The burden and characteristics of enteric fever at a healthcare facility in a densely populated area of kathmandu

Abhilasha Karkey, Amit Arjyal, Katherine L. Anders, Maciej F. Boni, Sabina Dongol, Samir Koirala, Phan Vu Tra My, Tran Vu Thieu Nga, Archie C.A. Clements, Kathryn E. Holt, Pham Thanh Duy, Jeremy N. Day, James I. Campbel, Gordon Dougan, Christiane Dolecek, Jeremy Farrar, Buddha Basnyat, Stephen Baker

Research output: Contribution to journalArticleResearchpeer-review

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.

Original languageEnglish
Article numbere13988
JournalPLoS ONE
Volume5
Issue number11
DOIs
Publication statusPublished - 9 Dec 2010

Cite this

Karkey, A., Arjyal, A., Anders, K. L., Boni, M. F., Dongol, S., Koirala, S., ... Baker, S. (2010). The burden and characteristics of enteric fever at a healthcare facility in a densely populated area of kathmandu. PLoS ONE, 5(11), [e13988]. https://doi.org/10.1371/journal.pone.0013988
Karkey, Abhilasha ; Arjyal, Amit ; Anders, Katherine L. ; Boni, Maciej F. ; Dongol, Sabina ; Koirala, Samir ; My, Phan Vu Tra ; Nga, Tran Vu Thieu ; Clements, Archie C.A. ; Holt, Kathryn E. ; Duy, Pham Thanh ; Day, Jeremy N. ; Campbel, James I. ; Dougan, Gordon ; Dolecek, Christiane ; Farrar, Jeremy ; Basnyat, Buddha ; Baker, Stephen. / The burden and characteristics of enteric fever at a healthcare facility in a densely populated area of kathmandu. In: PLoS ONE. 2010 ; Vol. 5, No. 11.
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title = "The burden and characteristics of enteric fever at a healthcare facility in a densely populated area of kathmandu",
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.",
author = "Abhilasha Karkey and Amit Arjyal and Anders, {Katherine L.} and Boni, {Maciej F.} and Sabina Dongol and Samir Koirala and My, {Phan Vu Tra} and Nga, {Tran Vu Thieu} and Clements, {Archie C.A.} and Holt, {Kathryn E.} and Duy, {Pham Thanh} and Day, {Jeremy N.} and Campbel, {James I.} and Gordon Dougan and Christiane Dolecek and Jeremy Farrar and Buddha Basnyat and Stephen Baker",
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Karkey, A, Arjyal, A, Anders, KL, Boni, MF, Dongol, S, Koirala, S, My, PVT, Nga, TVT, Clements, ACA, Holt, KE, Duy, PT, Day, JN, Campbel, JI, Dougan, G, Dolecek, C, Farrar, J, Basnyat, B & Baker, S 2010, 'The burden and characteristics of enteric fever at a healthcare facility in a densely populated area of kathmandu' PLoS ONE, vol. 5, no. 11, e13988. https://doi.org/10.1371/journal.pone.0013988

The burden and characteristics of enteric fever at a healthcare facility in a densely populated area of kathmandu. / Karkey, Abhilasha; Arjyal, Amit; Anders, Katherine L.; Boni, Maciej F.; Dongol, Sabina; Koirala, Samir; My, Phan Vu Tra; Nga, Tran Vu Thieu; Clements, Archie C.A.; Holt, Kathryn E.; Duy, Pham Thanh; Day, Jeremy N.; Campbel, James I.; Dougan, Gordon; Dolecek, Christiane; Farrar, Jeremy; Basnyat, Buddha; Baker, Stephen.

In: PLoS ONE, Vol. 5, No. 11, e13988, 09.12.2010.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - The burden and characteristics of enteric fever at a healthcare facility in a densely populated area of kathmandu

AU - Karkey, Abhilasha

AU - Arjyal, Amit

AU - Anders, Katherine L.

AU - Boni, Maciej F.

AU - Dongol, Sabina

AU - Koirala, Samir

AU - My, Phan Vu Tra

AU - Nga, Tran Vu Thieu

AU - Clements, Archie C.A.

AU - Holt, Kathryn E.

AU - Duy, Pham Thanh

AU - Day, Jeremy N.

AU - Campbel, James I.

AU - Dougan, Gordon

AU - Dolecek, Christiane

AU - Farrar, Jeremy

AU - Basnyat, Buddha

AU - Baker, Stephen

PY - 2010/12/9

Y1 - 2010/12/9

N2 - 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.

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