Abstract
Introduction: Invasive infections caused by Salmonella enterica serovar Typhi and Paratyphi A are estimated to account for 12-27 million febrile illness episodes worldwide annually. Determining the true burden of typhoidal Salmonellae infections is hindered by lack of population-based studies and adequate laboratory diagnostics. The Strategic Typhoid alliance across Africa and Asia study takes a systematic approach to measuring the age-stratified burden of clinical and subclinical disease caused by typhoidal Salmonellae infections at three high-incidence urban sites in Africa and Asia. We aim to explore the natural history of Salmonella transmission in endemic settings, addressing key uncertainties relating to the epidemiology of enteric fever identified through mathematical models, and enabling optimisation of vaccine strategies. Methods/design: Using census-defined denominator populations of ≥100 000 individuals at sites in Malawi, Bangladesh and Nepal, the primary outcome is to characterise the burden of enteric fever in these populations over a 24-month period. During passive surveillance, clinical and household data, and laboratory samples will be collected from febrile individuals. In parallel, healthcare utilisation and water, sanitation and hygiene surveys will be performed to characterise healthcare-seeking behaviour and assess potential routes of transmission. The rates of both undiagnosed and subclinical exposure to typhoidal Salmonellae (seroincidence), identification of chronic carriage and population seroprevalence of typhoid infection will be assessed through age-stratified serosurveys performed at each site. Secondary attack rates will be estimated among household contacts of acute enteric fever cases and possible chronic carriers. Ethics and dissemination: This protocol has been ethically approved by the Oxford Tropical Research Ethics Committee, the icddr,b Institutional Review Board, the Malawian National Health Sciences Research Committee and College of Medicine Research Ethics Committee and Nepal Health Research Council. The study is being conducted in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice. Informed consent was obtained before study enrolment. Results will be submitted to international peer-reviewed journals and presented at international conferences.
| Original language | English |
|---|---|
| Article number | e016283 |
| Number of pages | 9 |
| Journal | BMJ Open |
| Volume | 7 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - 1 Jun 2017 |
| Externally published | Yes |
Keywords
- Africa
- Asia
- diagnosis
- enteric fever
- febrile illness
- healthcare utilisation
- infection transmission
- resource-limited setting
- salmonella paratyphi a
- salmonella typhi
- seroepidemiology
- serosurveillance
- vaccination programme
Cite this
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The STRATAA study protocol : A programme to assess the burden of enteric fever in Bangladesh, Malawi and Nepal using prospective population census, passive surveillance, serological studies and healthcare utilisation surveys. / Darton, Thomas C.; Meiring, James E.; Tonks, Susan; Khan, Md Arifuzzaman; Khanam, Farhana; Shakya, Mila; Thindwa, Deus; Baker, Stephen; Basnyat, Buddha; Clemens, John D.; Dougan, Gordon; Dolecek, Christiane; Dunstan, Sarah J.; Gordon, Melita A; Heyderman, Robert S.; Holt, Kathryn E; Pitzer, Virginia E; Qadri, Firdausi; Kamarul Zaman, Tunku; Pollard, Andrew J.; STRATAA Study Consortium.
In: BMJ Open, Vol. 7, No. 6, e016283, 01.06.2017.Research output: Contribution to journal › Review Article › Other › peer-review
TY - JOUR
T1 - The STRATAA study protocol
T2 - A programme to assess the burden of enteric fever in Bangladesh, Malawi and Nepal using prospective population census, passive surveillance, serological studies and healthcare utilisation surveys
AU - Darton, Thomas C.
AU - Meiring, James E.
AU - Tonks, Susan
AU - Khan, Md Arifuzzaman
AU - Khanam, Farhana
AU - Shakya, Mila
AU - Thindwa, Deus
AU - Baker, Stephen
AU - Basnyat, Buddha
AU - Clemens, John D.
AU - Dougan, Gordon
AU - Dolecek, Christiane
AU - Dunstan, Sarah J.
AU - Gordon, Melita A
AU - Heyderman, Robert S.
AU - Holt, Kathryn E
AU - Pitzer, Virginia E
AU - Qadri, Firdausi
AU - Kamarul Zaman, Tunku
AU - Pollard, Andrew J.
