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    Tenacious Endemic Typhoid Fever in Samoa

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    Author
    Sikorski, Michael J
    Desai, Sachin N
    Tupua, Siaosi
    Thomsen, Robert E
    Han, Jane
    Rambocus, Savitra
    Nimarota-Brown, Susana
    Punimata, Linatupu
    Tusitala, Salesa
    Sialeipata, Michelle
    Hoffman, Seth A
    Tracy, J Kathleen
    Higginson, Ellen E
    Tennant, Sharon M
    Gauld, Jillian S
    Klein, Daniel J
    Ballard, Susan A
    Robins-Browne, Roy M
    Dougan, Gordon
    Nilles, Eric J
    Howden, Benjamin P
    Crump, John A
    Naseri, Take K
    Levine, Myron M
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    Date
    2020-07-29
    Journal
    Clinical Infectious Diseases
    Publisher
    Oxford University Press
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1093/cid/ciaa314
    Abstract
    BACKGROUND: Typhoid fever has been endemic on the island nation of Samoa (2016 population, 195 979) since the 1960s and has persisted through 2019, despite economic development and improvements in water supply and sanitation. METHODS: Salmonella enterica serovar Typhi isolates from the 2 hospitals with blood culture capability and matched patient demographic and clinical data from January 2008 through December 2019 were analyzed. Denominators to calculate incidence by island, region, and district came from 2011 and 2016 censuses and from 2017-2019 projections from Samoa's Bureau of Statistics. Data were analyzed to describe typhoid case burden and incidence from 2008 to 2019 by time, place, and person. RESULTS: In sum, 53-193 blood culture-confirmed typhoid cases occurred annually from 2008 to 2019, without apparent seasonality. Typhoid incidence was low among children age < 48 months (17.6-27.8/105), rose progressively in ages 5-9 years (54.0/105), 10-19 years (60.7-63.4/105), and 20-34 years (61.0-79.3/105), and then tapered off; 93.6% of cases occurred among Samoans < 50 years of age. Most typhoid cases and the highest incidence occurred in Northwest Upolu, but Apia Urban Area (served by treated water supplies) also exhibited moderate incidence. The proportion of cases from short-cycle versus long-cycle transmission is unknown. Samoan S. Typhi are pansusceptible to traditional first-line antibiotics. Nevertheless, enhanced surveillance in 2019 detected 4 (2.9%) deaths among 140 cases. CONCLUSIONS: Typhoid has been endemic in Samoa in the period 2008-2019. Interventions, including mass vaccination with a Vi-conjugate vaccine coadministered with measles vaccine are planned. © The Author(s) 2020.
    Keyword
    Salmonella Typhi
    Oceania
    Samoa
    epidemiology
    typhoid fever
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/13538
    ae974a485f413a2113503eed53cd6c53
    10.1093/cid/ciaa314
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