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Cited by 204Salmonella and Campylobacter epidemiologyBacterial Infections and VaccinesPneumonia and Respiratory Infections

Population-Based Incidence of Typhoid Fever in an Urban Informal Settlement and a Rural Area in Kenya: Implications for Typhoid Vaccine Use in Africa

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Breiman, Robert F., Cosmas, Leonard, Njuguna, Henry, Audi, Allan, Olack, Beatrice, Ochieng, John B., Wamola, Newton, Bigogo, Godfrey M. +7 more·2012·PLoS ONE
DOI 10.1371/journal.pone.0029119PMC PMC3261857
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Abstract

BACKGROUND: High rates of typhoid fever in children in urban settings in Asia have led to focus on childhood immunization in Asian cities, but not in Africa, where data, mostly from rural areas, have shown low disease incidence. We set out to compare incidence of typhoid fever in a densely populated urban slum and a rural community in Kenya, hypothesizing higher rates in the urban area, given crowding and suboptimal access to safe water, sanitation and hygiene. METHODS: During 2007-9, we conducted population-based surveillance in Kibera, an urban informal settlement in Nairobi, and in Lwak, a rural area in western Kenya. Participants had free access to study clinics; field workers visited their homes biweekly to collect information about acute illnesses. In clinic, blood cultures were processed from patients with fever or pneumonia. Crude and adjusted incidence rates were calculated. RESULTS: In the urban site, the overall crude incidence of Salmonella enterica serovar Typhi (S. Typhi) bacteremia was 247 cases per 100,000 person-years of observation (pyo) with highest rates in children 5-9 years old (596 per 100,000 pyo) and 2-4 years old (521 per 100,000 pyo). Crude overall incidence in Lwak was 29 cases per 100,000 pyo with low rates in children 2-4 and 5-9 years old (28 and 18 cases per 100,000 pyo, respectively). Adjusted incidence rates were highest in 2-4 year old urban children (2,243 per 100,000 pyo) which were >15-fold higher than rates in the rural site for the same age group. Nearly 75% of S. Typhi isolates were multi-drug resistant. CONCLUSIONS: This systematic urban slum and rural comparison showed dramatically higher typhoid incidence among urban children <10 years old with rates similar to those from Asian urban slums. The findings have potential policy implications for use of typhoid vaccines in increasingly urban Africa.

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  • The impacts of slum residents' inappropriate antibiotic consumption practices on community-level antimicrobial resistance may explain why a higher proportion of enteric and bloodstream infections among children living in urban informal settlements are resistant to first-line antibiotics compared to children living in rural areas.

    “Overall, the impacts of slum residents' inappropriate antibiotic consumption practices on community-level antimicrobial resistance may explain why a higher proportion of enteric and bloodstream infections among children living in urban informal settlements are resistant to first-line antibiotics, compared to children living in rural areas 27-29 .”

    From Urban informal settlements as hotspots of antimicrobial resistance and the need to curb environmental transmission. (2020) · cites this paper as [28]

    The Results (page unavailable), Table 4, show lower susceptibility to several commonly used antibiotics among S. Typhi isolates from urban Kibera than rural Lwak. The paper does not establish this comparison for enteric and bloodstream infections generally, or attribute the resistance difference to inappropriate antibiotic consumption by slum residents. (LLM, conf=0.86)

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Research works printed but not linked: 2

  1. [1]Ernst R 1994 Immigrant life in New York City. 1994 p.23 Syracuse: Syracuse University Press
  2. [11]Bauer A Kirby MMW Sherris JC Turk M 1966 Antibiotic susceptibility testing by a standardised single disc method. Am. J. Clin. Pathol 45 493 496 5325707

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Authors
Breiman, R. F., Cosmas, L., Njuguna, H., Audi, A., Olack, B., Ochieng, J. B., Wamola, N., Bigogo, G. M., Awiti, G., Tabu, C. W., Burke, H., Williamson, J., Oundo, J. O., Mintz, E. D., & Feikin, D. R.
Affiliations
  • Centers for Disease Control and Prevention (US)
  • Ministry of Health (KE)
Corresponding author
Breiman, Robert F.
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2012-01-19
Volume
7
Issue
1
Pages
e29119
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0029119
PMC
PMC3261857
OpenAlex
W2021755623
Cited by
204
References
42
Citations by year
2026: 2 · 2025: 10 · 2024: 12 · 2023: 10 · 2022: 9 · 2021: 9 · 2020: 16 · 2019: 16 · 2018: 21 · 2017: 17 · 2016: 13 · 2015: 24 · 2014: 22 · 2013: 15 · 2012: 8
FWCI
33.94
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, public-domain)
  • PubMed Central (publishedVersion, public-domain)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Centers for Disease Control and Prevention
Topics
  • Life Sciences › Agricultural and Biological Sciences › Food Science › Salmonella and Campylobacter epidemiology
  • Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
  • Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
Keywords
typhoid fever, Salmonella typhi, typhoid vaccine, urban informal settlements, slums, urban-rural differences, bacteremia, multidrug resistance, Kibera, Kenya, water, sanitation and hygiene, urbanization in Africa
MeSH terms
Africa, Child, Child, Preschool, Female, Humans, Male, Rural Population, Typhoid Fever, Typhoid-Paratyphoid Vaccines, Urban Population, Incidence

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