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Preventive Medicine Reports Feb 2022Typhoid fever continues to be a health challenge in low-and middle-income countries where access to clean water and sanitation infrastructure is scarce. The...
Typhoid fever continues to be a health challenge in low-and middle-income countries where access to clean water and sanitation infrastructure is scarce. The non-confirmatory diagnostic method continues to hinder effective diagnosis and treatment, ensuring in a high antimicrobial resistance. This systematic review and -analysis aimed to estimate the pooled prevalence and antimicrobial susceptibility level of typhoid fever in Ethiopia. The review was designed based on the condition-context-population review approach. Fifteen eligible articles were identified from PubMed, Google Scholar, and Science Direct databases. Risk of bias and quality of studies were assessed using the Joanna Briggs Institute's appraisal criteria. Heterogeneity was assessed using Cochran's Q test and statistics. The review protocol was registered in PROSPERO (registration number CRD42021224478). The estimated pooled prevalence of typhoid fever from blood and stool culture diagnosis was 3% (95% CI: 2%-4%, ) ( = 82.25) and Widal test examination 33% (95% CI: 22%-44%) ( = 99.14). The sub-group analyses identified a lower detection of typhoid fever of 2% (95% CI: 1%-3%) among febrile patients compared to typhoid suspected cases of 6% (95% CI: 2%-9%). The stool culture test identified was twofold higher, value of 4% (95% CI: 2%-7%) S. Typhi infection than blood culture test of 2% (95% CI: 1%-4%). The antimicrobial susceptibility of S. Typhi for antibiotics was 94%, 80% and 65% for ceftriaxone, ciprofloxacin, and gentamycin respectively. Low susceptibility of S. Typhi isolates against nalidixic acid 22% (95% CI: 2%-46%) and chloramphenicol 11% (95% CI: 2%-20%) were observed. The diagnosis of typhoid fever was under or overestimated depending on the diagnostic modality. The Widal test which identified as nonreliable has long been used in Ethiopia for the diagnosis of S. Typhi causing high diagnosis uncertainties. Antimicrobial susceptibility of S. Typhi was low for most nationally recommended antibiotics. Ethiopian Food and Drug Authority must strengthen its continued monitoring and enhanced national antimicrobial surveillance system using the best available state-of-the-art technology and or tools to inform the rising resistance of S. Typhi towards the prescription of standard antibiotics. Finally, it is crucial to develop an evidence-based clinical decision-making support system for the diagnosis, empiric treatment and prevention of antimicrobial resistance.
PubMed: 34976707
DOI: 10.1016/j.pmedr.2021.101670 -
BMC Infectious Diseases Sep 2018Salmonella Typhi is a human pathogen that causes typhoid fever. It is a major cause of morbidity and mortality in developing countries and is responsible for several... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Salmonella Typhi is a human pathogen that causes typhoid fever. It is a major cause of morbidity and mortality in developing countries and is responsible for several outbreaks in developed countries. Studying certain parameters of the pathogen, such as the incubation period, provides a better understanding of its pathophysiology and its characteristics within a population. Outbreak investigations and human experimental studies provide an avenue to study these relevant parameters.
METHODS
In this study, the authors have undertaken a systematic review of outbreak investigation reports and experimental studies, extracted reported data, tested for heterogeneity, identified subgroups of studies with limited evidence of heterogeneity between them and identified factors that may contribute to the distribution of incubation period. Following identification of relevant studies, we extracted both raw and summary incubation data. We tested for heterogeneity by deriving the value of I and conducting a KS-test to compare the distribution between studies. We performed a linear regression analysis to identify the factors associated with incubation period and using the resulting p-values from the KS-test, we conducted a hierarchical cluster analysis to classify studies with limited evidence of heterogeneity into subgroups.
RESULTS
We identified thirteen studies to be included in the review and extracted raw incubation period data from eleven. The value of I was 84% and the proportion of KS test p-values that were less than 0.05 was 63.6% indicating high heterogeneity not due to chance. We identified vaccine history and attack rates as factors that may be associated with incubation period, although these were not significant in the multivariable analysis (p-value: 0.1). From the hierarchical clustering analysis, we classified the studies into five subgroups. The mean incubation period of the subgroups ranged from 9.7 days to 21.2 days. Outbreaks reporting cases with previous vaccination history were clustered in a single subgroup and reported the longest incubation period.
