Abstract
The Typhoid Surveillance in Africa Program (TSAP) and the Severe Typhoid Fever in Africa (SETA) program have refined our understanding of age and geographic distribution of typhoid fever and other invasive salmonelloses in Africa and will help inform future typhoid control strategies, namely, introduction of typhoid conjugate vaccines.
Highlights
Until relatively recently, the burden of enteric fever caused by Salmonella in Africa was not well described
A 2004 review of global enteric fever epidemiology data showed that only 2 countries in Africa (South Africa and Egypt) conducted systematic population-based enteric fever surveillance between 1954 and 2000 [1, 2], the outputs of which provided the basis for the modeled incidence estimate of 50 cases per 100 000 for the entire African continent
Similar efforts are ongoing in Asia as part of the Surveillance for Enteric Fever in Asia Project (SEAP), another prospective, population-based surveillance study, which is generating incidence rates and cost-of-illness data, and characterizing the burden of sequelae associated with severe enteric fever in Bangladesh, Nepal, and Pakistan [7]
Summary
The Severe Enteric Fever in India (SEFI) project was launched to generate data on the burden of disease in India All of these multisite studies combine facility-based surveillance with healthcare utilization surveys to generate population denominators for incidence rate calculations. The Strategic Typhoid Alliance Across Africa and Asia (STRATAA) study is generating incidence estimates for disease caused by typhoidal salmonellae infections in Malawi, Bangladesh, and Nepal using a census-defined population denominator, as well as conducting serosurveys to identify chronic carriers and assess population seroprevalence [12] Data from these and other recent studies from Asia and Africa informed the WHO’s Strategic Advisory Group of Experts’ recent recommendation for use of TCV for primary vaccination. There is a strong pipeline of new TCV candidates, with three additional manufacturers conducting late-stage clinical trials, which will contribute to increased supply security and price competition [18]
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