Ceftriaxone-resistant Salmonella Typhi Outbreak in Hyderabad City of Sindh, Pakistan: High Time for the Introduction of Typhoid Conjugate Vaccine
Abstract Background The Aga Khan University clinical microbiology laboratory identified an outbreak of ceftriaxone-resistant Salmonella Typhi in Hyderabad, Pakistan, through antimicrobial resistance surveillance. An outbreak investigation was carried out to identify the risk factors and institute co...
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| Veröffentlicht in: | Clinical infectious diseases 2019-02, Vol.68 (Supplement_1), p.S16-S21 |
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| creator | Yousafzai, Mohammad Tahir Qamar, Farah Naz Shakoor, Sadia Saleem, Khalid Lohana, Heeramani Karim, Sultan Hotwani, Aneeta Qureshi, Shahida Masood, Naveed Rauf, Mudasir Khanzada, Jamshed Ahmed Kazi, Momin Hasan, Rumina |
| description | Abstract
Background
The Aga Khan University clinical microbiology laboratory identified an outbreak of ceftriaxone-resistant Salmonella Typhi in Hyderabad, Pakistan, through antimicrobial resistance surveillance. An outbreak investigation was carried out to identify the risk factors and institute control measures. Here we report the preliminary findings of this outbreak investigation, using data collected from 30 November 2016 to 28 March 2017.
Methods
The design for the investigation was a case-control study that included identification of culture-proven ceftriaxone-resistant S. Typhi cases, suspected cases from the households or neighborhood of the confirmed cases, and enrollment of controls matched by age to identify the risk factors. Data were collected through face-to-face interviews using a structured questionnaire. Blood cultures were obtained from all suspected cases. Drinking water samples from each household of cases and controls were obtained for microbiological testing. Geographic Information System coordinates were obtained for all cases and controls.
Results
Only 2 subdistricts of Hyderabad (Latifabad and Qasimabad) were affected. A total of 101 confirmed cases of ceftriaxone-resistant S. Typhi had been reported in 4 months with the first case reported on 30 November 2016. Median age was 48 (interquartile range, 29–84) months. The majority (60% [61/101]) of the cases were 6–60 months old. More than half (56% [57/101]) of the cases were male. About 60% of the cases were admitted to hospital and treated as inpatient. More than half (57/101) of the patients developed complications related to typhoid.
Conclusions
Community awareness was raised regarding chlorination of drinking water and sanitation measures in Hyderabad. These efforts were coordinated with the municipal water and sewage authority established to improve chlorination at processing plants and operationalize fecal sludge treatment plants. Outbreak investigation and control efforts have continued. Immunization of children with typhoid conjugate vaccine within Hyderabad city is planned. |
| doi_str_mv | 10.1093/cid/ciy877 |
| format | Article |
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Background
The Aga Khan University clinical microbiology laboratory identified an outbreak of ceftriaxone-resistant Salmonella Typhi in Hyderabad, Pakistan, through antimicrobial resistance surveillance. An outbreak investigation was carried out to identify the risk factors and institute control measures. Here we report the preliminary findings of this outbreak investigation, using data collected from 30 November 2016 to 28 March 2017.
Methods
The design for the investigation was a case-control study that included identification of culture-proven ceftriaxone-resistant S. Typhi cases, suspected cases from the households or neighborhood of the confirmed cases, and enrollment of controls matched by age to identify the risk factors. Data were collected through face-to-face interviews using a structured questionnaire. Blood cultures were obtained from all suspected cases. Drinking water samples from each household of cases and controls were obtained for microbiological testing. Geographic Information System coordinates were obtained for all cases and controls.
Results
Only 2 subdistricts of Hyderabad (Latifabad and Qasimabad) were affected. A total of 101 confirmed cases of ceftriaxone-resistant S. Typhi had been reported in 4 months with the first case reported on 30 November 2016. Median age was 48 (interquartile range, 29–84) months. The majority (60% [61/101]) of the cases were 6–60 months old. More than half (56% [57/101]) of the cases were male. About 60% of the cases were admitted to hospital and treated as inpatient. More than half (57/101) of the patients developed complications related to typhoid.
