Vera von Kalckreuth1, Frank Konings1, Peter Aaby2, Yaw Adu-Sarkodie3, Mohammad Ali4, Abraham Aseffa5, Stephen Baker6, Robert F Breiman7, Morten Bjerregaard-Andersen8, John D Clemens9, John A Crump10, Ligia Maria Cruz Espinoza1, Jessica Fung Deerin1, Nagla Gasmelseed11, Amy Gassama Sow12, Justin Im1, Karen H Keddy13, Leonard Cosmas14, Jürgen May15, Christian G Meyer16, Eric D Mintz17, Joel M Montgomery14, Beatrice Olack18, Gi Deok Pak1, Ursula Panzner1, Se Eun Park1, Raphaël Rakotozandrindrainy19, Heidi Schütt-Gerowitt20, Abdramane Bassiahi Soura21, Michelle R Warren1, Thomas F Wierzba1, Florian Marks1. 1. International Vaccine Institute, Seoul, Republic of Korea. 2. Bandim Health Project, Bissau, Guinea-Bissau. 3. Kumasi Centre for Collaborative Research in Tropical Medicine School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. 4. International Vaccine Institute, Seoul, Republic of Korea Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 5. Armauer Hansen Research Institute, Addis Ababa, Ethiopia. 6. Oxford University Clinical Resarch Unit, Ho Chi Minh City, Vietnam. 7. Centers for Disease Control and Prevention, Nairobi, Kenya Global Health Institute, Emory University, Atlanta, Georgia. 8. Bandim Health Project, Bissau, Guinea-Bissau Research Center for Vitamins and Vaccines, Copenhagen, Denmark. 9. International Vaccine Institute, Seoul, Republic of Korea International Centre for Diarrheal Disease Research, Dhaka, Bangladesh. 10. Division of Infectious Diseases and International Health, Duke University Medical Center Duke Global Health Institute, Duke University, Durham, North Carolina Kilimanjaro Christian Medical Centre, Moshi, Tanzania Centre for International Health, University of Otago, Dunedin, New Zealand. 11. University of Gezira, Wad Medani, Sudan. 12. Institute Pasteur Senegal Université Cheikh Anta Diop de Dakar, Senegal. 13. National Institute for Communicable Diseases School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 14. Centers for Disease Control and Prevention, Nairobi, Kenya. 15. Department of Infection Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg. 16. Institute of Tropical Medicine, Eberhard-Karls University Tübingen, Germany. 17. National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia. 18. Kenya Medical Research Institute, Nairobi, Kenya. 19. University of Antananarivo, Madagascar. 20. Institute of Medical Microbiology, University of Cologne, Germany. 21. Institut Supérieur des Sciences de la Population, University of Ouagadougou, Burkina Faso.
Abstract
BACKGROUND: New immunization programs are dependent on data from surveillance networks and disease burden estimates to prioritize target areas and risk groups. Data regarding invasive Salmonella disease in sub-Saharan Africa are currently limited, thus hindering the implementation of preventive measures. The Typhoid Fever Surveillance in Africa Program (TSAP) was established by the International Vaccine Institute to obtain comparable incidence data on typhoid fever and invasive nontyphoidal Salmonella (iNTS) disease in sub-Saharan Africa through standardized surveillance in multiple countries. METHODS: Standardized procedures were developed and deployed across sites for study site selection, patient enrolment, laboratory procedures, quality control and quality assurance, assessment of healthcare utilization and incidence calculations. RESULTS: Passive surveillance for bloodstream infections among febrile patients was initiated at thirteen sentinel sites in ten countries (Burkina Faso, Ethiopia, Ghana, Guinea-Bissau, Kenya, Madagascar, Senegal, South Africa, Sudan, and Tanzania). Each TSAP site conducted case detection using these standardized methods to isolate and identify aerobic bacteria from the bloodstream of febrile patients. Healthcare utilization surveys were conducted to adjust population denominators in incidence calculations for differing healthcare utilization patterns and improve comparability of incidence rates across sites. CONCLUSIONS: By providing standardized data on the incidence of typhoid fever and iNTS disease in sub-Saharan Africa, TSAP will provide vital input for targeted typhoid fever prevention programs.
BACKGROUND: New immunization programs are dependent on data from surveillance networks and disease burden estimates to prioritize target areas and risk groups. Data regarding invasive Salmonella disease in sub-Saharan Africa are currently limited, thus hindering the implementation of preventive measures. The Typhoid Fever Surveillance in Africa Program (TSAP) was established by the International Vaccine Institute to obtain comparable incidence data on typhoid fever and invasive nontyphoidal Salmonella (iNTS) disease in sub-Saharan Africa through standardized surveillance in multiple countries. METHODS: Standardized procedures were developed and deployed across sites for study site selection, patient enrolment, laboratory procedures, quality control and quality assurance, assessment of healthcare utilization and incidence calculations. RESULTS: Passive surveillance for bloodstream infections among febrile patients was initiated at thirteen sentinel sites in ten countries (Burkina Faso, Ethiopia, Ghana, Guinea-Bissau, Kenya, Madagascar, Senegal, South Africa, Sudan, and Tanzania). Each TSAP site conducted case detection using these standardized methods to isolate and identify aerobic bacteria from the bloodstream of febrile patients. Healthcare utilization surveys were conducted to adjust population denominators in incidence calculations for differing healthcare utilization patterns and improve comparability of incidence rates across sites. CONCLUSIONS: By providing standardized data on the incidence of typhoid fever and iNTS disease in sub-Saharan Africa, TSAP will provide vital input for targeted typhoid fever prevention programs.
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