CONCLUSIONS
We identified attack rate and previous vaccination as possible associating factors, however further work involving analyses of individual patient data and developing mathematical models is needed to confirm these as well as examine additional factors that have not been included in our study.
Topics: Databases, Factual; Disease Outbreaks; Humans; Infectious Disease Incubation Period; Linear Models; Salmonella Infections; Salmonella typhi; Serogroup
PubMed: 30261843
DOI: 10.1186/s12879-018-3391-3 -
BMC Infectious Diseases Feb 2014Human Salmonellosis is one of the major diseases in Ethiopia and several factors including under and mal-nutrition and HIV-AIDS may substantially contribute to its... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Human Salmonellosis is one of the major diseases in Ethiopia and several factors including under and mal-nutrition and HIV-AIDS may substantially contribute to its occurrence. Despite its importance, surveillance and monitoring systems are not in place and a comprehensive picture of its epidemiology is not available. The objectives of this study were to systematically review and estimate the prevalence of the disease and identify the dominant serogroups and serotypes in Ethiopia.
METHODS
Published studies on Salmonellosis in Ethiopia were electronically and manually searched. Eligible studies were selected by using inclusion and exclusion criteria. Generic, methodological and statistical information were extracted from the eligible studies. The extracted data included sample sizes, the numbers of Salmonella positive samples, serogroups and serotypes. The variations in prevalence estimates attributable to heterogeneities were assessed and pooled prevalence was estimated by the random effects model.
RESULTS
Twenty studies carried out between 1974 and 2012 were eligible. The pooled prevalence estimates of Salmonella in stool samples of diarrheic children, diarrheic adults and carriers were 8.72%, 5.68%, and 1.08% respectively. Invasive infections in children (5.71%) and adults (0.76%) were significantly different (p < 0.001). Non-typhi isolates accounted for 57.9% of the isolates from patients. Serogroup D occurred more frequently than serogroups C and B. S. Concord, S. Typhi, S. Typhimurium and S. Paratyphi were dominant and accounted for 82.1% of the serotypes isolated from patients.
CONCLUSION
The prevalence of Salmonellosis is considerable and most infections are due to four serotypes. The results imply the need for a policy to promote public hygiene and regularly screen individuals in contact with food items for public consumption.
Topics: Communicable Disease Control; Cross-Sectional Studies; Ethiopia; Food Contamination; Humans; Prevalence; Salmonella; Salmonella Infections; Serogroup
PubMed: 24552273
DOI: 10.1186/1471-2334-14-88 -
The Cochrane Database of Systematic... Oct 2011Review status: Current question - no update intended. Azithromycin treatments are included in the review: Fluoroquinolones for treating typhoid and paratyphoid fever... (Review)
Review
BACKGROUND
Review status: Current question - no update intended. Azithromycin treatments are included in the review: Fluoroquinolones for treating typhoid and paratyphoid fever (enteric fever). (Thaver D, Zaidi AKM, Critchley JA, Azmatullah A, Madni SA, Bhutta ZA. Fluoroquinolones for treating typhoid and paratyphoid fever (enteric fever). Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD004530. DOI: 10.1002/14651858.CD004530.pub3.) This latter review is being updated, and will be published in late 2011.Enteric fever (typhoid and paratyphoid fever) is potentially fatal. Infection with drug-resistant strains of the causative organism Salmonella enterica serovar Typhi or Paratyphi increases morbidity and mortality. Azithromycin may have better outcomes in people with uncomplicated forms of the disease.
OBJECTIVES
To compare azithromycin with other antibiotics for treating uncomplicated enteric fever.
SEARCH STRATEGY
In August 2008, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2008, Issue 3), MEDLINE, EMBASE, LILACS, and mRCT. We also searched conference proceedings, reference lists, and contacted researchers and a pharmaceutical company.
SELECTION CRITERIA
Randomized controlled trials comparing azithromycin with other antibiotics for treating children and adults with uncomplicated enteric fever confirmed by cultures of S. Typhi or Paratyphi in blood and/or stool.
DATA COLLECTION AND ANALYSIS
Both authors independently extracted data and assessed the risk of bias. Dichotomous data were presented and compared using the odds ratio, and continuous data were reported as arithmetic means with standard deviations and were combined using the mean difference (MD). Both were presented with 95% confidence intervals (CI).
