Determining the Best Immunization Strategy for Protecting African Children Against Invasive Salmonella Disease

• Type of Material: Article
• Authors: Hyon Jin Jeon, International Vaccine Institute; Gi Deok Pak, International Vaccine Institute; Justin Im, International Vaccine Institute; Ellis Owusu-Dabo, Kwame Nkrumah University Science & Technology; Yaw Adu-Sarkodie, Kwame Nkrumah University Science & Technology; Amy Gassama Sow, Institute Pasteur de Dakar; Abdramane Bassiahi Soura, University of Ouagadougou; Nagla Gasmelseed, University of Gezira; Karen H Keddy, University of Witwatersrand; Morten Bjerregaard-Andersen, Bandim Health Project; Frank Konings, International Vaccine Institute; Abraham Aseffa, ALERT Campus; John A Crump, Kilimanjaro Christian Medical Centre; Yun Chon, International Vaccine Institute; Robert Breiman, Emory University; Se Eun Park, International Vaccine Institute; Ligia Maria Cruz Espinoza, International Vaccine Institute; Hye Jin Seo, International Vaccine Institute; Jurgen May, Bernhard Nocht Institute for Tropical Medicine; Christian G Meyer, Eberhard Karls University of Tubingen; Jason R Andrews, Stanford University; Ursula Panzner, International Vaccine Institute; Vera von Kalckreuth, International Vaccine Institute; Thomas F Wierzba, International Vaccine Institute; Raphael Rakotozandrindrainy, University of Antananarivo; Gordon Dougan, University of Cambridge; Myron M Levine, University of Maryland; Joachim Hombach, World Health Organization; Jerome H Kim, International Vaccine Institute; John D Clemens, International Center for Diarrheal Disease Research; Stephen Baker, University of Oxford; Florian Marks, International Vaccine Institute
• Language: English
• Date: 2018-12-15
• Publisher: Oxford University Press (OUP): Policy B - Oxford Open Option C
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/cid/ciy386
• Title of Journal or Parent Work: Clinical Infectious Diseases
• ISSN: 1058-4838
• Volume: 67
• Issue: 12
• Start Page: 1824
• End Page: 1830
• Grant/Funding Information: This study was supported by the Bill & Melinda Gates Foundation (grants OPPGH5231 and OPP1127988). The International Vaccine Institute acknowledges its donors, including the Republic of Korea and the Swedish International Development Cooperation Agency.
• Keywords: Science & Technology; BURDEN; iNTS disease; EFFICACY; CONJUGATE VACCINE; Immunology; BLOOD; MULTICENTER; Salmonella Typhi; Microbiology; immunization; TYPHOID-FEVER; Life Sciences & Biomedicine; Infectious Diseases; typhoid conjugate vaccine; VI-CAPSULAR POLYSACCHARIDE; COUNTRIES
• Research Categories: Health Sciences, Immunology; Biology, Microbiology

Abstract

Background: The World Health Organization recently prequalified a typhoid conjugate vaccine (TCV), recommending its use in persons ≥6 months to 45 years residing in typhoid fever (TF)-endemic areas. We now need to consider how TCVs can have the greatest impact in the most vulnerable populations. Methods: The Typhoid Fever Surveillance in Africa Program (TSAP) was a blood culture-based surveillance of febrile patients from defined populations presenting at healthcare facilities in 10 African countries. TF and invasive non-typhoidal Salmonella (iNTS) disease incidences were estimated for 0-10 year-olds in one-year age increments. Results: Salmonella Typhi and iNTS were the most frequently isolated pathogens; 135 and 94 cases were identified, respectively. Analysis from three countries was excluded (incomplete person-years of observation (PYO) data). Thirty-seven of 123 TF cases (30.1%) and 71/90 iNTS disease cases (78.9%) occurred in children aged <5 years. No TF and 8/90 iNTS infections (8.9%) were observed in infants aged <9 months. The TF incidences (/100 000 PYO) for children aged <1 year and 1 to <2 years were 5 and 39, respectively; the highest incidence was 304 per 100 000 PYO in 4 to <5 year-olds. The iNTS disease incidence in the defined age groups ranged between 81 and 233 per 100 000 PYO, highest in 1 to <2 year-olds. TF and iNTS disease incidences were higher in West Africa. Conclusions: High burden of TF detected in young children strengthens the need for TCV introduction. Given the concurrent iNTS disease burden, development of a trivalent vaccine against S. Typhi, S. Typhimurium, and S. Enteritidis may be timely in this region.