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. 2020 Dec 1;71(Suppl 3):S196-S204.
doi: 10.1093/cid/ciaa1356.

Hospitalization of Pediatric Enteric Fever Cases, Dhaka, Bangladesh, 2017-2019: Incidence and Risk Factors

Shampa Saha  1 , K M Ishtiaque Sayeed  1 , Senjuti Saha  1   2 , Md Shafiqul Islam  1 , Afiour Rahaman  1 , Maksuda Islam  1 , Hafizur Rahman  1 , Raktim Das  1 , Md Mahmudul Hasan  1 , Mohammad Jamal Uddin  1 , Arif Mohammad Tanmoy  1 , A S M Nawshad Uddin Ahmed  1   3 , Stephen P Luby  4 , Jason R Andrews  4 , Denise O Garrett  5 , Samir K Saha  1   3
Affiliations

Hospitalization of Pediatric Enteric Fever Cases, Dhaka, Bangladesh, 2017-2019: Incidence and Risk Factors

Shampa Saha et al. Clin Infect Dis. .

Abstract

Background: Enteric fever causes substantial morbidity and mortality in low- and middle-income countries. Here, we analyzed Surveillance for Enteric Fever in Asia Project (SEAP) data to estimate the burden of enteric fever hospitalization among children aged <15 years and identify risk factors for hospitalization in Bangladesh.

Methods: SEAP used hospital surveillance paired with a community-based health-care utilization assessment. In SEAP hospital surveillance, blood was obtained for culture from children aged <15 years with ≥3 days of fever. In the hospital catchment area, a health-care utilization survey (HCUS) was conducted to estimate the proportion of febrile children hospitalized at the study hospitals. We analyzed hospital surveillance and HCUS data to estimate the health care-adjusted incidence of enteric fever hospitalization, and conducted univariable and multivariable logistic regressions.

Results: From July 2017 through June 2019, 2243 laboratory-confirmed enteric fever cases were detected in 2 study hospitals; 673 (30%) were hospitalized. The health care-adjusted incidence of enteric fever hospitalization among children <15 years old was 303/100 000 children/year (95% confidence interval [CI], 293-313). Salmonella Typhi contributed most to the enteric fever hospitalization incidence (277/100 000 children/year; 95% CI, 267-287). The incidence was highest among children aged 2 to <5 years (552/100 000 children/year; 95% CI, 522-583), followed by those aged <2 years (316/100 000 children/year; 95% CI, 288-344). Factors independently associated with enteric fever hospitalization included fever duration, diarrhea, vomiting, abdominal pain, and leukocytopenia.

Conclusions: We estimated a high burden of hospitalization due to enteric fever among children aged <5 years in Bangladesh. The introduction of a typhoid conjugate vaccine would protect children from typhoid and avert typhoid hospitalizations.

Keywords: enteric fever; hospitalization; incidence; risk factors; typhoid.

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Figures

Figure 1.
Figure 1.
Maps showing population density in Bangladesh by (A) districts and location of Dhaka district, (B) location of the study catchment area in Dhaka district, and (C) location of the study hospitals in the study catchment area.
Figure 2.
Figure 2.
Enteric fever cases aged <15 years enrolled (n = 11 968) by recruitment location, with Salmonella Typhi and S. Paratyphi isolated, and hospitalized at Dhaka Shishu Hospital and Dr MR Khan Shishu Hospital, Dhaka, Bangladesh, July 2017–June 2019. Abbreviations: IPD, inpatient department; OPD, outpatient department; S., Salmonella.
Figure 3.
Figure 3.
Distribution of total number of enteric fever cases (n = 2243) and hospitalizations (n = 673) by month at Dhaka Shishu Hospital and Dr MR Khan Shishu Hospital, Dhaka, Bangladesh, July 2017–June 2019.
See this image and copyright information in PMC

References

    1. Mogasale V, Maskery B, Ochiai RL, et al. Burden of typhoid fever in low-income and middle-income countries: a systematic, literature-based update with risk-factor adjustment. Lancet Glob Heal 2014; 2:e570–80. - PubMed
    1. Antillón M, Warren JL, Crawford FW, et al. The burden of typhoid fever in low- and middle-income countries: a meta-regression approach. PLOS Negl Trop Dis 2017; 11:e0005376. - PMC - PubMed
    1. Stanaway JD, Reiner RC, Blacker BF, et al. The global burden of typhoid and paratyphoid fevers: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Infect Dis 2019; 19:369–81. - PMC - PubMed
    1. Wierzba TF, Sanders JW. The global burden of enteric fevers in the age of typhoid-conjugate vaccines. Lancet Infect Dis 2019; 19:340–1. - PubMed
    1. Fraser A, Goldberg E, Acosta CJ, Paul M, Leibovici L. Vaccines for preventing typhoid fever. In: Fraser A, ed. Cochrane database of systematic reviews. Chichester, United Kingdom: John Wiley & Sons, Ltd, 2007. Available at: http://doi.wiley.com/10.1002/14651858.CD001261.pub2. Accessed 22 February 2020. - DOI - PubMed

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