Abstract
The burden of Salmonella enterica serotype Typhi (S. Typhi) shedding in stool and its contribution to transmission in endemic settings is unknown. During passive surveillance S. Typhi shedding was seen during convalescence in 332 bacteremic patient with typhoid, although none persisted at 1-year follow-up. Anti–virulence capsule (Vi)–immunoglobulin (Ig) G titers were measured in age-stratified cohort of serosurveillance participants. Systematic stool sampling of 303 participants with high anti–Vi-IgG titers identified 1 asymptomatic carrier with shedding. These findings suggest that ongoing S. Typhi transmission in this setting is more likely to occur from acute convalescent cases, although better approaches are needed to identify true chronic carriers in the community to enable typhoid elimination.
Highlights
Humans are the only natural host and reservoir of Salmonella enterica serotype Typhi
Passive surveillance The total number of individuals included in the study census was 111,695, among whom 4,509 patients met the inclusion criteria and were enrolled to the passive surveillance study between August 2016 and January 2019
In patients with only positive stool cultures, 1 out of 9 was positive on day 30 and none were positive at later time points
Summary
Humans are the only natural host and reservoir of Salmonella enterica serotype Typhi Typhi shedding from both acutely infected patients and from asymptomatic chronic carriers detected by serosurveillance. At enrollment (day 0), blood and stool specimens were collected for culture to confirm acute typhoid cases.
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