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Trends, Associations, and Antimicrobial Resistance of Salmonella Typhi and Paratyphi in Pakistan.
Am J Trop Med Hyg. 2018 09; 99(3_Suppl):48-54.AJ

Abstract

Typhoid remains a major cause of morbidity and mortality in endemic countries. This review analyzed typhoid burden changes in Pakistan and its association with contextual factors. A retrospective cohort study on blood culture-positive typhoid and antibiotic resistance was conducted from three tertiary hospitals and contextual factor data obtained from primary household surveys. Salmonella Typhi/Paratyphi positivity rates were estimated and trend analysis was carried out using positive cases out of total number of blood cultures performed. Contextual factors' associations were determined through bivariate correlation analysis, using STATA (SataCorp, College Station, TX). We report a total of 17,387 S. Typhi-positive and 8,286 S. Paratyphi A and B-positive specimens from 798,137 blood cultures performed. The results suggest an overall decline in typhoid incidence as S. Typhi positivity rates declined from 6.42% in 1992 to 1.32% in 2015 and S. Paratyphi (A and B) from 1.29% to 0.39%. Subgroup analysis suggests higher S. Typhi prevalence in adults older than 18 years, whereas S. Paratyphi is greater in children aged 5-18 years. The relative contribution of S. Paratyphi to overall confirmed cases increased from 16.8% in 1992 to 23% in 2015. The analysis suggests high burden of fluoroquinolone resistance and multidrug-resistant S. Typhi strains. Statistically significant associations of water, sanitation indicators, and literacy rates were observed with typhoid positivity. Despite some progress, typhoid remains endemic and a strong political will is required for targeted typhoid control strategies. A multipronged approach of improving water, sanitation and hygiene in combination with large-scale immunization in endemic settings of Pakistan could help reduce burden and prevent epidemics.

Authors+Show Affiliations

Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan.Department of Pathology, The Aga Khan University, Karachi, Pakistan.Department of Pathology, The Aga Khan University, Karachi, Pakistan.Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan.Armed Forces Institute of Pathology, National University of Medical Sciences, Rawalpindi, Pakistan.Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan.Armed Forces Institute of Pathology, National University of Medical Sciences, Rawalpindi, Pakistan.Department of Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada. Centre of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan. Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada.

Pub Type(s)

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

Language

eng

PubMed ID

30047366

Citation

Das, Jai K., et al. "Trends, Associations, and Antimicrobial Resistance of Salmonella Typhi and Paratyphi in Pakistan." The American Journal of Tropical Medicine and Hygiene, vol. 99, no. 3_Suppl, 2018, pp. 48-54.
Das JK, Hasan R, Zafar A, et al. Trends, Associations, and Antimicrobial Resistance of Salmonella Typhi and Paratyphi in Pakistan. Am J Trop Med Hyg. 2018;99(3_Suppl):48-54.
Das, J. K., Hasan, R., Zafar, A., Ahmed, I., Ikram, A., Nizamuddin, S., Fatima, S., Akbar, N., Sultan, F., & Bhutta, Z. A. (2018). Trends, Associations, and Antimicrobial Resistance of Salmonella Typhi and Paratyphi in Pakistan. The American Journal of Tropical Medicine and Hygiene, 99(3_Suppl), 48-54. https://doi.org/10.4269/ajtmh.18-0145
Das JK, et al. Trends, Associations, and Antimicrobial Resistance of Salmonella Typhi and Paratyphi in Pakistan. Am J Trop Med Hyg. 2018;99(3_Suppl):48-54. PubMed PMID: 30047366.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Trends, Associations, and Antimicrobial Resistance of Salmonella Typhi and Paratyphi in Pakistan. AU - Das,Jai K, AU - Hasan,Rumina, AU - Zafar,Afia, AU - Ahmed,Imran, AU - Ikram,Aamer, AU - Nizamuddin,Summiya, AU - Fatima,Saleel, AU - Akbar,Nauman, AU - Sultan,Faisal, AU - Bhutta,Zulfiqar A, Y1 - 2018/07/24/ PY - 2018/7/27/pubmed PY - 2019/9/4/medline PY - 2018/7/27/entrez SP - 48 EP - 54 JF - The American journal of tropical medicine and hygiene JO - Am J Trop Med Hyg VL - 99 IS - 3_Suppl N2 - Typhoid remains a major cause of morbidity and mortality in endemic countries. This review analyzed typhoid burden changes in Pakistan and its association with contextual factors. A retrospective cohort study on blood culture-positive typhoid and antibiotic resistance was conducted from three tertiary hospitals and contextual factor data obtained from primary household surveys. Salmonella Typhi/Paratyphi positivity rates were estimated and trend analysis was carried out using positive cases out of total number of blood cultures performed. Contextual factors' associations were determined through bivariate correlation analysis, using STATA (SataCorp, College Station, TX). We report a total of 17,387 S. Typhi-positive and 8,286 S. Paratyphi A and B-positive specimens from 798,137 blood cultures performed. The results suggest an overall decline in typhoid incidence as S. Typhi positivity rates declined from 6.42% in 1992 to 1.32% in 2015 and S. Paratyphi (A and B) from 1.29% to 0.39%. Subgroup analysis suggests higher S. Typhi prevalence in adults older than 18 years, whereas S. Paratyphi is greater in children aged 5-18 years. The relative contribution of S. Paratyphi to overall confirmed cases increased from 16.8% in 1992 to 23% in 2015. The analysis suggests high burden of fluoroquinolone resistance and multidrug-resistant S. Typhi strains. Statistically significant associations of water, sanitation indicators, and literacy rates were observed with typhoid positivity. Despite some progress, typhoid remains endemic and a strong political will is required for targeted typhoid control strategies. A multipronged approach of improving water, sanitation and hygiene in combination with large-scale immunization in endemic settings of Pakistan could help reduce burden and prevent epidemics. SN - 1476-1645 UR - https://www.unboundmedicine.com/medline/citation/30047366/Trends_Associations_and_Antimicrobial_Resistance_of_Salmonella_Typhi_and_Paratyphi_in_Pakistan_ L2 - https://ajtmh.org/doi/10.4269/ajtmh.18-0145 DB - PRIME DP - Unbound Medicine ER -