joomla-split-menu/category/85-2011r. Accessed September 26, 2016.
  22. Muti M, Gombe N, Tshimanga M, Takundwa L, Bangure D, Mungofa S, Chonzi P, , 2014. Typhoid outbreak investigation in Dzivaresekwa, suburb of Harare City, Zimbabwe, 2011. Pan Afr Med J 18: 309. [Google Scholar]
  23. Polonsky JA, Martinez-Pino I, Nackers F, Chonzi P, Manangazira P, Van HM, Maes P, Porten K, Luquero FJ, , 2014. Descriptive epidemiology of typhoid fever during an epidemic in Harare, Zimbabwe, 2012. PLoS One 9: e114702. [Google Scholar]
  24. National Institute for Communicable Diseases, 2016. Typhoid: NICD Guidelines for Diagnosis, Management and Public Health Response. Avialable at: http://www.nicd.ac.za/assets/files/Guidelines_typhoid_20160125.pdf. Accessed July 4, 2016.
  25. Clinical Laboratory Standards Institute, 2015. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fifth Informational Supplement. Wayne, PA: Clinical Laboratory Standards Institute.
  26. Ribot EM, Fair MA, Gautom R, Cameron DN, Hunter SB, Swaminathan B, Barrett TJ, , 2006. Standardization of pulsed-field gel electrophoresis protocols for the subtyping of Escherichia coli O157:H7, Salmonella, and Shigella for PulseNet. Foodborne Pathog Dis 3: 5967. [Google Scholar]
  27. Blecher M, Davén J, Kollipara A, Maharaj Y, Mansvelder A, Gaarekwe O, , 2017. Health spending at a time of low economic growth and fiscal constraint. In: Padarath A, Barron P, editors. South African Health Review 2017. Durban: Health Systems Trust. Available at: http://www.hst.org.za/publications/south-african-health-review-2017.
  28. WHO UNICEF Joint Monitoring Programme, 2015. Progress on Sanitation and Drinking Water – 2015 Update and MDG Assessment. Available at: https://washdata.org/. Accessed July 4, 2016.
  29. Turton AR, Meissner R, Mampane PN, Seremo O, , 2004. A Hydropolitical History of South Africa’s International River Basins. Pretoria, South Africa: University of Pretoria.
  30. Statistics South Africa, 2003–2015. Midyear Population Estimates. Available at: http://www.statssa.gov.za/. Accessed July 4, 2016.
  31. Keddy KH, Smith AM, Sooka A, Ismail H, Oliver S, , 2010. Fluoroquinolone-resistant typhoid, South Africa. Emerg Infect Dis 16: 879880. [Google Scholar]
  32. Smith AM, Group for Enteric, Respiratory and Meningeal Disease Surveillance in South Africa (GERMS-SA) , 2011. International collaboration tracks typhoid fever cases over two continents from South Africa to Australia. J Med Microbiol 60: 14051407. [Google Scholar]
  33. The World Bank, 2018. South Africa. Available at: http://www.worldbank.org/. Accessed July 4, 2016.
  34. Blechler M, Kollipara A, De Jager P, Zulu N, , 2011. Health financing. Padarath A, English R, eds. South Africa Health Review 2011. Durban, South Africa: Health Systems Trust 2011, 29–48. Available at: http://www.hst.org.za/publications/south-african-health-review-2011. Accessed May 7, 2018.
  35. National Department of Health SA, 2012. Vaccinator’s Manual: Expanded Programme on Immunisation in South Africa (EPI-SA). South Africa. Available at: www.health.gov.za/index.php/Downloads/VaccinatorsManualFinal.pdf. Accessed September 26, 2016.
  36. National Institute for Communicable Diseases, 2016. Salmonella typhi Cases in South Africa, 2016. Johannesburg, South Africa: National Institute for Communicable Diseases Communiqué.
  37. World Health Organization, 2016. World Health Statitics 2016: Monitoring for the Sustainable Development Goals: 2016. Geneva, Switzerland: WHO.
  38. Nguyen TC, 1997. Short courses of ofloxacin for the treatment of enteric fever. Trans R Soc Trop Med Hyg 91: 347349. [Google Scholar]
  39. Parry CM, 2015. Clinically and microbiologically derived azithromycin susceptibility breakpoints for Salmonella enterica serovars Typhi and Paratyphi A. Antimicrob Agents Chemother 59: 27562764. [Google Scholar]
  40. Thompson CN, 2017. Treatment response in enteric fever in an era of increasing antimicrobial resistance: an individual patient data analysis of 2092 participants enrolled into 4 randomized, controlled trials in Nepal. Clin Infect Dis 64: 15221531. [Google Scholar]
  41. Keddy KH, Sooka A, Letsoalo ME, Hoyland G, Chaignat CL, Morrissey AB, Crump JA, , 2011. Sensitivity and specificity of typhoid fever rapid antibody tests for laboratory diagnosis at two sub-Saharan African sites. Bull World Health Organ 89: 640647. [Google Scholar]
  42. Wong VK, 2015. Phylogeographical analysis of the dominant multidrug-resistant H58 clade of Salmonella typhi identifies inter- and intracontinental transmission events. Nat Genet 47: 632639. [Google Scholar]
  43. Wong VK, International Typhoid Consortium , 2016. Molecular surveillance identifies multiple transmissions of typhoid in west Africa. PLoS Negl Trop Dis 10: e0004781. [Google Scholar]
  44. Das S, Ray U, Dutta S, , 2016. Revisit of fluoroquinolone and azithromycin susceptibility breakpoints for Salmonella enterica serovar Typhi. J Med Microbiol 65: 632640. [Google Scholar]
  45. Davis WW, 2018. Notes from the field: typhoid fever outbreak—Harare, Zimbabwe, October 2016–March 2017. MMWR Morb Mortal Wkly Rep 67: 342343. [Google Scholar]
  46. Crump JA, 2011. Invasive bacterial and fungal infections among hospitalized HIV-infected and HIV-uninfected adults and adolescents in northern Tanzania. Clin Infect Dis 52: 341348. [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.18-0182
/content/journals/10.4269/ajtmh.18-0182