MAIN RESULTS
Seven trials involving 773 participants met the inclusion criteria. The trials used adequate methods to generate the allocation sequence and conceal allocation, and were open label. Three trials exclusively included adults, two included children, and two included both adults and children; all were hospital inpatients. One trial evaluated azithromycin against chloramphenicol and did not demonstrate a difference for any outcome (77 participants, 1 trial). When compared with fluoroquinolones in four trials, azithromycin significantly reduced clinical failure (OR 0.48, 95% CI 0.26 to 0.89; 564 participants, 4 trials) and duration of hospital stay (MD -1.04 days, 95% CI -1.73 to -0.34 days; 213 participants, 2 trials); all four trials included people with multiple-drug-resistant or nalidixic acid-resistant strains of S. Typhi or S. Paratyphi. We detected no statistically significant difference in the other outcomes. Compared with ceftriaxone, azithromycin significantly reduced relapse (OR 0.09, 95% CI 0.01 to 0.70; 132 participants, 2 trials) and not other outcome measures. Few adverse events were reported, and most were mild and self limiting.
AUTHORS' CONCLUSIONS
Azithromycin appears better than fluoroquinolone drugs in populations that included participants with drug-resistant strains. Azithromycin may perform better than ceftriaxone.
Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Child; Humans; Paratyphoid Fever; Randomized Controlled Trials as Topic; Typhoid Fever
PubMed: 21975751
DOI: 10.1002/14651858.CD006083.pub3 -
Journal of Global Health Dec 2015Children suffer the highest burden of enteric fever among populations in South Asian countries. The clinical features are non-specific, vary in populations, and are... (Review)
Review
BACKGROUND
Children suffer the highest burden of enteric fever among populations in South Asian countries. The clinical features are non-specific, vary in populations, and are often difficult to distinguish clinically from other febrile illnesses, leading to delayed or inappropriate diagnosis and treatment. We undertook a systematic review to assess the clinical profile and laboratory features of enteric fever across age groups, economic regions, level of care and antibiotic susceptibility patterns.
METHODS
We searched PubMed (January 1964-December 2013) for studies describing clinical features in defined cohorts of patients over varying time periods. Studies with all culture-confirmed cases or those with at least 50% culture-confirmed cases were included. 242 reports were screened out of 4398 relevant articles and 180 reports were included for final review.
RESULTS
96% of studies were from an urban location, 96% were hospital-based studies, with 41% of studies were from South Asia. Common clinical features in hospitalized children include high-grade fever, coated tongue, anaemia, nausea/vomiting, diarrhea, constipation, hepatomegaly, splenomegaly neutrophilia, abdominal distension and GI bleeding. In adults' nausea/vomiting, thrombocytopenia and GI perforation predominate. The case-fatality rate in children under 5 years is higher than school aged children and adolescents, and is highest in Sub Saharan Africa and North Africa/Middle East regions. Multi-drug resistant enteric fever has higher rates of complications than drug sensitive enteric fever, but case fatality rates were comparable in both.
CONCLUSIONS
Our findings indicate variability in disease presentation in adults compared to children, in different regions and in resistant vs sensitive cases. Majority of studies are from hospitalized cases, and are not disaggregated by age. Despite higher complications in MDR enteric fever, case fatality rate is comparable to sensitive cases, with an overall hospital based CFR of 2%, which is similar to recent global estimates. This review underscores the importance of further epidemiological studies in community settings among children and adults, and the need for further preventable measures to curtail the burden of disease.
Topics: Adolescent; Adult; Africa; Asia; Child; Child, Preschool; Diarrhea; Female; Global Health; Humans; Incidence; Laboratories; Male; Paratyphoid Fever; Salmonella paratyphi A; Salmonella typhi; Typhoid Fever
PubMed: 26649174
DOI: 10.7189/jogh.05.020407 -
PLoS Neglected Tropical Diseases Oct 2018The temporal and spatial change in trends of antimicrobial resistance (AMR) in typhoid have not been systematically studied, and such information will be critical for...
BACKGROUND
The temporal and spatial change in trends of antimicrobial resistance (AMR) in typhoid have not been systematically studied, and such information will be critical for defining intervention, as well as planning sustainable prevention strategies.
