Multiple introductions of multidrug-resistant typhoid associated with acute infection and asymptomatic carriage, Kenya.
Dyson, Zoe A
Kavai, Susan M
Onsare, Robert Sanaya
Clemens, John David
Holt, Kathryn E
eLife Sciences Publications Ltd
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Kariuki, S., Dyson, Z. A., Mbae, C., Ngetich, R., Kavai, S. M., Wairimu, C., Anyona, S., et al. (2021). Multiple introductions of multidrug-resistant typhoid associated with acute infection and asymptomatic carriage, Kenya.. eLife, (10:e67852)https://doi.org/10.7554/eLife.67852
Background: Understanding the dynamics of infection and carriage of typhoid in endemic settings is critical to finding solutions to prevention and control. Methods: In a 3 year case-control study, we investigated typhoid among children aged <16 years (4,670 febrile cases and 8,549 age matched controls) living in an informal settlement, Nairobi, Kenya. Results: 148 S. Typhi isolates from cases and 95 from controls (stool culture) were identified; a carriage frequency of 1%. Whole-genome sequencing showed 97% of cases and 88% of controls were genotype 4.3.1 (Haplotype 58), with the majority of each (76% and 88%) being multidrug-resistant strains in 3 sublineages of H58 genotype (East Africa 1 (EA1), EA2, and EA3), with sequences from cases and carriers intermingled. Conclusions: The high rate of multidrug-resistant H58 S.Typhi, and the close phylogenetic relationships between cases and controls, provides evidence for the role of carriers as a reservoir for the community spread of typhoid in this setting. Funding: National Institutes of Health (R01AI099525); Wellcome Trust (106158/Z/14/Z); European Commission (TyphiNET No 845681); National Institute for Health Research (NIHR); Bill and Melinda Gates Foundation (OPP1175797).
S. enterica serovar typhi, epidemiology, global health, infectious disease, microbiology
Wellcome Trust (106158/Z/14/Z)
External DOI: https://doi.org/10.7554/eLife.67852
This record's URL: https://www.repository.cam.ac.uk/handle/1810/329176
Attribution 4.0 International
Licence URL: https://creativecommons.org/licenses/by/4.0/