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

Thomas C. Darton, James E. Meiring, Susan Tonks, Md Arifuzzaman Khan, Farhana Khanam, Mila Shakya, Deus Thindwa, Stephen Baker, Buddha Basnyat, John D. Clemens, Gordon Dougan, Christiane Dolecek, Sarah J. Dunstan, Melita A Gordon, Robert S. Heyderman, Kathryn E Holt, Virginia E Pitzer, Firdausi Qadri, Tunku Kamarul Zaman, Andrew J. Pollard & 1 others STRATAA Study Consortium

Research output: Contribution to journalReview ArticleOtherpeer-review

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 languageEnglish
Article numbere016283
Number of pages9
JournalBMJ Open
Volume7
Issue number6
DOIs
Publication statusPublished - 1 Jun 2017
Externally publishedYes

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

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. / 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. In: BMJ Open. 2017 ; Vol. 7, No. 6.
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title = "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",
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.",
keywords = "Africa, Asia, diagnosis, enteric fever, febrile illness, healthcare utilisation, infection transmission, resource-limited setting, salmonella paratyphi a, salmonella typhi, seroepidemiology, serosurveillance, vaccination programme",
author = "Darton, {Thomas C.} and Meiring, {James E.} and Susan Tonks and Khan, {Md Arifuzzaman} and Farhana Khanam and Mila Shakya and Deus Thindwa and Stephen Baker and Buddha Basnyat and Clemens, {John D.} and Gordon Dougan and Christiane Dolecek and Dunstan, {Sarah J.} and Gordon, {Melita A} and Heyderman, {Robert S.} and Holt, {Kathryn E} and Pitzer, {Virginia E} and Firdausi Qadri and {Kamarul Zaman}, Tunku and Pollard, {Andrew J.} and {STRATAA Study Consortium}",
year = "2017",
month = "6",
day = "1",
doi = "10.1136/bmjopen-2017-016283",
language = "English",
volume = "7",
journal = "BMJ Open",
issn = "2044-6055",
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number = "6",

}

Darton, TC, Meiring, JE, Tonks, S, Khan, MA, Khanam, F, Shakya, M, Thindwa, D, Baker, S, Basnyat, B, Clemens, JD, Dougan, G, Dolecek, C, Dunstan, SJ, Gordon, MA, Heyderman, RS, Holt, KE, Pitzer, VE, Qadri, F, Kamarul Zaman, T, Pollard, AJ & STRATAA Study Consortium 2017, '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' BMJ Open, vol. 7, no. 6, e016283. https://doi.org/10.1136/bmjopen-2017-016283

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 journalReview ArticleOtherpeer-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 -