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Molecular Surveillance Identifies Multiple Transmissions of Typhoid in West Africa

Wong, Vanessa K, Holt, Kathryn E, Okoro, Chinyere, Baker, Stephen, Pickard, Derek J, Marks, Florian, Page, Andrew J, Olanipekun, Grace, Munir, Huda, Alter, Roxanne, Fey, Paul D, Feasey, Nicholas ORCID: https://orcid.org/0000-0003-4041-1405, Weill, Francois-Xavier, Le Hello, Simon, Hart, Peter J, Kariuki, Samuel, Breiman, Robert F, Gordon, Melita A, Heyderman, Robert S, Jacobs, Jan, Lunguya, Octavie, Msefula, Chisomo, MacLennan, Calman A, Keddy, Karen H, Smith, Anthony M, Onsare, Robert S, De Pinna, Elizabeth, Nair, Satheesh, Amos, Ben, Dougan, Gordon and Obaro, Stephen (2016) 'Molecular Surveillance Identifies Multiple Transmissions of Typhoid in West Africa'. PLoS Neglected Tropical Diseases, Vol 10, Issue 9, e0004781.

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Abstract

Background
The burden of typhoid in sub-Saharan African (SSA) countries has been difficult to estimate, in part, due to suboptimal laboratory diagnostics. However, surveillance blood cultures at two sites in Nigeria have identified typhoid associated with Salmonella enterica serovar Typhi (S. Typhi) as an important cause of bacteremia in children.

Methods
A total of 128 S. Typhi isolates from these studies in Nigeria were whole-genome sequenced, and the resulting data was used to place these Nigerian isolates into a worldwide context based on their phylogeny and carriage of molecular determinants of antibiotic resistance.

Results
Several distinct S. Typhi genotypes were identified in Nigeria that were related to other clusters of S. Typhi isolates from north, west and central regions of Africa. The rapidly expanding S. Typhi clade 4.3.1 (H58) previously associated with multiple antimicrobial resistances in Asia and in east, central and southern Africa, was not detected in this study. However, antimicrobial resistance was common amongst the Nigerian isolates and was associated with several plasmids, including the IncHI1 plasmid commonly associated with S. Typhi.

Conclusions
These data indicate that typhoid in Nigeria was established through multiple independent introductions into the country, with evidence of regional spread. MDR typhoid appears to be evolving independently of the haplotype H58 found in other typhoid endemic countries. This study highlights an urgent need for routine surveillance to monitor the epidemiology of typhoid and evolution of antimicrobial resistance within the bacterial population as a means to facilitate public health interventions to reduce the substantial morbidity and mortality of typhoid.

Item Type: Article
Corporate Authors: International Typhoid Consortium
Subjects: QW Microbiology and Immunology > Bacteria > QW 138 Enterobacteriaceae
WA Public Health > Preventive Medicine > WA 110 Prevention and control of communicable diseases. Transmission of infectious diseases
WC Communicable Diseases > Infection. Bacterial Infections > Enteric Infections > WC 270 Typhoid fever
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1371/journal.pntd.0004781
SWORD Depositor: JISC Pubrouter
Depositing User: JISC Pubrouter
Date Deposited: 06 Oct 2016 15:47
Last Modified: 06 Feb 2018 13:13
URI: https://archive.lstmed.ac.uk/id/eprint/6227

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