TY - JOUR
T1 - Estimating the subnational prevalence of antimicrobial resistant Salmonella enterica serovars Typhi and Paratyphi A infections in 75 endemic countries, 1990–2019: a modelling study
AU - Browne, Annie J.
AU - Chipeta, Michael G.
AU - Fell, Frederick J.
AU - Haines-Woodhouse, Georgina
AU - Kashef Hamadani, Bahar H.
AU - Kumaran, Emmanuelle A.P.
AU - Robles Aguilar, Gisela
AU - McManigal, Barney
AU - Andrews, Jason R.
AU - Ashley, Elizabeth A.
AU - Audi, Allan
AU - Baker, Stephen
AU - Banda, Happy C.
AU - Basnyat, Buddha
AU - Bigogo, Godfrey
AU - Ngoun, Chanpheaktra
AU - Chansamouth, Vilada
AU - Chunga, Angeziwa
AU - Clemens, John D.
AU - Davong, Viengmon
AU - Dougan, Gordon
AU - Dunachie, Susanna J.
AU - Feasey, Nick
AU - Garrett, Denise O.
AU - Gordon, Melita A.
AU - Hasan, Rumina
AU - Haselbeck, Andrea H.
AU - Henry, Nathaniel J.
AU - Heyderman, Robert S.
AU - Holm, Marianne
AU - Jeon, Hyon Jin
AU - Karkey, Abhilasha
AU - Khanam, Farhana
AU - Luby, Stephen P.
AU - Malik, Faisal Riaz
AU - Marks, Florian
AU - Mayxay, Mayfong
AU - Meiring, James E.
AU - Moore, Catrin E.
AU - Munywoki, Patrick K.
AU - Musicha, Patrick
AU - Newton, Paul N.
AU - Pak, Gideok
AU - Phommasone, Koukeo
AU - Pokharel, Sunil
AU - Pollard, Andrew J.
AU - Qadri, Firdausi
AU - Qamar, Farah N.
AU - Rattanavong, Sayaphet
AU - Reiner, Bobby
PY - 2024/2/14
Y1 - 2024/2/14
N2 - Background Enteric fever, a systemic infection caused by Salmonella enterica serovars Typhi and Paratyphi A, remains a major cause of morbidity and mortality in low-income and middle-income countries. Enteric fever is preventable through the provision of clean water and adequate sanitation and can be successfully treated with antibiotics. However, high levels of antimicrobial resistance (AMR) compromise the effectiveness of treatment. We provide estimates of the prevalence of AMR S Typhi and S Paratyphi A in 75 endemic countries, including 30 locations without data.Methods We used a Bayesian spatiotemporal modelling framework to estimate the percentage of multidrug resistance (MDR), fluoroquinolone non-susceptibility (FQNS), and third-generation cephalosporin resistance in S Typhi and S Paratyphi A infections for 1403 administrative level one districts in 75 endemic countries from 1990 to 2019. We incorporated data from a comprehensive systematic review, public health surveillance networks, and large multicountry studies on enteric fever. Estimates of the prevalence of AMR and the number of AMR infections (based on enteric fever incidence estimates by the Global Burden of Diseases study) were produced at the country, super-region, and total endemic area level for each year of the study.Findings We collated data from 601 sources, comprising 184225 isolates of S Typhi and S Paratyphi A, covering 45 countries over 30 years. We identified a decline of MDR S Typhi in south Asia and southeast Asia, whereas in sub-Saharan Africa, the overall prevalence increased from 6·0% (95% uncertainty interval 4·3–8·0) in 1990 to 72·7% (67·7–77·3) in 2019. Starting from low levels in 1990, the prevalence of FQNS S Typhi increased rapidly, reaching 95·2% (91·4–97·7) in south Asia in 2019. This corresponded to 2·5 million (1·5–3·8) MDR S Typhi infections and 7·4 million (4·7–11·3) FQNS S Typhi infections in endemic countries in 2019. The prevalence of third-generation cephalosporin-resistant S Typhi remained low across the whole endemic area over the study period, except for Pakistan where prevalence of third-generation cephalosporin resistance in S Typhi reached 61·0% (58·0–63·8) in 2019. For S Paratyphi A, we estimated low prevalence of MDR and third-generation cephalosporin resistance in all endemic countries, but a drastic