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      Typhoid fever in paediatric patients in Quetta, Balochistan, Pakistan

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          Abstract

          Objectives: To determine the seropositivity of typhoid fever in febrile pediatric patients presenting to tertiary care center.

          Methods: This observational study was conducted at Children Hospital Quetta (CHQ) from July 2011 to March 2012. The children with three or more days fever, no obvious focus of infection and clinically suspected of typhoid fever were screened. Sterile Blood samples were obtained from febrile patients and Widal and Typhidot® tests were performed for the diagnosis of Typhoid fever in the suspected populations.

          Results: Total of 2964 clinically suspected patients were screened for typhoid fever. Of these, 550 (18.6%) patients were positive serologically. The higher prevalence of the disease in hot summer season and increasing pattern of the disease was observed in summer days. The disease was higher in school age children under 5-10 years. Although non-significant association was observed on sex basis.

          Conclusion: The findings highlight the considerable burden of typhoid fever in pre-school and school-aged children. The variation in the disease pattern has also been observed under seasonal variation and different age groups, all of which need to be considered in deliberations to control the typhoid fever.

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          A study of typhoid fever in five Asian countries: disease burden and implications for controls.

          D Clemens, Do Gia Canh, C. Acosta … (2008)
          To inform policy-makers about introduction of preventive interventions against typhoid, including vaccination. A population-based prospective surveillance design was used. Study sites where typhoid was considered a problem by local authorities were established in China, India, Indonesia, Pakistan and Viet Nam. Standardized clinical, laboratory, and surveillance methods were used to investigate cases of fever of >or= 3 days' duration for a one-year period. A total of 441,435 persons were under surveillance, 159,856 of whom were aged 5-15 years. A total of 21,874 episodes of fever were detected. Salmonella typhi was isolated from 475 (2%) blood cultures, 57% (273/475) of which were from 5-15 year-olds. The annual typhoid incidence (per 100,000 person years) among this age group varied from 24.2 and 29.3 in sites in Viet Nam and China, respectively, to 180.3 in the site in Indonesia; and to 412.9 and 493.5 in sites in Pakistan and India, respectively. Altogether, 23% (96/413) of isolates were multidrug resistant (chloramphenicol, ampicillin and trimethoprim-sulfamethoxazole). The incidence of typhoid varied substantially between sites, being high in India and Pakistan, intermediate in Indonesia, and low in China and Viet Nam. These findings highlight the considerable, but geographically heterogeneous, burden of typhoid fever in endemic areas of Asia, and underscore the importance of evidence on disease burden in making policy decisions about interventions to control this disease.
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            Typhoid fever in children aged less than 5 years.

            J. B. Singh, A Naficy, R. Kumar … (1999)
            Calculation of the incidence of typhoid fever during preschool years is important to define the optimum age of immunisation and the choice of vaccines for public-health programmes in developing countries. Hospital-based studies have suggested that children younger than 5 years do not need vaccination against typhoid fever, but this view needs to be re-examined in community-based longitudinal studies. We undertook a prospective follow-up study of residents of a low-income urban area of Delhi, India, with active surveillance for case detection. A baseline census was undertaken in 1995. Between Nov 1, 1995, and Oct 31, 1996, we visited 8172 residents of 1820 households in Kalkaji, Delhi, twice weekly to detect febrile cases. Blood samples were obtained from febrile patients, and those who tested positive for Salmonella typhi were treated with ciprofloxacin. 63 culture-positive typhoid fever cases were detected. Of these, 28 (44%) were in children aged under 5 years. The incidence rate of typhoid per 1000 person-years was 27.3 at age under 5 years, 11.7 at 5-19 years, and 1.1 between 19 and 40 years. The difference in the incidence of typhoid fever between those under 5 years and those aged 5-19 years (15.6 per 1000 person-years [95% CI 4.7-26.5]), and those aged 19-40 years (26.2 [16.0-36.3]) was significant (p<0.001 for both). The difference between the incidence of typhoid at 5-19 years and the incidence at 19-40 years was also significant (10.6 [6.3-14.8], p<0.001). Morbidity in those under 5 and in older people was similar in terms of duration of fever, signs and symptoms, and need for hospital admission. Our findings challenge the common view that typhoid fever is a disorder of school-age children and of adults. Typhoid is a common and significant cause of morbidity between 1 and 5 years of age. The optimum age of typhoid immunisation and the choice of vaccines needs to be reassessed.
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              Typhoid fever in children: some epidemiological considerations from Karachi, Pakistan.