Conclusions
Community awareness was raised regarding chlorination of drinking water and sanitation measures in Hyderabad. These efforts were coordinated with the municipal water and sewage authority established to improve chlorination at processing plants and operationalize fecal sludge treatment plants. Outbreak investigation and control efforts have continued. Immunization of children with typhoid conjugate vaccine within Hyderabad city is planned.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/ciy877</identifier><identifier>PMID: 30767003</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Adolescent ; Ceftriaxone - pharmacology ; Child ; Child, Preschool ; Disease Outbreaks ; Female ; Humans ; Infant ; Male ; Pakistan - epidemiology ; Salmonella typhi - drug effects ; Sanitation ; Supplement ; Typhoid Fever - epidemiology ; Typhoid Fever - microbiology ; Typhoid Fever - prevention & control ; Typhoid-Paratyphoid Vaccines - immunology ; Water Microbiology ; Water Quality ; Water Supply ; Young Adult</subject><ispartof>Clinical infectious diseases, 2019-02, Vol.68 (Supplement_1), p.S16-S21</ispartof><rights>The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. 2019</rights><rights>The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-10b59f6f6f9cdf95a3563640006efdc9aebc8fa721ae069190922144aff5e6903</citedby><cites>FETCH-LOGICAL-c372t-10b59f6f6f9cdf95a3563640006efdc9aebc8fa721ae069190922144aff5e6903</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30767003$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yousafzai, Mohammad Tahir</creatorcontrib><creatorcontrib>Qamar, Farah Naz</creatorcontrib><creatorcontrib>Shakoor, Sadia</creatorcontrib><creatorcontrib>Saleem, Khalid</creatorcontrib><creatorcontrib>Lohana, Heeramani</creatorcontrib><creatorcontrib>Karim, Sultan</creatorcontrib><creatorcontrib>Hotwani, Aneeta</creatorcontrib><creatorcontrib>Qureshi, Shahida</creatorcontrib><creatorcontrib>Masood, Naveed</creatorcontrib><creatorcontrib>Rauf, Mudasir</creatorcontrib><creatorcontrib>Khanzada, Jamshed Ahmed</creatorcontrib><creatorcontrib>Kazi, Momin</creatorcontrib><creatorcontrib>Hasan, Rumina</creatorcontrib><title>Ceftriaxone-resistant Salmonella Typhi Outbreak in Hyderabad City of Sindh, Pakistan: High Time for the Introduction of Typhoid Conjugate Vaccine</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>Abstract
Background
The Aga Khan University clinical microbiology laboratory identified an outbreak of ceftriaxone-resistant Salmonella Typhi in Hyderabad, Pakistan, through antimicrobial resistance surveillance. An outbreak investigation was carried out to identify the risk factors and institute control measures. Here we report the preliminary findings of this outbreak investigation, using data collected from 30 November 2016 to 28 March 2017.
Methods
The design for the investigation was a case-control study that included identification of culture-proven ceftriaxone-resistant S. Typhi cases, suspected cases from the households or neighborhood of the confirmed cases, and enrollment of controls matched by age to identify the risk factors. Data were collected through face-to-face interviews using a structured questionnaire. Blood cultures were obtained from all suspected cases. Drinking water samples from each household of cases and controls were obtained for microbiological testing. Geographic Information System coordinates were obtained for all cases and controls.
Results
Only 2 subdistricts of Hyderabad (Latifabad and Qasimabad) were affected. A total of 101 confirmed cases of ceftriaxone-resistant S. Typhi had been reported in 4 months with the first case reported on 30 November 2016. Median age was 48 (interquartile range, 29–84) months. The majority (60% [61/101]) of the cases were 6–60 months old. More than half (56% [57/101]) of the cases were male. About 60% of the cases were admitted to hospital and treated as inpatient. More than half (57/101) of the patients developed complications related to typhoid.