increase of FQNS, which reached 95·0% (93·7–96·1; 3·5 million [2·2–5·6] infections) in 2019.Interpretation This study provides a comprehensive and detailed analysis of the prevalence of MDR, FQNS, and third-generation cephalosporin resistance in S Typhi and S Paratyphi A infections in endemic countries, spanning the last 30 years. Our analysis highlights the increasing levels of AMR in this preventable infection and serves as a resource to guide urgently needed public health interventions, such as improvements in water, sanitation, and hygiene and typhoid fever vaccination campaigns
AB - Background Enteric fever, a systemic infection caused by Salmonella enterica serovars Typhi and Paratyphi A, remains a major cause of morbidity and mortality in low-income and middle-income countries. Enteric fever is preventable through the provision of clean water and adequate sanitation and can be successfully treated with antibiotics. However, high levels of antimicrobial resistance (AMR) compromise the effectiveness of treatment. We provide estimates of the prevalence of AMR S Typhi and S Paratyphi A in 75 endemic countries, including 30 locations without data.Methods We used a Bayesian spatiotemporal modelling framework to estimate the percentage of multidrug resistance (MDR), fluoroquinolone non-susceptibility (FQNS), and third-generation cephalosporin resistance in S Typhi and S Paratyphi A infections for 1403 administrative level one districts in 75 endemic countries from 1990 to 2019. We incorporated data from a comprehensive systematic review, public health surveillance networks, and large multicountry studies on enteric fever. Estimates of the prevalence of AMR and the number of AMR infections (based on enteric fever incidence estimates by the Global Burden of Diseases study) were produced at the country, super-region, and total endemic area level for each year of the study.Findings We collated data from 601 sources, comprising 184225 isolates of S Typhi and S Paratyphi A, covering 45 countries over 30 years. We identified a decline of MDR S Typhi in south Asia and southeast Asia, whereas in sub-Saharan Africa, the overall prevalence increased from 6·0% (95% uncertainty interval 4·3–8·0) in 1990 to 72·7% (67·7–77·3) in 2019. Starting from low levels in 1990, the prevalence of FQNS S Typhi increased rapidly, reaching 95·2% (91·4–97·7) in south Asia in 2019. This corresponded to 2·5 million (1·5–3·8) MDR S Typhi infections and 7·4 million (4·7–11·3) FQNS S Typhi infections in endemic countries in 2019. The prevalence of third-generation cephalosporin-resistant S Typhi remained low across the whole endemic area over the study period, except for Pakistan where prevalence of third-generation cephalosporin resistance in S Typhi reached 61·0% (58·0–63·8) in 2019. For S Paratyphi A, we estimated low prevalence of MDR and third-generation cephalosporin resistance in all endemic countries, but a drastic increase of FQNS, which reached 95·0% (93·7–96·1; 3·5 million [2·2–5·6] infections) in 2019.Interpretation This study provides a comprehensive and detailed analysis of the prevalence of MDR, FQNS, and third-generation cephalosporin resistance in S Typhi and S Paratyphi A infections in endemic countries, spanning the last 30 years. Our analysis highlights the increasing levels of AMR in this preventable infection and serves as a resource to guide urgently needed public health interventions, such as improvements in water, sanitation, and hygiene and typhoid fever vaccination campaigns
U2 - 10.1016/s2214-109x(23)00585-5
DO - 10.1016/s2214-109x(23)00585-5
M3 - Article
SN - 2572-116X
VL - 12
SP - e406-e418
JO - The Lancet Global Health
JF - The Lancet Global Health
IS - 3
ER -
