Multiple introductions of multidrug-resistant typhoid associated with acute infection and asymptomatic carriage, Kenya.
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Authors
Mbae, Cecilia
Ngetich, Ronald
Kavai, Susan M
Wairimu, Celestine
Anyona, Stephen
Gitau, Naomi
Onsare, Robert Sanaya
Ongandi, Beatrice
Duchene, Sebastian
Ali, Mohamed
Clemens, John David
Holt, Kathryn E
Dougan, Gordon
Publication Date
2021-09-13Journal Title
eLife
ISSN
2050-084X
Volume
10
Language
eng
Type
Article
This Version
VoR
Metadata
Show full item recordCitation
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 https://doi.org/10.7554/elife.67852
Abstract
<h4>Background</h4>Understanding the dynamics of infection and carriage of typhoid in endemic settings is critical to finding solutions to prevention and control.<h4>Methods</h4>In a 3-year case-control study, we investigated typhoid among children aged <16 years (4670 febrile cases and 8549 age matched controls) living in an informal settlement, Nairobi, Kenya.<h4>Results</h4>148 <i>S</i>. 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 three sublineages of the H58 genotype (East Africa 1 (EA1), EA2, and EA3), with sequences from cases and carriers intermingled.<h4>Conclusions</h4>The high rate of multidrug-resistant H58 <i>S</i>. 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.<h4>Funding</h4>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).
Keywords
Microbiology, Children, Infectious disease, epidemiology, Kenya, Typhoid, Global Health, Carriage, Multidrug-resistant, S. Enterica Serovar Typhi, H58 Lineages
Sponsorship
NIAID NIH HHS (R01 AI099525)
Bill and Melinda Gates Foundation (OPP1175797)
Department of Health (AMR Theme)
European Commission (TyphiNET No 845681)
National Institutes of Health (R01AI099525)
Wellcome Trust (106158/Z/14/Z)
Identifiers
PMC8494480, 34515028
External DOI: https://doi.org/10.7554/elife.67852
This record's URL: https://www.repository.cam.ac.uk/handle/1810/329525
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