Abstract
BackgroundEnteric fever can lead to prolonged hospital stays, clinical complications, and death. The Surveillance for Enteric Fever in Asia Project (SEAP), a prospective surveillance study, characterized the burden of enteric fever, including illness severity, in selected settings in Bangladesh, Nepal, and Pakistan. We assessed disease severity, including hospitalization, clinical complications, and death among SEAP participants.MethodsWe analyzed clinical and laboratory data from blood culture–confirmed enteric fever cases enrolled in SEAP hospitals and associated network laboratories from September 2016 to September 2019. We used hospitalization and duration of hospital stay as proxies for severity. We conducted a follow-up interview 6 weeks after enrollment to ascertain final outcomes.ResultsOf the 8705 blood culture-confirmed enteric fever cases enrolled, we identified 6 deaths (case-fatality ratio, .07%; 95% CI, .01–.13%), 2 from Nepal, 4 from Pakistan, and none from Bangladesh. Overall, 1.7% (90/5205) of patients recruited from SEAP hospitals experienced a clinical complication (Bangladesh, 0.6% [18/3032]; Nepal, 2.3% [12/531]; Pakistan, 3.7% [60/1642]). The most identified complications were hepatitis (n = 36), septic shock (n = 22), and pulmonary complications/pneumonia (n = 13). Across countries, 32% (2804/8669) of patients with hospitalization data available were hospitalized (Bangladesh, 27% [1295/4868]; Nepal, 29% [455/1595]; Pakistan, 48% [1054/2206]), with a median hospital stay of 5 days (IQR, 3–7).ConclusionsWhile defined clinical complications and deaths were uncommon at the SEAP sites, the high proportion of hospitalizations and prolonged hospital stays highlight illness severity and the need for enteric fever control measures, including the use of typhoid conjugate vaccines.
Highlights
MethodsWe analyzed clinical and laboratory data from blood culture–confirmed enteric fever cases enrolled in Surveillance for Enteric Fever in Asia Project (SEAP) hospitals and associated network laboratories from September 2016 to September 2019
Enteric fever can lead to prolonged hospital stays, clinical complications, and death
While defined clinical complications and deaths were uncommon at the Surveillance for Enteric Fever in Asia Project (SEAP) sites, the high proportion of hospitalizations and prolonged hospital stays highlight illness severity and the need for enteric fever control measures, including the use of typhoid conjugate vaccines
Summary
We analyzed clinical and laboratory data from blood culture–confirmed enteric fever cases enrolled in SEAP hospitals and associated network laboratories from September 2016 to September 2019. We used hospitalization and duration of hospital stay as proxies for severity. We conducted clinical and laboratory surveillance for enteric fever from September 2016 to September 2019 at selected hospitals and through enhanced laboratory surveillance at additional participating hospitals and clinics (laboratory network sites) that provide both outpatient and inpatient services. SEAP sites in Dhaka, Bangladesh, included 2 large pediatric hospitals and 3 laboratories (serving both adult and pediatric populations); in Nepal, 1 hospital in Kathmandu and 1 in Kavrepalanchok, plus 8 laboratories; and in Karachi, Pakistan, 2 tertiary hospitals, 3 laboratories, and surgical wards in 2 additional hospitals. Study site selection was described previously; in brief, Bangladesh, Nepal, and Pakistan were selected as countries with a known burden of enteric fever. Typhi is characterized as resistant to first-line antibiotics (chloramphenicol, ampicillin, and trimethoprimsulfamethoxazole), fluoroquinolones, and third-generation cephalosporins [12]
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