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. 2022 Dec 19;108(2):285-292.
doi: 10.4269/ajtmh.22-0075. Print 2023 Feb 1.

Typhoid Fever in the Eastern Mediterranean Region: A Systematic Review, 1990-2021

Grace D Appiah  1 , Phong Le  1 , Graeme Prentice-Mott  1 , Megan Bias  2 , Caroline Pratt  1 , Ghassan M Matar  3 , Talia Pindyck  1 , Antoine Abou Fayad  3 , Sunkyung Kim  1 , Eric D Mintz  1
Affiliations

Typhoid Fever in the Eastern Mediterranean Region: A Systematic Review, 1990-2021

Grace D Appiah et al. Am J Trop Med Hyg. .

Abstract

The occurrence and antimicrobial resistance (AMR) of typhoid fever in the WHO Eastern Mediterranean Region (EMR) are poorly characterized. Robust surveillance data are needed to inform strategies for typhoid control and prevention in the region. We conducted a systematic review of typhoid fever occurrence, complications, and AMR patterns in EMR countries. We identified 70 studies published from 1990 to 2021, including a total of 44,541 cases with blood culture confirmed typhoid fever in 12 EMR countries, with 48 (69%) studies and 42,008 cases from Pakistan. Among 56 studies with AMR data, fluroquinolone (68% of 13,013 tested isolates), and multidrug resistance (40% of 15,765 tested isolates) were common. Forty (57%) of the 56 studies were from Pakistan, and all reports of extensively drug resistant Salmonella Typhi (48% of 9,578 tested isolates) were from studies in Pakistan. Our findings support the need for continued efforts to strengthen surveillance and laboratory capacity for blood-culture detection of typhoid fever in the region, including data from an ongoing collaboration among CDC, the American University of Beirut, and the WHO EMR office.

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Figures

Figure 1.
Figure 1.
(A) PRISMA diagram of study selection process, publications from 2009 to 2019, and (B) flow diagram from 2019 to 2021.
Figure 2.
Figure 2.
Number of included studies (N = 70) by WHO Eastern Mediterranean Region country, 1990–2021.
Figure 3.
Figure 3.
Number of typhoid fever cases (N = 44,451) by WHO Eastern Mediterranean Region country, 1990–2021.
Figure 4.
Figure 4.
Trends in antimicrobial resistance profiles of tested isolates by resistant type in Pakistan (bottom) vs. other WHO Eastern Mediterranean Region countries (top) over study years, 1990–2021.
See this image and copyright information in PMC

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