1. Molecular Surveillance Identifies Multiple Transmissions of Typhoid in West Africa
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Ben Amos, Roxanne Alter, Samuel Kariuki, Elizabeth de Pinna, Robert F. Breiman, Anthony M. Smith, Calman A. MacLennan, Nicholas A. Feasey, Peter J. Hart, Stephen K. Obaro, Gordon Dougan, Chinyere K. Okoro, Huda Munir, Melita A. Gordon, Andrew J. Page, Vanessa K. Wong, Octavie Lunguya, Paul D. Fey, Simon Le Hello, Robert S. Heyderman, Chisomo L. Msefula, Robert S. Onsare, Kathryn E. Holt, Florian Marks, Derek Pickard, Karen H. Keddy, Stephen Baker, François-Xavier Weill, Satheesh Nair, Grace Olanipekun, Jan Jacobs, The Wellcome Trust Sanger Institute [Cambridge], Addenbrooke's Hospital, Cambridge University NHS Trust, Bio21 Molecular Science & Biotechnology Institute [Melbourne] (School of Chemistry), Faculty of Science [Melbourne], University of Melbourne-University of Melbourne, University of Melbourne, Oxford University Clinical Research Unit [Ho Chi Minh City] (OUCRU), Nuffield Department of Clinical Medicine [Oxford], University of Oxford [Oxford], London School of Hygiene and Tropical Medicine (LSHTM), Department of Epidemiology, International Vaccine Institute (IVI), International Foundation Against Infectious Diseases in Nigeria (IFAIN), Department of Medical Microbiology, Aminu Kano Teaching Hospital, University of Nebraska Medical Center, University of Nebraska System, Liverpool School of Tropical Medicine (LSTM), Centre National de Référence - National Reference Center Escherichia coli, Shigella et Salmonella (CNR-ESS), Institut Pasteur [Paris], Institut National de Recherche Biomédicale [Kinshasa] (INRB), St. George’s, University of London, Kenya Medical Research Institute (KEMRI), Global Disease Detection Division, Centers for Disease Control and Prevention, Emory Global Health Institute [Atlanta] (EGHI), Emory University [Atlanta, GA], University of Liverpool, University College of London [London] (UCL), Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), University of Malawi, National Institute for Communicable Diseases [Johannesburg] (NICD), St Augustine’s Hospital, Division of Pediatric Infectious Diseases, University of Nebraska System-University of Nebraska System, University of Abuja, Bingham University, This work was supported by a number of organizations. The Wellcome Trust Sanger Institute authors were funded by Wellcome Trust Award 098051, NAF was supported by the Wellcome Trust Research Fellowship WT092152MA. NAF, RSH and this work were supported by a strategic award from the Wellcome Trust for the MLW Clinical Research Programme (101113/Z/13/Z). KEH was supported by the NHMRC of Australia (fellowship #1061409) and the Victorian Life Sciences Computation Initiative (VLSCI) (grant #VR0082). CAM was supported by a Clinical Research Fellowship from GlaxoSmithKline and PJH by a UK Medical Research Council PhD studentship. This work forms part of an EU FP7 Marie Curie Actions Industry Academia Partnerships and Pathways (IAPP) Consortium Programme, entitled GENDRIVAX (Genome-driven vaccine development for bacterial infections), involving the Wellcome Trust Sanger Institute, KEMRI Nairobi and Novartis Vaccines Institute for Global Health. The Institut Pasteur (IP) authors were funded by the IP, the Institut de Veille Sanitaire, and by the French Government 'Investissement d'Avenir' program(Integrative Biology of Emerging Infectious Diseases' Laboratory of Excellence, grant no. ANR-10-LABX-62-IBEID). CO was supported by Society in Science, The Branco Weiss Fellowship, administered by the ETH Zurich. JJ was supported by the antibioticresistance surveillance project in DR Congo, funded by Project 2.01 of the Third Framework Agreement between the Belgian Directorate General of Development Cooperation and the Institute of Tropical Medicine, Antwerp, Belgium. FM was supported by a research grant from the Bill & Melinda Gates Foundation. The findings and conclusions contained within this publication are those of the authors and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation. SK was supported by the NIH Grant Number R01 AI099525-02. SB is a Sir Henry Dale Fellow, jointly funded by the Wellcome Trust and the Royal Society(100087/Z/12/Z). SO was supported by the National Institute Of Allergy And Infectious Diseases (NIAID) of the National Institutes of Health (#R01AI097493). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in study design, data collection and analysis,decision to publish, or preparation of the manuscript., ANR-10-LABX-0062,IBEID,Integrative Biology of Emerging Infectious Diseases(2010), Baker, Stephen [0000-0003-1308-5755], Marks, Florian [0000-0002-6043-7170], Dougan, Gordon [0000-0003-0022-965X], Apollo - University of Cambridge Repository, University of Oxford, Institut Pasteur [Paris] (IP), and Ryan, E
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0301 basic medicine ,Bacterial Diseases ,Veterinary medicine ,Salmonella typhi ,Pathology and Laboratory Medicine ,Global Health ,Salmonella Typhi ,Geographical Locations ,0302 clinical medicine ,Salmonella ,Epidemiology ,Global health ,Medicine and Health Sciences ,Typhoid ,Medicine ,Public and Occupational Health ,Clade ,Mammals ,lcsh:Public aspects of medicine ,International Typhoid Consortium ,3. Good health ,Bacterial Pathogens ,Europe ,Infectious Diseases ,Medical Microbiology ,Vertebrates ,Pathogens ,Research Article ,medicine.medical_specialty ,lcsh:Arctic medicine. Tropical medicine ,lcsh:RC955-962 ,030231 tropical medicine ,Nigeria ,Microbiology ,complex mixtures ,Typhoid fever ,wa_110 ,03 medical and health sciences ,Antibiotic resistance ,Enterobacteriaceae ,Environmental health ,Microbial Control ,Animals ,Microbial Pathogens ,QR355 ,Pharmacology ,Bacteria ,business.industry ,qw_138 ,wc_270 ,Public Health, Environmental and Occupational Health ,Organisms ,Biology and Life Sciences ,lcsh:RA1-1270 ,medicine.disease ,bacterial infections and mycoses ,R1 ,United Kingdom ,030104 developmental biology ,Carriage ,Parasitology ,Amniotes ,People and Places ,Africa ,Cats ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Antimicrobial Resistance ,business - 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., Author Summary Typhoid fever, a serious bloodstream infection caused by the bacterium Salmonella Typhi, is a major cause of disease and death around the world. There have been limited data on the epidemiology of typhoid in many countries in sub-Saharan African, including Nigeria. Recent evidence, however, showed that typhoid was an important cause of bacteraemia in children residing in two regions of Nigeria. Here, we analyzed the whole genome sequences of 128 S. Typhi isolates from two studies in order to elucidate the population structure and characterize the genetic components of antimicrobial resistance. We found that the multiple S. Typhi genotypes identified were closely related to other S. Typhi from neighboring regions of Africa and that multidrug resistance (MDR) was common among these isolates, and in many cases was associated with the IncHI1 plasmid known to cause MDR typhoid. These results provide evidence that typhoid was established in Nigeria as a result of several independent introductions into the country and that there has been extensive exchange of S. Typhi in and around the region of West Africa. This study emphasizes the importance of surveillance to improve our understanding of the epidemiology of typhoid, which is needed to underpin public health measures to reduce the spread of disease and facilitate patient management.
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- 2016
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