METHODOLOGY AND FINDINGS
To identify the phenotypic trends in AMR, 13,833 individual S. Typhi isolates, reported from 1973 to 2018 in 62 publications, were analysed to determine the AMR preponderance over time. Separate analyses of molecular resistance determinants present in over 4,000 isolates reported in 61 publications were also conducted. Multi-drug resistant (MDR) typhoid is in decline in Asia in a setting of high fluoroquinolone resistance while it is on the increase in Africa. Mutations in QRDRs in gyrA (S83F, D87N) and parC (S80I) are the most common mechanisms responsible for fluoroquinolone resistance. Cephalosporin resistant S. Typhi, dubbed extensively drug-resistant (XDR) is a real threat and underscores the urgency in deploying the Vi-conjugate vaccines.
CONCLUSION
From these observations, it appears that AMR in S. Typhi will continue to emerge leading to treatment failure, changes in antimicrobial policy and further resistance developing in S. Typhi isolates and other Gram-negative bacteria in endemic regions. The deployment of typhoid conjugate vaccines to control the disease in endemic regions may be the best defence.
Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Genes, Bacterial; Genotype; Global Health; Humans; Phenotype; Salmonella typhi; Typhoid Fever
PubMed: 30307935
DOI: 10.1371/journal.pntd.0006779 -
The Cochrane Database of Systematic... May 2017Differentiating both typhoid (Salmonella Typhi) and paratyphoid (Salmonella Paratyphi A) infection from other causes of fever in endemic areas is a diagnostic challenge.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Differentiating both typhoid (Salmonella Typhi) and paratyphoid (Salmonella Paratyphi A) infection from other causes of fever in endemic areas is a diagnostic challenge. Although commercial point-of-care rapid diagnostic tests (RDTs) for enteric fever are available as alternatives to the current reference standard test of blood or bone marrow culture, or to the widely used Widal Test, their diagnostic accuracy is unclear. If accurate, they could potentially replace blood culture as the World Health Organization (WHO)-recommended main diagnostic test for enteric fever.
OBJECTIVES
To assess the diagnostic accuracy of commercially available rapid diagnostic tests (RDTs) and prototypes for detecting Salmonella Typhi or Paratyphi A infection in symptomatic persons living in endemic areas.
SEARCH METHODS
We searched the Cochrane Infectious Diseases Group Specialized Register, MEDLINE, Embase, Science Citation Index, IndMED, African Index Medicus, LILACS, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) up to 4 March 2016. We manually searched WHO reports, and papers from international conferences on Salmonella infections. We also contacted test manufacturers to identify studies.
SELECTION CRITERIA
We included diagnostic accuracy studies of enteric fever RDTs in patients with fever or with symptoms suggestive of enteric fever living in endemic areas. We classified the reference standard used as either Grade 1 (result from a blood culture and a bone marrow culture) or Grade 2 (result from blood culture and blood polymerase chain reaction, or from blood culture alone).
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted the test result data. We used a modified QUADAS-2 extraction form to assess methodological quality. We performed a meta-analysis when there were sufficient studies for the test and heterogeneity was reasonable.
MAIN RESULTS
Thirty-seven studies met the inclusion criteria and included a total of 5080 participants (range 50 to 1732). Enteric fever prevalence rates in the study populations ranged from 1% to 75% (median prevalence 24%, interquartile range (IQR) 11% to 46%). The included studies evaluated 16 different RDTs, and 16 studies compared two or more different RDTs. Only three studies used the Grade 1 reference standard, and only 11 studies recruited unselected febrile patients. Most included studies were from Asia, with five studies from sub-Saharan Africa. All of the RDTs were designed to detect S.Typhi infection only.Most studies evaluated three RDTs and their variants: TUBEX in 14 studies; Typhidot (Typhidot, Typhidot-M, and TyphiRapid-Tr02) in 22 studies; and the Test-It Typhoid immunochromatographic lateral flow assay, and its earlier prototypes (dipstick, latex agglutination) developed by the Royal Tropical Institute, Amsterdam (KIT) in nine studies. Meta-analyses showed an average sensitivity of 78% (95% confidence interval (CI) 71% to 85%) and specificity of 87% (95% CI 82% to 91%) for TUBEX; and an average sensitivity of 69% (95% CI 59% to 78%) and specificity of 90% (95% CI 78% to 93%) for all Test-It Typhoid and prototype tests (KIT). Across all forms of the Typhidot test, the average sensitivity was 84% (95% CI 73% to 91%) and specificity was 79% (95% CI 70% to 87%). When we based the analysis on the 13 studies of the Typhidot test that either reported indeterminate test results or where the test format means there are no indeterminate results, the average sensitivity was 78% (95% CI 65% to 87%) and specificity was 77% (95% CI 66% to 86%). We did not identify any difference in either sensitivity or specificity between TUBEX, Typhidot, and Test-it Typhoid tests when based on comparison to the 13 Typhidot studies where indeterminate results are either reported or not applicable. If TUBEX and Test-it Typhoid are compared to all Typhidot studies, the sensitivity of Typhidot was higher than Test-it Typhoid (15% (95% CI 2% to 28%), but other comparisons did not show a difference at the 95% level of CIs.In a hypothetical cohort of 1000 patients presenting with fever where 30% (300 patients) have enteric fever, on average Typhidot tests reporting indeterminate results or where tests do not produce indeterminate results will miss the diagnosis in 66 patients with enteric fever, TUBEX will miss 66, and Test-It Typhoid and prototype (KIT) tests will miss 93. In the 700 people without enteric fever, the number of people incorrectly diagnosed with enteric fever would be 161 with Typhidot tests, 91 with TUBEX, and 70 with Test-It Typhoid and prototype (KIT) tests. The CIs around these estimates were wide, with no difference in false positive results shown between tests.The quality of the data for each study was evaluated using a standardized checklist called QUADAS-2. Overall, the certainty of the evidence in the studies that evaluated enteric fever RDTs was low.
AUTHORS' CONCLUSIONS
In 37 studies that evaluated the diagnostic accuracy of RDTs for enteric fever, few studies were at a low risk of bias. The three main RDT tests and variants had moderate diagnostic accuracy. There was no evidence of a difference between the average sensitivity and specificity of the three main RDT tests. More robust evaluations of alternative RDTs for enteric fever are needed.
Topics: Adult; Child; False Negative Reactions; False Positive Reactions; Humans; Immunoassay; Paratyphoid Fever; Polymerase Chain Reaction; Reagent Kits, Diagnostic; Reference Standards; Sensitivity and Specificity; Typhoid Fever
PubMed: 28545155
DOI: 10.1002/14651858.CD008892.pub2 -
Journal of Infection in Developing... Sep 2021Salmonella infections are endemic in Nigeria. There is lack of reliable data on culture-positive Salmonella with national coverage. This systemic review of literatures...
INTRODUCTION
Salmonella infections are endemic in Nigeria. There is lack of reliable data on culture-positive Salmonella with national coverage. This systemic review of literatures was undertaken to aggregate data on culture proven cases of human Salmonellae and to determine the prevailing serotypes for disease burden estimations.
METHODOLOGY
This involved comprehensive search engines of Pubmed, Google Scholar, Google and Embase for the literatures on culture positive human Salmonellae from 1999-2018. This review documented the prevalence, common Salmonella serotypes. antibiotic resistance and risk factors associated with human Salmonella infections.
RESULTS
This study revealed that 21out of 36 States in Nigeria reported Salmonella-associated diseases, spanning the six geopolitical zones. Our study revealed prevalence of 1.9% (2,732/143,756) Salmonella-bacteraemia and 16.3% (1,967/12,081) Salmonella-associated gastroenteritis. Fifty-three 53 Salmonella serotypes were identified. 39 serotypes were associated with Salmonella-bacteraemia and 31 serotypes with Salmonella-gastroenteritis. Salmonella typhi remains the commonest serotype accounting for 85.2% for Salmonella-bacteraemia and 73.1% Salmonella-gastroenteritis. S. typhimurium (3.8%) was mostly implicated invasive non-typhoidal serotype followed S. enteritidis (2.8%) among others. Human Immunodeficiency Virus-infected individuals, malnutrition was among factors predisposing Salmonella infections. Over 60% of the reported Salmonella isolates developed resistance to two or more of 23 antibiotics recorded, mostly ampicillin, cotrimoxazole, tetracycline and amoxicillin.
