Today in Cannes, France, Coalition against Typhoid members presented at the 6th International Conference on Vaccines for Enteric Diseases (VED) 2011. The presenters included past Sabin Blog contributors, who shared their work on pilot vaccination programs in Pakistan and Nepal. Also featured was new data on hyper-endemic typhoid in Africa, presented by Robert Breiman, M.D. of CDC Kenya. Dr. Breiman's work also appeared in the August Global Immunization Newsletter (GIN). The GIN post, authored by Chris Nelson and Ciro de Quadros of the Coalition against Typhoid (CaT) Secretariat, is re-posted below.
New Evidence of Highly Endemic Typhoid in Africaby Chris Nelson and Ciro de Quadros
Rob Breiman and his team at CDC-Kenya have documented rates of typhoid fever in urban Nairobi comparable to those reported from urban slums in Asia. Using population-based surveillance and laboratory confirmation of S. Typhi, his team reports rates were highest in the youngest age groups 2-4 years of age (adj incidence >2,000 per 100,000 pyo). Nearly 75% of all S. Typhi isolates were multi-drug resistant (MDR).
These results provide new evidence of unrecognized burden of typhoid fever in sub-Saharan Africa and the threat of MDR typhoid, especially in rapidly growing urban informal settlements/slums.
While outbreak and other case reports are common, regional estimates of typhoid burden and MDR typhoid have been limited by the absence of rigorous surveillance systems. Recently, IVI launched an African surveillance network with the objective of documenting rates of laboratory confirmed typhoid, paratyphoid, and non-typhoidal salmonellosis, and evaluating multi-drug resistance. This evidence will serve as the basis for developing a comprehensive and integrated typhoid prevention and control strategy for the region.
Kenyan Ministry of Public Health and Sanitation officials recognize the threat of typhoid fever and recently reported plans are in place to begin vaccinating food service workers in local schools.