AU - STRATAA Study Consortium
PY - 2017/6/1
Y1 - 2017/6/1
N2 - Introduction: Invasive infections caused by Salmonella enterica serovar Typhi and Paratyphi A are estimated to account for 12-27 million febrile illness episodes worldwide annually. Determining the true burden of typhoidal Salmonellae infections is hindered by lack of population-based studies and adequate laboratory diagnostics. The Strategic Typhoid alliance across Africa and Asia study takes a systematic approach to measuring the age-stratified burden of clinical and subclinical disease caused by typhoidal Salmonellae infections at three high-incidence urban sites in Africa and Asia. We aim to explore the natural history of Salmonella transmission in endemic settings, addressing key uncertainties relating to the epidemiology of enteric fever identified through mathematical models, and enabling optimisation of vaccine strategies. Methods/design: Using census-defined denominator populations of ≥100 000 individuals at sites in Malawi, Bangladesh and Nepal, the primary outcome is to characterise the burden of enteric fever in these populations over a 24-month period. During passive surveillance, clinical and household data, and laboratory samples will be collected from febrile individuals. In parallel, healthcare utilisation and water, sanitation and hygiene surveys will be performed to characterise healthcare-seeking behaviour and assess potential routes of transmission. The rates of both undiagnosed and subclinical exposure to typhoidal Salmonellae (seroincidence), identification of chronic carriage and population seroprevalence of typhoid infection will be assessed through age-stratified serosurveys performed at each site. Secondary attack rates will be estimated among household contacts of acute enteric fever cases and possible chronic carriers. Ethics and dissemination: This protocol has been ethically approved by the Oxford Tropical Research Ethics Committee, the icddr,b Institutional Review Board, the Malawian National Health Sciences Research Committee and College of Medicine Research Ethics Committee and Nepal Health Research Council. The study is being conducted in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice. Informed consent was obtained before study enrolment. Results will be submitted to international peer-reviewed journals and presented at international conferences.
AB - Introduction: Invasive infections caused by Salmonella enterica serovar Typhi and Paratyphi A are estimated to account for 12-27 million febrile illness episodes worldwide annually. Determining the true burden of typhoidal Salmonellae infections is hindered by lack of population-based studies and adequate laboratory diagnostics. The Strategic Typhoid alliance across Africa and Asia study takes a systematic approach to measuring the age-stratified burden of clinical and subclinical disease caused by typhoidal Salmonellae infections at three high-incidence urban sites in Africa and Asia. We aim to explore the natural history of Salmonella transmission in endemic settings, addressing key uncertainties relating to the epidemiology of enteric fever identified through mathematical models, and enabling optimisation of vaccine strategies. Methods/design: Using census-defined denominator populations of ≥100 000 individuals at sites in Malawi, Bangladesh and Nepal, the primary outcome is to characterise the burden of enteric fever in these populations over a 24-month period. During passive surveillance, clinical and household data, and laboratory samples will be collected from febrile individuals. In parallel, healthcare utilisation and water, sanitation and hygiene surveys will be performed to characterise healthcare-seeking behaviour and assess potential routes of transmission. The rates of both undiagnosed and subclinical exposure to typhoidal Salmonellae (seroincidence), identification of chronic carriage and population seroprevalence of typhoid infection will be assessed through age-stratified serosurveys performed at each site. Secondary attack rates will be estimated among household contacts of acute enteric fever cases and possible chronic carriers. Ethics and dissemination: This protocol has been ethically approved by the Oxford Tropical Research Ethics Committee, the icddr,b Institutional Review Board, the Malawian National Health Sciences Research Committee and College of Medicine Research Ethics Committee and Nepal Health Research Council. The study is being conducted in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice. Informed consent was obtained before study enrolment. Results will be submitted to international peer-reviewed journals and presented at international conferences.
KW - Africa
KW - Asia
KW - diagnosis
KW - enteric fever
KW - febrile illness
KW - healthcare utilisation
KW - infection transmission
KW - resource-limited setting
KW - salmonella paratyphi a
KW - salmonella typhi
KW - seroepidemiology
KW - serosurveillance
KW - vaccination programme
UR - http://www.scopus.com/inward/record.url?scp=85021725479&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2017-016283
DO - 10.1136/bmjopen-2017-016283
M3 - Review Article
VL - 7
JO - BMJ Open
JF - BMJ Open
SN - 2044-6055
IS - 6
M1 - e016283
ER -