Dynamic Incidence of Typhoid Fever over a 10-Year Period (2010-2019) in Kibera, an Urban Informal Settlement in Nairobi, Kenya

• Type of Material: Article
• Authors: Eri Ng'eno, Kenya Medical Research Institute, Nairobi; Margaret Lind, Yale University; Allan Audi, Kenya Medical Research Institute, Nairobi; Alice Ouma, Kenya Medical Research Institute, Nairobi; Clifford Oduor, Kenya Medical Research Institute, Nairobi; Patrick K Munywoki, Centers for Disease Control and Prevention, Nairobi; George O Agogo, Centers for Disease Control and Prevention, Nairobi; George Odongo, Centers for Disease Control and Prevention, Atlanta; Samuel Kiplangat, Kenya Medical Research Institute, Nairobi; Newton Wamola, Kenya Medical Research Institute, Nairobi; Mike Powel Osita, Kenya Medical Research Institute, Nairobi; Robert Mugoh, Kenya Medical Research Institute, Nairobi; Caroline Ochieng, Kenya Medical Research Institute, Nairobi; Victor Omballa, Kenya Medical Research Institute, Nairobi; Ondari D Mogeni, Kenya Medical Research Institute, Nairobi; Matthew Mikoleit, Centers for Disease Control and Prevention, Atlanta; Barry S Fields, Centers for Disease Control and Prevention, Atlanta; Joel M Montgomery, Centers for Disease Control and Prevention, Atlanta; Jillian Gauld, Institute for Disease Modelling, Seattle, Washington; Robert F Breiman, Emory University; Bonventure Juma, Centers for Disease Control and Prevention, Nairobi; Elizabeth Hunsperger, Centers for Disease Control and Prevention, Nairobi; Marc-Alain Widdowson, Institute of Tropical Medicine, Antwerp; Godfrey Bigogo, Kenya Medical Research Institute, Kisumu; Eric D Mintz, Centers for Disease Control and Prevention, Atlanta; Jennifer R Verani, Centers for Disease Control and Prevention, Atlanta
• Language: English
• Date: 2023-07-01
• Publisher: Emory University Libraries
• Publication Version: Final Published Version
• Copyright Statement: © 2022 The American Journal of Tropical Medicine and Hygiene
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.4269/ajtmh.22-0736
• Title of Journal or Parent Work: American Journal of Tropical Medicine and Hygiene
• Volume: 109
• Issue: 1
• Start Page: 22
• End Page: 31
• Grant/Funding Information: Funding for the PBIDS platform in Kibera is provided by the U.S. CDC through a cooperative agreement with Kenya Medical Research Institute. This work was also supported in part by the Bill & Melinda Gates Foundation (Grant no. OPP1162700). The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the CDC and Kenya Medical Research Institute.
• Keywords: Kenya; Child; Humans; Typhoid Fever; Salmonella typhi; Child, Preschool; Anti-Bacterial Agents; Incidence; Ciprofloxacin
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Typhoid fever burden can vary over time. Long-term data can inform prevention strategies; however, such data are lacking in many African settings. We reexamined typhoid fever incidence and antimicrobial resistance (AMR) over a 10-year period in Kibera, a densely populated urban informal settlement where a high burden has been previously described. We used data from the Population Based Infectious Diseases Surveillance platform to estimate crude and adjusted incidence rates and prevalence of AMR in nearly 26, 000 individuals of all ages. Demographic and healthcare-seeking information was collected through household visits. Blood cultures were processed for patients with acute fever or lower respiratory infection. Between 2010 and 2019, 16, 437 participants were eligible for blood culture and 11, 848 (72.1%) had a culture performed. Among 11, 417 noncontaminated cultures (96.4%), 237 grew Salmonella enterica serovar Typhi (2.1%). Overall crude and adjusted incidences were 95 and 188 cases per 100, 000 person-years of observation (pyo), respectively. Annual crude incidence varied from 144 to 233 between 2010 and 2012 and from 9 to 55 between 2013 and 2018 and reached 130 per 100, 000 pyo in 2019. Children 5-9 years old had the highest overall incidence (crude, 208; adjusted, 359 per 100, 000 pyo). Among isolates tested, 156 of 217 were multidrug resistant (resistant to chloramphenicol, ampicillin, and trimethoprim/sulfamethoxazole [71.9%]) and 6 of 223 were resistant to ciprofloxacin (2.7%). Typhoid fever incidence resurged in 2019 after a prolonged period of low rates, with the highest incidence among children. Typhoid fever control measures, including vaccines, could reduce morbidity in this setting.