Conclusions
Community awareness was raised regarding chlorination of drinking water and sanitation measures in Hyderabad. These efforts were coordinated with the municipal water and sewage authority established to improve chlorination at processing plants and operationalize fecal sludge treatment plants. Outbreak investigation and control efforts have continued. Immunization of children with typhoid conjugate vaccine within Hyderabad city is planned.</description><subject>Adolescent</subject><subject>Ceftriaxone - pharmacology</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Disease Outbreaks</subject><subject>Female</subject><subject>Humans</subject><subject>Infant</subject><subject>Male</subject><subject>Pakistan - epidemiology</subject><subject>Salmonella typhi - drug effects</subject><subject>Sanitation</subject><subject>Supplement</subject><subject>Typhoid Fever - epidemiology</subject><subject>Typhoid Fever - microbiology</subject><subject>Typhoid Fever - prevention & control</subject><subject>Typhoid-Paratyphoid Vaccines - immunology</subject><subject>Water Microbiology</subject><subject>Water Quality</subject><subject>Water Supply</subject><subject>Young Adult</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><sourceid>EIF</sourceid><recordid>eNp9kVGLFSEYhiWKdtu66QeEN0FEUzoenbGLIA7VWVjYYE_dyjeOnnF3Rk_qRPMz-sd5OttSNyGi6PM9fvgi9JSS15RI9ka7vsylbZp76JRy1lSCS3q_7Alvq1XL2hP0KKVrQihtCX-IThhpREMIO0U_18bm6OBH8KaKJrmUwWd8BeNUTsYR8HbZDw5fzrmLBm6w83iz9CZCBz1eu7zgYPGV8_3wCn-Gm9_1b_HG7Qa8dZPBNkScB4PPfY6hn3V2wR9KDtrgiiL463kH2eCvoLXz5jF6YGFM5snteoa-fPywXW-qi8tP5-v3F5VmTZ0rSjourShD6t5KDowLJlaEEGFsryWYTrcWmpqCIUJSSWRd09UKrOVGSMLO0Lujdz93k-m1KQ3CqPbRTRAXFcCpf2-8G9QufFeCNYJIWQQvbgUxfJtNympySR_-zJswJ1XTlnPOmBAFfXlEdQwpRWPvnqFEHTJUJUN1zLDAz_5u7A79E1oBnh-BMO__J_oF8-GoZg</recordid><startdate>20190215</startdate><enddate>20190215</enddate><creator>Yousafzai, Mohammad Tahir</creator><creator>Qamar, Farah Naz</creator><creator>Shakoor, Sadia</creator><creator>Saleem, Khalid</creator><creator>Lohana, Heeramani</creator><creator>Karim, Sultan</creator><creator>Hotwani, Aneeta</creator><creator>Qureshi, Shahida</creator><creator>Masood, Naveed</creator><creator>Rauf, Mudasir</creator><creator>Khanzada, Jamshed Ahmed</creator><creator>Kazi, Momin</creator><creator>Hasan, Rumina</creator><general>Oxford University Press</general><scope>TOX</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190215</creationdate><title>Ceftriaxone-resistant Salmonella Typhi Outbreak in Hyderabad City of Sindh, Pakistan: High Time for the Introduction of Typhoid Conjugate Vaccine</title><author>Yousafzai, Mohammad Tahir ; Qamar, Farah Naz ; Shakoor, Sadia ; Saleem, Khalid ; Lohana, Heeramani ; Karim, Sultan ; Hotwani, Aneeta ; Qureshi, Shahida ; Masood, Naveed ; Rauf, Mudasir ; Khanzada, Jamshed Ahmed ; Kazi, Momin ; Hasan, Rumina</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-10b59f6f6f9cdf95a3563640006efdc9aebc8fa721ae069190922144aff5e6903</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>Ceftriaxone - pharmacology</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Disease Outbreaks</topic><topic>Female</topic><topic>Humans</topic><topic>Infant</topic><topic>Male</topic><topic>Pakistan - epidemiology</topic><topic>Salmonella typhi - drug effects</topic><topic>Sanitation</topic><topic>Supplement</topic><topic>Typhoid Fever - epidemiology</topic><topic>Typhoid Fever - microbiology</topic><topic>Typhoid Fever - prevention & control</topic><topic>Typhoid-Paratyphoid Vaccines - immunology</topic><topic>Water Microbiology</topic><topic>Water Quality</topic><topic>Water Supply</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yousafzai, Mohammad Tahir</creatorcontrib><creatorcontrib>Qamar, Farah Naz</creatorcontrib><creatorcontrib>Shakoor, Sadia</creatorcontrib><creatorcontrib>Saleem, Khalid</creatorcontrib><creatorcontrib>Lohana, Heeramani</creatorcontrib><creatorcontrib>Karim, Sultan</creatorcontrib><creatorcontrib>Hotwani, Aneeta</creatorcontrib><creatorcontrib>Qureshi, Shahida</creatorcontrib><creatorcontrib>Masood, Naveed</creatorcontrib><creatorcontrib>Rauf, Mudasir</creatorcontrib><creatorcontrib>Khanzada, Jamshed