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Review
. 2015 Nov 1;61 Suppl 4(Suppl 4):S332-8.
doi: 10.1093/cid/civ729.

Invasive Nontyphoidal Salmonella Infections Among Children in Mali, 2002-2014: Microbiological and Epidemiologic Features Guide Vaccine Development

Milagritos D Tapia  1 , Sharon M Tennant  1 , Kristin Bornstein  2 , Uma Onwuchekwa  3 , Boubou Tamboura  3 , Almoustapha Maiga  3 , Mamadou B Sylla  3 , Seydou Sissoko  3 , Nana Kourouma  3 , Aliou Toure  3 , Dramane Malle  3 , Sofie Livio  1 , Samba O Sow  3 , Myron M Levine  1
Affiliations
Review

Invasive Nontyphoidal Salmonella Infections Among Children in Mali, 2002-2014: Microbiological and Epidemiologic Features Guide Vaccine Development

Milagritos D Tapia et al. Clin Infect Dis. .

Abstract

Background: In 2002, following establishment of a clinical microbiology laboratory in the government hospital that admits children with severe illnesses in Bamako, Mali, surveillance to identify pathogens causing invasive bacterial infections (septicemia, bacteremia, meningitis, etc) was initiated.

Methods: Parents/guardians of children aged <16 years admitted to l'Hôpital Gabriel Touré with high fever or clinical syndromes compatible with focal invasive bacterial disease were asked for consent to culture their child's blood/body fluid. Standard bacteriologic techniques speciated isolates; Salmonella serovars were determined.

Results: From July 2002 through June 2014, 687 nontyphoidal Salmonella (NTS) isolates were obtained from 667 children; 667 yielded a single serovar and 20 grew 2 Salmonella serovars, 1 being NTS. Four serovars accounted for 87% of the 687 NTS isolates, including Salmonella Enteritidis (n = 244 [35.5%]), Salmonella Typhimurium (n = 221 [32.2%]), I:4,[5],12:i:- (n = 42 [6.1%]), and Salmonella Dublin (n = 89 [13.0%]). Of 553 patients with invasive NTS from whom 1 of the 4 predominant serovars was isolated in pure culture, 448 (81.0%) were aged <5 years and case fatality was 20.3%; Salmonella Enteritidis case fatality (27.8%) was higher than for other serovars (P = .0009). NTS disease showed a seasonal peak following the rainy season and into the cool, dry season. Since 2010, Salmonella Enteritidis cases have risen and Salmonella Typhimurium fallen.

Conclusions: NTS has become the predominant invasive pathogen as Haemophilus influenzae type b and pneumococcal vaccine use in Mali has diminished invasive disease due to those pathogens. The age distribution and limited serovars involved make control of NTS disease by vaccines epidemiologically feasible, if products under development prove safe and efficacious.

Keywords: Mali; emerging infections; invasive bacterial infections; nontyphoidal Salmonella; surveillance.

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Figures

Figure 1.
Figure 1.
Serovar distribution of the 687 nontyphoidal Salmonella isolates obtained from 667 children.
Figure 2.
Figure 2.
Age distribution of the 636 pediatric cases of invasive nontyphoidal Salmonella (NTS) whose cultures yielded a pure culture of a single NTS serovar. The age distributions of the remaining 31 children with invasive NTS whose cultures yielded >1 Salmonella serovar are not shown. NTS (black) and Typhimurium, I:4,[5],12:i:-, I:4,[5],12:NM and Enteritidis combined (white).
Figure 3.
Figure 3.
Seasonality of the nontyphoidal Salmonella (NTS) cases: Salmonella Typhimurium, I:4,[5],12:i:-, I:4,[5],12:NM, and Salmonella Enteritidis.
Figure 4.
Figure 4.
Frequency of Salmonella Typhimurium, I:4,[5],12:i:-, I:4,[5],12:NM, and Salmonella Enteritidis cases by year over the 12-year study period.
See this image and copyright information in PMC

References

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