Epidemiology and risk factors for typhoid fever in Central Division, Fiji, 2014–2017: A case-control study

Typhoid fever is endemic in Fiji, with high reported annual incidence. We sought to identify the sources and modes of transmission of typhoid fever in Fiji with the aim to inform disease control. We identified and surveyed patients with blood culture-confirmed typhoid fever from January 2014 through...

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Veröffentlicht in:PLoS neglected tropical diseases Jg. 12; H. 6; S. e0006571
Hauptverfasser: Prasad, Namrata, Jenkins, Aaron P., Naucukidi, Lanieta, Rosa, Varanisese, Sahu-Khan, Aalisha, Kama, Mike, Jenkins, Kylie M., Jenney, Adam W. J., Jack, Susan J., Saha, Debasish, Horwitz, Pierre, Jupiter, Stacy D., Strugnell, Richard A., Mulholland, E. Kim, Crump, John A.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States Public Library of Science 01.06.2018
Public Library of Science (PLoS)
Schlagworte:
Analysis
Biology and Life Sciences
Blood culture
Care and treatment
Confidence intervals
Contamination
Control
Disease control
Disease transmission
Drinking water
Earth Sciences
Epidemiology
Ethnicity
Fever
Funding
Gender
Health sciences
Laboratories
Medicine
Medicine and Health Sciences
Minority & ethnic groups
Patients
People and Places
Population
Public health
Residential areas
Risk analysis
Risk factors
Rural areas
Salmonella
Salmonella enterica
Sanitation
Sanitation facilities
Studies
Surface water
Surveys
Transmission
Tropical diseases
Typhoid
Typhoid fever
Water availability
Water pollution
Water shortages
Water supply
Waterborne diseases
Fiji
New Zealand
Bangladesh
Victoria Australia
Australia
Oceania
ISSN:1935-2735, 1935-2727, 1935-2735
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Zusammenfassung:Typhoid fever is endemic in Fiji, with high reported annual incidence. We sought to identify the sources and modes of transmission of typhoid fever in Fiji with the aim to inform disease control. We identified and surveyed patients with blood culture-confirmed typhoid fever from January 2014 through January 2017. For each typhoid fever case we matched two controls by age interval, gender, ethnicity, and residential area. Univariable and multivariable analysis were used to evaluate associations between exposures and risk for typhoid fever. We enrolled 175 patients with typhoid fever and 349 controls. Of the cases, the median (range) age was 29 (2-67) years, 86 (49%) were male, and 84 (48%) lived in a rural area. On multivariable analysis, interrupted water availability (odds ratio [OR] = 2.17; 95% confidence interval [CI] 1.18-4.00), drinking surface water in the last 2 weeks (OR = 3.61; 95% CI 1.44-9.06), eating unwashed produce (OR = 2.69; 95% CI 1.48-4.91), and having an unimproved or damaged sanitation facility (OR = 4.30; 95% CI 1.14-16.21) were significantly associated with typhoid fever. Frequent handwashing after defecating (OR = 0.57; 95% CI 0.35-0.93) and using soap for handwashing (OR = 0.61; 95% CI 0.37-0.95) were independently associated with a lower odds of typhoid fever. Poor sanitation facilities appear to be a major source of Salmonella Typhi in Fiji, with transmission by drinking contaminated surface water and consuming unwashed produce. Improved sanitation facilities and protection of surface water sources and produce from contamination by human feces are likely to contribute to typhoid control in Fiji.
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I have read the journal's policy and the authors of this manuscript have the following competing interests: DS at present is a full time employee of GlaxoSmithKline vaccine.
JAC and EKM also contributed equally to this work.
ISSN:1935-2735
1935-2727
1935-2735
DOI:10.1371/journal.pntd.0006571