Ahmed</creatorcontrib><creatorcontrib>Kazi, Momin</creatorcontrib><creatorcontrib>Hasan, Rumina</creatorcontrib><collection>Oxford Journals Open Access Collection</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yousafzai, Mohammad Tahir</au><au>Qamar, Farah Naz</au><au>Shakoor, Sadia</au><au>Saleem, Khalid</au><au>Lohana, Heeramani</au><au>Karim, Sultan</au><au>Hotwani, Aneeta</au><au>Qureshi, Shahida</au><au>Masood, Naveed</au><au>Rauf, Mudasir</au><au>Khanzada, Jamshed Ahmed</au><au>Kazi, Momin</au><au>Hasan, Rumina</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ceftriaxone-resistant Salmonella Typhi Outbreak in Hyderabad City of Sindh, Pakistan: High Time for the Introduction of Typhoid Conjugate Vaccine</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2019-02-15</date><risdate>2019</risdate><volume>68</volume><issue>Supplement_1</issue><spage>S16</spage><epage>S21</epage><pages>S16-S21</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><abstract>Abstract
Background
The Aga Khan University clinical microbiology laboratory identified an outbreak of ceftriaxone-resistant Salmonella Typhi in Hyderabad, Pakistan, through antimicrobial resistance surveillance. An outbreak investigation was carried out to identify the risk factors and institute control measures. Here we report the preliminary findings of this outbreak investigation, using data collected from 30 November 2016 to 28 March 2017.
Methods
The design for the investigation was a case-control study that included identification of culture-proven ceftriaxone-resistant S. Typhi cases, suspected cases from the households or neighborhood of the confirmed cases, and enrollment of controls matched by age to identify the risk factors. Data were collected through face-to-face interviews using a structured questionnaire. Blood cultures were obtained from all suspected cases. Drinking water samples from each household of cases and controls were obtained for microbiological testing. Geographic Information System coordinates were obtained for all cases and controls.
Results
Only 2 subdistricts of Hyderabad (Latifabad and Qasimabad) were affected. A total of 101 confirmed cases of ceftriaxone-resistant S. Typhi had been reported in 4 months with the first case reported on 30 November 2016. Median age was 48 (interquartile range, 29–84) months. The majority (60% [61/101]) of the cases were 6–60 months old. More than half (56% [57/101]) of the cases were male. About 60% of the cases were admitted to hospital and treated as inpatient. More than half (57/101) of the patients developed complications related to typhoid.
Conclusions
Community awareness was raised regarding chlorination of drinking water and sanitation measures in Hyderabad. These efforts were coordinated with the municipal water and sewage authority established to improve chlorination at processing plants and operationalize fecal sludge treatment plants. Outbreak investigation and control efforts have continued. Immunization of children with typhoid conjugate vaccine within Hyderabad city is planned.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>30767003</pmid><doi>10.1093/cid/ciy877</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Ceftriaxone - pharmacology Child Child, Preschool Disease Outbreaks Female Humans Infant Male Pakistan - epidemiology Salmonella typhi - drug effects Sanitation Supplement Typhoid Fever - epidemiology Typhoid Fever - microbiology Typhoid Fever - prevention & control Typhoid-Paratyphoid Vaccines - immunology Water Microbiology Water Quality Water Supply Young Adult |
| title | Ceftriaxone-resistant Salmonella Typhi Outbreak in Hyderabad City of Sindh, Pakistan: High Time for the Introduction of Typhoid Conjugate Vaccine |
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