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Typhoid fever in children aged less than 5 years.
Lancet. 1999 Aug 28; 354(9180):734-7.Lct

Abstract

BACKGROUND

Calculation of the incidence of typhoid fever during preschool years is important to define the optimum age of immunisation and the choice of vaccines for public-health programmes in developing countries. Hospital-based studies have suggested that children younger than 5 years do not need vaccination against typhoid fever, but this view needs to be re-examined in community-based longitudinal studies. We undertook a prospective follow-up study of residents of a low-income urban area of Delhi, India, with active surveillance for case detection.

METHODS

A baseline census was undertaken in 1995. Between Nov 1, 1995, and Oct 31, 1996, we visited 8172 residents of 1820 households in Kalkaji, Delhi, twice weekly to detect febrile cases. Blood samples were obtained from febrile patients, and those who tested positive for Salmonella typhi were treated with ciprofloxacin.

FINDINGS

63 culture-positive typhoid fever cases were detected. Of these, 28 (44%) were in children aged under 5 years. The incidence rate of typhoid per 1000 person-years was 27.3 at age under 5 years, 11.7 at 5-19 years, and 1.1 between 19 and 40 years. The difference in the incidence of typhoid fever between those under 5 years and those aged 5-19 years (15.6 per 1000 person-years [95% CI 4.7-26.5]), and those aged 19-40 years (26.2 [16.0-36.3]) was significant (p<0.001 for both). The difference between the incidence of typhoid at 5-19 years and the incidence at 19-40 years was also significant (10.6 [6.3-14.8], p<0.001). Morbidity in those under 5 and in older people was similar in terms of duration of fever, signs and symptoms, and need for hospital admission.

INTERPRETATION

Our findings challenge the common view that typhoid fever is a disorder of school-age children and of adults. Typhoid is a common and significant cause of morbidity between 1 and 5 years of age. The optimum age of typhoid immunisation and the choice of vaccines needs to be reassessed.

Authors+Show Affiliations

Indian Council for Medical Research, Advanced Centre for Diarrhoeal Disease Research, Division of Paediatric Gastroenterology, New Delhi.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

10475185

Citation

Sinha, A, et al. "Typhoid Fever in Children Aged Less Than 5 Years." Lancet (London, England), vol. 354, no. 9180, 1999, pp. 734-7.
Sinha A, Sazawal S, Kumar R, et al. Typhoid fever in children aged less than 5 years. Lancet. 1999;354(9180):734-7.
Sinha, A., Sazawal, S., Kumar, R., Sood, S., Reddaiah, V. P., Singh, B., Rao, M., Naficy, A., Clemens, J. D., & Bhan, M. K. (1999). Typhoid fever in children aged less than 5 years. Lancet (London, England), 354(9180), 734-7.
Sinha A, et al. Typhoid Fever in Children Aged Less Than 5 Years. Lancet. 1999 Aug 28;354(9180):734-7. PubMed PMID: 10475185.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Typhoid fever in children aged less than 5 years. AU - Sinha,A, AU - Sazawal,S, AU - Kumar,R, AU - Sood,S, AU - Reddaiah,V P, AU - Singh,B, AU - Rao,M, AU - Naficy,A, AU - Clemens,J D, AU - Bhan,M K, PY - 1999/9/4/pubmed PY - 2000/3/18/medline PY - 1999/9/4/entrez KW - Age Factors KW - Asia KW - Bacterial And Fungal Diseases KW - Child KW - Community Health Services KW - Delivery Of Health Care KW - Demographic Factors KW - Developing Countries KW - Diseases KW - Health KW - Health Services KW - Immunization KW - India KW - Infections KW - Population KW - Population Characteristics KW - Primary Health Care KW - Public Health KW - Research Report KW - Southern Asia KW - Typhoid Fever KW - Vaccination KW - Youth SP - 734 EP - 7 JF - Lancet (London, England) JO - Lancet VL - 354 IS - 9180 N2 - BACKGROUND: Calculation of the incidence of typhoid fever during preschool years is important to define the optimum age of immunisation and the choice of vaccines for public-health programmes in developing countries. Hospital-based studies have suggested that children younger than 5 years do not need vaccination against typhoid fever, but this view needs to be re-examined in community-based longitudinal studies. We undertook a prospective follow-up study of residents of a low-income urban area of Delhi, India, with active surveillance for case detection. METHODS: A baseline census was undertaken in 1995. Between Nov 1, 1995, and Oct 31, 1996, we visited 8172 residents of 1820 households in Kalkaji, Delhi, twice weekly to detect febrile cases. Blood samples were obtained from febrile patients, and those who tested positive for Salmonella typhi were treated with ciprofloxacin. FINDINGS: 63 culture-positive typhoid fever cases were detected. Of these, 28 (44%) were in children aged under 5 years. The incidence rate of typhoid per 1000 person-years was 27.3 at age under 5 years, 11.7 at 5-19 years, and 1.1 between 19 and 40 years. The difference in the incidence of typhoid fever between those under 5 years and those aged 5-19 years (15.6 per 1000 person-years [95% CI 4.7-26.5]), and those aged 19-40 years (26.2 [16.0-36.3]) was significant (p<0.001 for both). The difference between the incidence of typhoid at 5-19 years and the incidence at 19-40 years was also significant (10.6 [6.3-14.8], p<0.001). Morbidity in those under 5 and in older people was similar in terms of duration of fever, signs and symptoms, and need for hospital admission. INTERPRETATION: Our findings challenge the common view that typhoid fever is a disorder of school-age children and of adults. Typhoid is a common and significant cause of morbidity between 1 and 5 years of age. The optimum age of typhoid immunisation and the choice of vaccines needs to be reassessed. SN - 0140-6736 UR - https://www.unboundmedicine.com/medline/citation/10475185/Typhoid_fever_in_children_aged_less_than_5_years_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0140-6736(98)09001-1 DB - PRIME DP - Unbound Medicine ER -