              Fahad Siddiqui, Fauziah Rabbani, Rumina Hasan … (2006)
              The morbidity of typhoid fever is highest in Asia with 93% of global episodes occurring in this region. Southeast Asia has an estimated incidence of 110 cases/100,000 population, which is the third highest incidence rate for any region. Pakistan falls into this region. There is also a considerable seasonal variation of typhoid fever, carrying significant public health importance. Children are worst affected. Population-based data from Pakistan are scarce. From June 1999 to December 2001 a fortnightly surveillance system was established in two squatter settlements in Karachi, Pakistan, with two study centers, each staffed by a doctor and five community health workers. Cases of continuous high-grade fever for three or more days were referred to these centers and screened clinically. Blood culture and Typhidot tests were done. One-third of the 4198 cases with febrile episodes of three or more days detected in the community were screened at the centers; 341 were clinically suspected of having typhoid fever. Forty-nine were positive by culture whereas 161 were positive by serology. Ten cases were multi-drug resistant. Incidence of culture-proven typhoid was estimated to be 170 (95% CI: 120, 220)/100,000 population, whereas serology-based incidence was 710 (95% CI: 620, 810)/100,000 population. Peak incidence was noted in October followed by May and June. Passive surveillance, even when augmented by household visits, misses a significant portion of suspected cases. Morbidity of typhoid is quite high in Pakistan and needs public health intervention. Hot months have higher incidence of typhoid. Healthcare behavior studies will help to develop a better surveillance system.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Pak J Med Sci
                Journal ID (iso-abbrev): Pak J Med Sci
                Journal ID (publisher-id): PJMS
                Title: Pakistan Journal of Medical Sciences
                Publisher: Professional Medical Publicaitons (Karachi, Pakistan )
                ISSN (Print): 1682-024X
                ISSN (Electronic): 1681-715X
                Publication date (Print): Jul-Aug 2013
                Volume: 29
                Issue: 4
                Pages: 929-932
                Affiliations
                [1 ]Muhammad Naeem Khan, Department of Microbiology, University of Balochistan, Quetta, Pakistan.
                [2 ]Muhammad Shafee, Lecturer, Center for Advanced studies in Vaccinology & Biotechnology (CASVAB), University of Balochistan, Quetta, Pakistan.
                [3 ]Kamran Hussain, Microbiologist Children Hospital, Quetta, Pakistan. Center for Advanced studies in Vaccinology & Biotechnology (CASVAB), University of Balochistan, Quetta, Pakistan.
                [4 ]Abdul Samad, Assistant Professor, Center for Advanced studies in Vaccinology & Biotechnology (CASVAB), University of Balochistan, Quetta, Pakistan.
                [5 ]Muhammad Arif Awan,Assistant Professor, Center for Advanced studies in Vaccinology & Biotechnology (CASVAB), University of Balochistan, Quetta, Pakistan.
                [6 ]Abdul Manan, Lecturer, Department of Microbiology, University of Balochistan, Quetta, Pakistan.
                [7 ]Abdul Wadood, Chairman, Department of Microbiology, University of Balochistan, Quetta, Pakistan.
                Author notes
                Correspondence: Muhammad Shafee, Lecturer, Center for Advanced studies in Vaccinology & Biotechnology (CASVAB), University of Balochistan Brewery, Road Quetta, Quetta, Pakistan. Phone: 0812853843, Cell: 0333-7837828, E-mail: shafeedr73@gmail.com
                Article
                Publisher ID: pjms-29-929
                DOI: 10.12669/pjms.294.3251
                PMC ID: 3817751
                SO-VID: 7afdb4e1-5e05-4b42-badc-c472acddbd1c
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 12 December 2012
                Date revision received : 30 May 2013
                Date accepted : 2 June 2013
                Categories
                Subject: Original Article

                Keywords: typhoid fever,typhidot,prevalence,widal
                Data availability:
                Keywords: typhoid fever, typhidot, prevalence, widal

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