Data & Media loading...

Supplemental Figures and Tables

  • Received : 02 Mar 2018
  • Accepted : 10 May 2018

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
{"cc_re__cc_re__cc_by_4_0": ["hoid fever over a 35-year period. Ongoing challenges remain including potential for large outbreaks, a large immigrant population, and emerging antimicrobial resistance. Continued active surveillance is mandatory.</p></p>\n</div>\n<div class=\"copyright-info\">\n\u00a9 The American Society of Tropical Medicine and Hygiene\n</div>\n<div class=\"article-licence-description\">\n<xhtml:span xml:lang=\"en\">\n<p>\n<span class=\"gen\">[open-access] </span>This is an open-access article distributed under the terms of the <a href=\"https://creativecommons.org/licenses/by/4.0/\" target=\"xrefwindow\">Creative Commons Attribution License</a>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</p>\n</xhtml:span>\n</div>\n</div>\n<div id=\"metrics_content\" class=\"tab-pane metrics hidden-js-div tabbedsection\">\n<div class=\"itemMetricsLoading\">\n<img src=\"/images/jp/spinner.gif\" alt=\"Loading\" />\n<p>Article metrics loading...</p>\n</div>\nThe graphs shown below represent data from March 2017\n<div class=\"metricsContainer retrie"], "copyright__copyright__copyright": ["ect Dis 52: 341348. [Google Scholar]\nhttp://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.18-0182\n/content/journals/10.4269/ajtmh.18-0182\n\nData & Media loading...\n\nSupplemental Figures and Tables\n\n  \u2022 Received : 02 Mar 2018\n  \u2022 Accepted : 10 May 2018\n\nMost Cited This Month\n\nThis is a required field\nPlease enter a valid email address\nApproval was a Success\nInvalid data\nAn Error Occurred\nApproval was partially successful, following selected items could not be processed due to error", "ect Dis 52: 341348. [Google Scholar]\nhttp://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.18-0182\n/content/journals/10.4269/ajtmh.18-0182\n\nData & Media loading...\n\nSupplemental Figures and Tables\n\n  \u2022 Received : 02 Mar 2018\n  \u2022 Accepted : 10 May 2018\n\nMost Cited This Month\n\nThis is a required field\nPlease enter a valid email address\nApproval was a Success\nInvalid data\nAn Error Occurred\nApproval was partially successful, following selected items could not be processed due to error", "ect Dis 52: 341348. [Google Scholar]\nhttp://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.18-0182\n/content/journals/10.4269/ajtmh.18-0182\n\nData & Media loading...\n\nSupplemental Figures and Tables\n\n  \u2022 Received : 02 Mar 2018\n  \u2022 Accepted : 10 May 2018\n\nMost Cited This Month\n\nThis is a required field\nPlease enter a valid email address\nApproval was a Success\nInvalid data\nAn Error Occurred\nApproval was partially successful, following selected items could not be processed due to error", "ect Dis 52: 341348. [Google Scholar]\nhttp://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.18-0182\n/content/journals/10.4269/ajtmh.18-0182\n\nData & Media loading...\n\nSupplemental Figures and Tables\n\n  \u2022 Received : 02 Mar 2018\n  \u2022 Accepted : 10 May 2018\n\nMost Cited This Month\n\nThis is a required field\nPlease enter a valid email address\nApproval was a Success\nInvalid data\nAn Error Occurred\nApproval was partially successful, following selected items could not be processed due to error", "ect Dis 52: 341348. [Google Scholar]\nhttp://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.18-0182\n/content/journals/10.4269/ajtmh.18-0182\n\nData & Media loading...\n\nSupplemental Figures and Tables\n\n  \u2022 Received : 02 Mar 2018\n  \u2022 Accepted : 10 May 2018\n\nMost Cited This Month\n\nThis is a required field\nPlease enter a valid email address\nApproval was a Success\nInvalid data\nAn Error Occurred\nApproval was partially successful, following selected items could not be processed due to error"]}