Abstract
Non-typhoidal Salmonella (NTS) ranks first among causes of bloodstream infection in children under five years old in the Democratic Republic of Congo and has a case fatality rate of 15%. Main host-associated risk factors are Plasmodium falciparum malaria, anemia and malnutrition. NTS transmission in sub-Saharan Africa is poorly understood. NTS bloodstream infections mostly occur during the rainy season, which may reflect seasonal variation in either environmental transmission or host susceptibility. We hypothesized that environment- and host-associated factors contribute independently to the seasonal variation in NTS bloodstream infections in children under five years old admitted to Kisantu referral hospital in 2013–2019. We used remotely sensed rainfall and temperature data as proxies for environmental factors and hospital data for host-associated factors. We used principal component analysis to disentangle the interrelated environment- and host-associated factors. With timeseries regression, we demonstrated a direct association between rainfall and NTS variation, independent of host-associated factors. While the latter explained 17.5% of NTS variation, rainfall explained an additional 9%. The direct association with rainfall points to environmental NTS transmission, which should be explored by environmental sampling studies. Environmental and climate change may increase NTS transmission directly or via host susceptibility, which highlights the importance of preventive public health interventions.
Highlights
Non-typhoidal Salmonella (NTS) disease is a leading cause of bloodstream infection in sub-Saharan Africa
This study revealed a direct association between rainfall and NTS seasonal dynamics, independent of seasonal variation in host-susceptibility
There was no evidence for delayed effects of environmentassociated factors, in contrast to the up to two months delayed association between Plasmodium falciparum (Pf) malaria & anemia cases and NTS bloodstream infections
Summary
Non-typhoidal Salmonella (NTS) disease is a leading cause of bloodstream infection in sub-Saharan Africa. In analogy to Salmonella Typhi, the humanrestricted cause of typhoid fever, transmission of NTS in sub-Saharan Africa may occur through food and water contaminated with human feces[2,3]. Such waterborne environmental transmission could be further aggravated by poor sanitation, poor access to clean water and poor h ygiene[3]. A better understanding of environmental drivers will provide insights into the potential environmental NTS transmission pathways and the potential impact of environmental change, and will orient control measures In this retrospective study, we aimed to explain the seasonal dynamics of NTS bloodstream infections in children under five years old admitted to Kisantu hospital. We used timeseries regression to assess their independent association with NTS seasonal dynamics
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
