Incidence of Enteric Fever in a Pediatric Cohort in North India: Comparison with Estimates from 20 Years Earlier

Abstract

Background An earlier cohort in 1995–1996 showed a very high burden of typhoid in Delhi. Our aim was to estimate the current overall and age-specific incidence of culture-confirmed enteric fever among children aged 6 months to 15 years in Delhi. Methods We enrolled a cohort of 6000 children aged 6 months to <14 years in South Delhi and followed them up weekly for 24 months or until 15 completed years of child age, whichever was earlier. Blood culture to confirm enteric fever was done in children with ≥3 consecutive days of fever. Results We recorded a total of 14 650 episodes of fever in the 11 510 person-years (PY) of follow-up. A total of 81 fever episodes were positive for enteric fever. The incidence (95% confidence interval) of all enteric fever was 703.7 (560.5–874.7) per 100 000 PY. The incidences of typhoid and paratyphoid fevers were 608.1 (95% confidence interval, 481.1–768.7) and 111.7 (59.5–191.1) per 100 000 PY, respectively, highest among children aged 10–15 years. Conclusions Despite a 35% reduction in incidence compared with the 1995–1996 cohort, our study suggested a substantial burden of enteric fever in the population. Continued efforts to improve water, sanitation, and hygiene parameters along with implementation of novel vaccination strategies and disease surveillance can help achieve the goal of disease elimination.

Association of water, sanitation, hygiene and food practices with enteric fever in a paediatric cohort in North India

“…Multiple initiatives during these years have affected the WASH and food hygiene practices as well as immunisation schedules across different states in the country. Contrary to the speculations of a lower burden, our recent study reported a high burden of enteric fever, that is, 703.7 (95% CI 560.5 to 874.7) per 100 000 PY 15…”

“…Contrary to the speculations of a lower burden, our recent study reported a high burden of enteric fever, that is, 703.7 (95% CI 560.5 to 874.7) per 100 000 PY. 15 …”

Profile of Enteric Fever in Children Admitted to a Tertiary Care Center in North India

“…This high incidence in school-going children is in line with the trends reported by Sinha et al in their pediatric cohort study from North India. 9 However, Saigal et al reported maximum cases in the 1- to 5-year-old group. The difference may be because of inclusion of only admitted children in our study.…”

Clinical and antimicrobial susceptibility profile of typhoid fever in children in the era of antibiotic resistance

“…2 There is a perceived decline in both the incidence and the severity of typhoid fever based on hospital and communitybased reports. [4][5][6] This could be due to improvements in water, sanitation, and hygiene (WASH) indicators, sociodemographic parameters, and local vaccine introduction. However, an apparent decline in numbers may arise from under-reporting, delayed healthcare seeking, poor access to quality diagnostic facilities, and indiscriminate early antibiotic use in febrile illness.…”

“…However, an apparent decline in numbers may arise from under-reporting, delayed healthcare seeking, poor access to quality diagnostic facilities, and indiscriminate early antibiotic use in febrile illness. Increasing antimicrobial resistance, 6 an increasing proportion of infections in very young children, and increased paratyphoid infections are significant concerns. 7,8 Antimicrobials initially lowered the case fatality rate of typhoid fever to <2%, 9 but the emergence of multidrugresistant (MDR) Salmonella, resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole in the 1980s, led to the adoption of fluoroquinolones as new first-line treatment, with extended-spectrum cephalosporins as an alternative.…”