Abstract
Enteric fever, caused by Salmonella enterica serovars Typhi and Paratyphi A (S. Typhi and S. Paratyphi A) remains a major public health problem in many settings. The disease is limited to locations with poor sanitation which facilitates the transmission of the infecting organisms. Efficacious and inexpensive vaccines are available for S. Typhi, yet are not commonly deployed to control the disease. Lack of vaccination is due partly to uncertainty of the disease burden arising from a paucity of epidemiological information in key locations. We have collected and analyzed data from 3,898 cases of blood culture-confirmed enteric fever from Patan Hospital in Lalitpur Sub-Metropolitan City (LSMC), between June 2005 and May 2009. Demographic data was available for a subset of these patients (n = 527) that were resident in LSMC and who were enrolled in trials. We show a considerable burden of enteric fever caused by S. Typhi (2,672; 68.5%) and S. Paratyphi A (1,226; 31.5%) at this Hospital over a four year period, which correlate with seasonal fluctuations in rainfall. We found that local population density was not related to incidence and we identified a focus of infections in the east of LSMC. With data from patients resident in LSMC we found that the median age of those with S. Typhi (16 years) was significantly less than S. Paratyphi A (20 years) and that males aged 15 to 25 were disproportionately infected. Our findings provide a snapshot into the epidemiological patterns of enteric fever in Kathmandu. The uneven distribution of enteric fever patients within the population suggests local variation in risk factors, such as contaminated drinking water. These findings are important for initiating a vaccination scheme and improvements in sanitation. We suggest any such intervention should be implemented throughout the LSMC area.
Highlights
Enteric fever is a term given to the human diseases caused by invasive Salmonella serovars, namely, Salmonella enterica serovar Typhi
Enteric fever is a persistent problem in Kathmandu and in other urban locations in South and South-East Asia [7,26]
We present some epidemiological features of enteric fever in Lalitpur SubMetropolitan City (LSMC)
Summary
Enteric fever is a term given to the human diseases caused by invasive Salmonella serovars, namely, Salmonella enterica serovar Typhi Typhi) and the various Salmonella enterica serovar Paratyphi serovars S. Typhi generally predominates with respect to the aetiology of enteric fever, yet S. Paratyphi A is recognized as an escalating cause [3,4,5]. Enteric fever disproportionately affects children and is characterized by persistent fever, malaise and may cause a protracted illness lasting several weeks. The global distribution of the disease is limited to areas with poor standards of hygiene and sanitation, which facilitate transmission [7]. Enteric fever remains a public health concern in endemic urban locations, exacerbated by the circulation of diverse genotypes and antimicrobial resistant organisms [10,11,12]
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