Estimating typhoid incidence from community-based serosurveys: a multicohort study

Kristen Aiemjoy; Jessica C Seidman; Senjuti Saha; Sira Jam Munira; Mohammad Saiful Islam Sajib; Syed Muktadir Al Sium; Anik Sarkar; Nusrat Alam; Farha Nusrat Zahan; Md Shakiul Kabir; Dipesh Tamrakar; Krista Vaidya; Rajeev Shrestha; Jivan Shakya; Nishan Katuwal; Sony Shrestha; Mohammad Tahir Yousafzai; Junaid Iqbal; Irum Fatima Dehraj; Yasmin Ladak; Noshi Maria; Mehreen Adnan; Sadaf Pervaiz; Alice S Carter; Ashley T Longley; Clare Fraser; Edward T Ryan; Ariana Nodoushani; Alessio Fasano; Maureen M Leonard; Victoria Kenyon; Isaac I Bogoch; Hyon Jin Jeon; Andrea Haselbeck; Se Eun Park; Raphaël M Zellweger; Florian Marks; Ellis Owusu-Dabo; Yaw Adu-Sarkodie; Michael Owusu; Peter Teunis; Stephen P Luby; Denise O Garrett; Farah Naz Qamar; Samir K Saha; Richelle C Charles; Jason R Andrews

doi:10.1016/S2666-5247(22)00114-8

Estimating typhoid incidence from community-based serosurveys: a multicohort study

Lancet Microbe. 2022 Aug;3(8):e578-e587. doi: 10.1016/S2666-5247(22)00114-8. Epub 2022 Jun 21.

Authors

Kristen Aiemjoy¹, Jessica C Seidman², Senjuti Saha³, Sira Jam Munira³, Mohammad Saiful Islam Sajib³, Syed Muktadir Al Sium⁴, Anik Sarkar³, Nusrat Alam³, Farha Nusrat Zahan³, Md Shakiul Kabir³, Dipesh Tamrakar⁵, Krista Vaidya⁵, Rajeev Shrestha⁵, Jivan Shakya⁵, Nishan Katuwal⁵, Sony Shrestha⁵, Mohammad Tahir Yousafzai⁶, Junaid Iqbal⁶, Irum Fatima Dehraj⁶, Yasmin Ladak⁶, Noshi Maria⁶, Mehreen Adnan⁶, Sadaf Pervaiz⁶, Alice S Carter², Ashley T Longley⁷, Clare Fraser⁸, Edward T Ryan⁹, Ariana Nodoushani⁸, Alessio Fasano¹⁰, Maureen M Leonard¹⁰, Victoria Kenyon¹¹, Isaac I Bogoch¹², Hyon Jin Jeon¹³, Andrea Haselbeck¹⁴, Se Eun Park¹⁴, Raphaël M Zellweger¹⁴, Florian Marks¹⁵, Ellis Owusu-Dabo¹⁶, Yaw Adu-Sarkodie¹⁶, Michael Owusu¹⁶, Peter Teunis¹⁷, Stephen P Luby¹⁸, Denise O Garrett², Farah Naz Qamar⁶, Samir K Saha³, Richelle C Charles⁹, Jason R Andrews¹⁸

Affiliations

¹ Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA; Division of Epidemiology, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA. Electronic address: kaiemjoy@ucdavis.edu.
² Sabin Vaccine Institute, Washington, DC, USA.
³ Child Health Research Foundation, Dhaka, Bangladesh.
⁴ Child Health Research Foundation, Dhaka, Bangladesh; Bangladesh Council of Scientific and Industrial Research, Dhaka, Bangladesh.
⁵ Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal.
⁶ Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
⁷ Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
⁸ Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.
⁹ Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA; Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA.
¹⁰ Center for Celiac Research and Treatment, MassGeneral Hospital for Children, Boston, MA, USA; Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA.
¹¹ Center for Celiac Research and Treatment, MassGeneral Hospital for Children, Boston, MA, USA.
¹² Department of Medicine, University of Toronto, Toronto, ON, Canada.
¹³ International Vaccine Institute, Seoul, South Korea; Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK.
¹⁴ International Vaccine Institute, Seoul, South Korea.
¹⁵ International Vaccine Institute, Seoul, South Korea; Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK; Department of Microbiology and Parasitology, University of Antananarivo, Antananarivo, Madagascar; Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.
¹⁶ School of Medical Sciences, Kwame Nkrumah University for Science and Technology, Kumasi, Ghana.
¹⁷ Center for Global Safe Water, Sanitation and Hygiene, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
¹⁸ Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA.

Abstract

Background: The incidence of enteric fever, an invasive bacterial infection caused by typhoidal Salmonellae (Salmonella enterica serovars Typhi and Paratyphi), is largely unknown in regions without blood culture surveillance. The aim of this study was to evaluate whether new diagnostic serological markers for typhoidal Salmonella can reliably estimate population-level incidence.

Methods: We collected longitudinal blood samples from patients with blood culture-confirmed enteric fever enrolled from surveillance studies in Bangladesh, Nepal, Pakistan, and Ghana between 2016 and 2021 and conducted cross-sectional serosurveys in the catchment areas of each surveillance site. We used ELISAs to measure quantitative IgA and IgG antibody responses to hemolysin E and S Typhi lipopolysaccharide. We used Bayesian hierarchical models to fit two-phase power-function decay models to the longitudinal antibody responses among enteric fever cases and used the joint distributions of the peak antibody titres and decay rate to estimate population-level incidence rates from cross-sectional serosurveys.

Findings: The longitudinal antibody kinetics for all antigen-isotypes were similar across countries and did not vary by clinical severity. The seroincidence of typhoidal Salmonella infection among children younger than 5 years ranged between 58·5 per 100 person-years (95% CI 42·1-81·4) in Dhaka, Bangladesh, to 6·6 per 100 person-years (4·3-9·9) in Kavrepalanchok, Nepal, and followed the same rank order as clinical incidence estimates.

Interpretation: The approach described here has the potential to expand the geographical scope of typhoidal Salmonella surveillance and generate incidence estimates that are comparable across geographical regions and time.

Funding: Bill & Melinda Gates Foundation.

Translations: For the Nepali, Bengali and Urdu translations of the abstract see Supplementary Materials section.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Bangladesh / epidemiology
Bayes Theorem
Child
Cross-Sectional Studies
Humans
Incidence
Salmonella
Typhoid Fever* / diagnosis

Abstract

Publication types

MeSH terms

Grants and funding