The global burden of non-typhoidal salmonella invasive disease: a systematic analysis for the Global Burden of Disease Study 2017

Abstract

SummaryBackgroundNon-typhoidal salmonella invasive disease is a major cause of global morbidity and mortality. Malnourished children, those with recent malaria or sickle-cell anaemia, and adults with HIV infection are at particularly high risk of disease. We sought to estimate the burden of disease attributable to non-typhoidal salmonella invasive disease for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017.MethodsWe did a systematic review of scientific databases and grey literature, and estimated non-typhoidal salmonella invasive disease incidence and mortality for the years 1990 to 2017, by age, sex, and geographical location using DisMod-MR, a Bayesian meta-regression tool. We estimated case fatality by age, HIV status, and sociodemographic development. We also calculated the HIV-attributable fraction and estimated health gap metrics, including disability-adjusted life-years (DALYs).FindingsWe estimated that 535 000 (95% uncertainty interval 409 000–705 000) cases of non-typhoidal salmonella invasive disease occurred in 2017, with the highest incidence in sub-Saharan Africa (34·5 [26·6–45·0] cases per 100 000 person-years) and in children younger than 5 years (34·3 [23·2–54·7] cases per 100 000 person-years). 77 500 (46 400–123 000) deaths were estimated in 2017, of which 18 400 (12 000–27 700) were attributable to HIV. The remaining 59 100 (33 300–98 100) deaths not attributable to HIV accounted for 4·26 million (2·38–7·38) DALYs in 2017. Mean all-age case fatality was 14·5% (9·2–21·1), with higher estimates among children younger than 5 years (13·5% [8·4–19·8]) and elderly people (51·2% [30·2–72·9] among those aged ≥70 years), people with HIV infection (41·8% [30·0–54·0]), and in areas of low sociodemographic development (eg, 15·8% [10·0–22·9] in sub-Saharan Africa).InterpretationWe present the first global estimates of non-typhoidal salmonella invasive disease that have been produced as part of GBD 2017. Given the high disease burden, particularly in children, elderly people, and people with HIV infection, investigating the sources and transmission pathways of non-typhoidal salmonella invasive disease is crucial to implement effective preventive and control measures.FundingBill & Melinda Gates Foundation.

Evaluation of WGS-subtyping methods for epidemiological surveillance of foodborne salmonellosis.

“…Typhoid fever is caused by the human restricted Salmonella enterica serovars Typhi and Paratyphi (2). Although non-typhoidal Salmonella (NTS) serovars, predominantly cause a self-limiting diarrhoeal illness they have adapted to cause invasive extraintestinal disease known as invasive NTS (iNTS) which can result in bacteraemia and focal systemic infections (3,4) . There are two licenced vaccines for prevention of typhoid fever however, they are not effective against NTS (5) moreover, management of iNTS illness is complicated by the emergence of multidrug resistant (MDR) strains (6).…”

“…Salmonella serovars responsible for typhoid fever kill over 250,000 humans per year (7) while non-typhoidal Salmonella (NTS) serovars responsible for diarrhoeal illness cause over 155,000 deaths annually (8). Interestingly, NTS have adapted to cause febrile bacteraemia and serious systemic infections; it has been estimated that over 680,000 people die every year as a result of infection by invasive NTS (iNTS) (3). Salmonella Typhimurium and Salmonella Dublin have been associated with systemic illness (4,5).…”

Complement evasion mechanisms of the systemic pathogens Yersiniae and Salmonellae

“…NTS are either host-specific, residing in one to a few animal species, or may be present in many different animal hosts. Regardless, all serotypes can cause disease in humans ranging from a self-limiting gastroenteritis to severe, invasive disease [126]. Salmonellosis onset occurs between 6 and 72 h after ingestion and generally lasts up to 1 week with symptoms of fever, abdominal pain, diarrhea, nausea, and sometimes vomiting.…”

“…Recently, certain sequence types have emerged with a greater capacity to cause invasive disease and resemble typhoidal disease characteristics like decreased damage in the intestine, dissemination, and resistance to phagocytes, and complement. S. Typhimurium ST313 (ST313), in particular, in sub-Saharan Africa, causes approximately 500 000 cases and 70 000 deaths annually due to invasive disease [126]. Much work has gone into determining how isolates in this sequence type emerged evolutionarily and the mechanism by which they lead to more frequent invasive disease.…”

Analysis of Salmonella enterica Enteritidis isolates from chicken and chicken meat products using PFGE, and MLST

“…It is especially common in foods prepared with contaminated poultry meat or egg. Although infection with non-typhoid Salmonella strains is mostly associated with mild self-limiting gastroenteritis, occasionally, severe invasive infections can result[19,20]. Moreover, the emergence of multidrug-resistant (MDR) isolates are characterized by reduced susceptibility to the commonly used antimicrobials portend an even severe health hazard.…”