CONCLUSIONS
This study revealed 39 Invasive and 31 non-invasive Salmonella serotypes. Ampicillin, cotrimoxazole, amoxicillin-clavulanate and tetracycline are the most frequently reported antibiotics resisted by Salmonella isolates. This antimicrobial resistance exhibited poses a threat to public health. Data generated from this review would serve as a baseline information for future surveillance studies.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Child; Child, Preschool; Drug Resistance, Bacterial; Female; Humans; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Middle Aged; Nigeria; Salmonella; Salmonella Infections; Young Adult
PubMed: 34669589
DOI: 10.3855/jidc.12186 -
Tropical Medicine & International... Dec 2019Hospital-based studies of community-onset bloodstream infections (CO-BSI) are less resource-intensive to carry out than population-based incidence studies. We examined...
OBJECTIVES
Hospital-based studies of community-onset bloodstream infections (CO-BSI) are less resource-intensive to carry out than population-based incidence studies. We examined several metrics capturing the potential role of Salmonella Typhi as a cause of CO-BSI for making inferences about incidence.
METHODS
We systematically reviewed three databases for hospital-based studies of CO-BSI. We determined, by study, the prevalence and rank order of Salmonella among pathogenic bloodstream isolates, and the prevalence ratio of Salmonella Typhi to Escherichia coli (S:E ratio). We then describe these hospital-based study metrics in relation to population-based typhoid fever incidence data from a separate systematic review.
RESULTS
Forty-four studies met the inclusion criteria, of which 23 (52.3%) isolated Salmonella Typhi at least once. Among studies isolating Salmonella Typhi, the median (interquartile range) prevalence and rank order of Salmonella Typhi compared to other pathogens isolated in BSI was 8.3% (3.2-37.9%) and 3 (1-6), respectively. The median (interquartile range) S:E ratio was 1.0 (0.4-3.0). With respect to incidence, in Pemba Island, Tanzania, prevalence, rank order, S:E ratio, and incidence was 64.8%, 1, 9.2 and 110 cases per 100 000, respectively, and in Boulkiemdé, Burkina Faso, was 13.3%, 3, 2.3 and 249 cases per 100 000.
CONCLUSIONS
We describe considerable variation in place and time for Salmonella Typhi prevalence, rank order, and S:E ratio among hospital-based studies of CO-BSI. Data from simultaneous typhoid prevalence and incidence studies are limited. We propose that hospital-based study metrics warrant evaluation for making inference about typhoid incidence and as covariates in typhoid incidence models.
Topics: Bacteremia; Burkina Faso; Female; Hospitalization; Humans; Incidence; Male; Prevalence; Salmonella typhi; Tanzania; Typhoid Fever
PubMed: 31633858
DOI: 10.1111/tmi.13319 -
The American Journal of Tropical... Sep 2020Typhoid fever transmission occurs through ingestion of food or water contaminated with Typhi, and case-control studies are often conducted to identify outbreak sources... (Meta-Analysis)
Meta-Analysis
Typhoid fever transmission occurs through ingestion of food or water contaminated with Typhi, and case-control studies are often conducted to identify outbreak sources and transmission vehicles. However, there is no current summary of the associations among water, sanitation, and hygiene (WASH); and food exposures and typhoid from case-control studies. We conducted a systematic review and meta-analysis of case-control studies to evaluate the associations among typhoid fever and predicted WASH or food exposure risk factors (13), and protective factors (7). Overall, 19 manuscripts describing 22 case-control studies were included. Two studies were characterized as having low risk of bias, one as medium risk, and 19 as high risk. In total, nine of 13 predicted risk factors were associated with increased odds of typhoid (odds ratio [OR] = 1.4-2.4, = 30.5-74.8%.), whereas five of seven predicted protective factors were associated with lower odds of typhoid (OR = 0.52-0.73, = 38.7-84.3%). In five types of sensitivity analyses, two (8%) of 26 summary associations changed significance from the original analysis. Results highlight the following: the importance of household hygiene transmission pathways, the need for further research around appropriate food interventions and the risk of consuming specific foods and beverages outside the home, and the absence of any observed association between sanitation exposures and typhoid fever. We recommend that typhoid interventions focus on interrupting household transmission routes and that future studies provide more detailed information about WASH and food exposures to inform better targeted interventions.
Topics: Case-Control Studies; Disease Outbreaks; Food Microbiology; Hand Disinfection; Humans; Odds Ratio; Risk Factors; Salmonella typhi; Sanitation; Typhoid Fever; Water Microbiology; Water Supply
PubMed: 32700668
DOI: 10.4269/ajtmh.19-0479