An Appraisal of the Clinical Features of Pediatric Enteric Fever: Systematic Review and Meta-analysis of the Age-Stratified Disease Occurrence

Abstract

Children bear a substantial proportion of the enteric fever disease burden in endemic areas. Controversy persists regarding which age groups are most affected, leading to uncertainty about optimal intervention strategies. We performed a systematic review and meta-analysis of studies in Asia and Africa to compare the relative proportion of children with enteric fever in the age groups <5 years, 5-9 years, and 10-14 years. Overall, studies conducted in Africa showed a relatively smaller occurrence of disease in the youngest age group, whereas in Asia the picture was more mixed with a very large degree of heterogeneity in estimates. The clinical features of enteric fever reviewed here differ between younger and older children and adults, likely leading to further uncertainty over disease burden. It is evident from our review that preschool children and infants also contribute a significant proportion of disease burden but have not been adequately targeted via vaccination programs, which have been focusing primarily on school-based vaccination campaigns.

Keywords: clinical.; enteric fever; paratyphoid; pediatric; typhoid.

Figure 1.

Search strategy and characteristics of included studies in the meta-analysis.

Figure 2.

Meta-analysis comparing the age-stratified prevalence of pediatric enteric fever cases in Africa. Studies in the meta-analysis are identified based on author name, year of publication with country codes in parenthesis (country codes used are those supplied by the International Organization for Standardization). Studies with ≤50 cases were excluded. Proportion is (number of children in age group / number of children in the study aged 0–14 years). Proportions are standardized according to population age distributions for the 3 age categories. The analysis was done using random-effects model. Abbreviations: CD, Democratic Republic of Congo; CI, confidence interval; IV, inverse variance; KE, Kenya; MW, Malawi; SE, standard error; ZA, Zimbabwe; ZM, Zambia.

Figure 3.

Meta-analysis comparing the age-stratified prevalence of pediatric enteric fever cases in Asia. Studies in the meta-analysis are identified based on author name, year of publication with country codes in parenthesis (country codes used are those supplied by the International Standardization Organisation). Studies with ≤50 cases were excluded. Proportion is (number of children in age group / number of children in the study aged 0–14 years). Proportions are standardized according to population age distributions for the 3 age categories. The analysis was done using random-effects model. Abbreviations: BD, Bangladesh; CI, confidence interval; ID, Indonesia; IN, India; IV, inverse variance; NP, Nepal; PH, Philippines; PK, Pakistan; SE, standard error; VN, Vietnam.