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. 2015 Dec 3;9(12):e0004212.
doi: 10.1371/journal.pntd.0004212. eCollection 2015 Dec.

Environmental Transmission of Typhoid Fever in an Urban Slum

Adam Akullian  1 , Eric Ng'eno  2 , Alastair I Matheson  1 , Leonard Cosmas  3 , Daniel Macharia  3 , Barry Fields  3 , Godfrey Bigogo  2 , Maina Mugoh  2 , Grace John-Stewart  4 , Judd L Walson  4 , Jonathan Wakefield  5 , Joel M Montgomery  3
Affiliations

Environmental Transmission of Typhoid Fever in an Urban Slum

Adam Akullian et al. PLoS Negl Trop Dis. .

Erratum in

Abstract

Background: Enteric fever due to Salmonella Typhi (typhoid fever) occurs in urban areas with poor sanitation. While direct fecal-oral transmission is thought to be the predominant mode of transmission, recent evidence suggests that indirect environmental transmission may also contribute to disease spread.

Methods: Data from a population-based infectious disease surveillance system (28,000 individuals followed biweekly) were used to map the spatial pattern of typhoid fever in Kibera, an urban informal settlement in Nairobi Kenya, between 2010-2011. Spatial modeling was used to test whether variations in topography and accumulation of surface water explain the geographic patterns of risk.

Results: Among children less than ten years of age, risk of typhoid fever was geographically heterogeneous across the study area (p = 0.016) and was positively associated with lower elevation, OR = 1.87, 95% CI (1.36-2.57), p <0.001. In contrast, the risk of typhoid fever did not vary geographically or with elevation among individuals more than ten years of age [corrected].

Conclusions: Our results provide evidence of indirect, environmental transmission of typhoid fever among children, a group with high exposure to fecal pathogens in the environment. Spatially targeting sanitation interventions may decrease enteric fever transmission.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Spatial distribution of 110 cases and 440 controls between 2010–2011 in Kibera, Kenya.
Fig 2
Fig 2. Distribution (by percentage of total) of 110 typhoid fever infections and 440 population-based controls by age in Kibera.
Fig 3
Fig 3. Monthly distribution of 110 incident typhoid cases between 2010–2011 in Kibera with monthly precipitation overlaid.
Fig 4
Fig 4. (A) Smoothed log odds (contours) of typhoid fever by age group across the study area, adjusted for age and household size, with cases (black points) and controls (grey points) overlaid.
P-values test for significance of the observed spatial pattern in log odds against a homogenous risk surface (i.e., where the log odds is zero at all locations). (B) Adjusted odds ratios from the multi-variate logistic model (Table 2) for the association between elevation and typhoid fever for both children (<10 years) and adults/adolescents (>10 years), with 95% CI overlaid (dashed lines). Odds ratio of 1 (ref odds = 1740 meters in elevation) indicated by horizontal red line.
See this image and copyright information in PMC

References

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