Shifts in Geographic Distribution and Antimicrobial Resistance during a Prolonged Typhoid Fever Outbreak — Bundibugyo and Kasese Districts, Uganda, 2009–2011

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dc.contributor.authorSpalding Walters, Maroya
dc.contributor.authorRouth, Janell
dc.contributor.authorMikoleit, Matthew
dc.contributor.authorKadivane, Samuel
dc.contributor.authorOuma, Caroline
dc.contributor.authorMubiru, Denis
dc.contributor.authorMbusa, Ben
dc.contributor.authorMurangi, Amos
dc.contributor.authorEjoku, Emmanuel
dc.contributor.authorRwantangle, Absalom
dc.contributor.authorKule, , Uziah
dc.contributor.authorLule, John
dc.contributor.authorGarrett, Nancy
dc.contributor.authorHalpin, Jessica
dc.contributor.authorMaxwell, Nikki
dc.contributor.authorKagirita, Atek
dc.contributor.authorMulabya, Fred
dc.contributor.authorMakumbi, Issa
dc.contributor.authorFreeman, Molly
dc.contributor.authorJoyce, Kevin
dc.contributor.authorHill, Vince
dc.contributor.authorDowning, Robert
dc.contributor.authorMintz, Eric
dc.date.accessioned2023-06-23T18:37:45Z
dc.date.available2023-06-23T18:37:45Z
dc.date.issued2014
dc.description.abstractSalmonella enterica serovar Typhi is transmitted by fecally contaminated food and water and causes approximately 22 million typhoid fever infections worldwide each year. Most cases occur in developing countries, where approximately 4% of patients develop intestinal perforation (IP). In Kasese District, Uganda, a typhoid fever outbreak notable for a high IP rate began in 2008. We report that this outbreak continued through 2011, when it spread to the neighboring district of Bundibugyo. Methodology/Principal Findings: A suspected typhoid fever case was defined as IP or symptoms of fever, abdominal pain, and $1 of the following: gastrointestinal disruptions, body weakness, joint pain, headache, clinically suspected IP, or nonresponsiveness to antimalarial medications. Cases were identified retrospectively via medical record reviews and prospectively through laboratory-enhanced case finding. Among Kasese residents, 709 cases were identified from August 1, 2009–December 31, 2011; of these, 149 were identified during the prospective period beginning November 1, 2011. Among Bundibugyo residents, 333 cases were identified from January 1–December 31, 2011, including 128 cases identified during the prospective period beginning October 28, 2011. IP was reported for 507 (82%) and 59 (20%) of Kasese and Bundibugyo cases, respectively. Blood and stool cultures performed for 154 patients during the prospective period yielded isolates from 24 (16%) patients. Three pulsed-field gel electrophoresis pattern combinations, including one observed in a Kasese isolate in 2009, were shared among Kasese and Bundibugyo isolates. Antimicrobial susceptibility was assessed for 18 isolates; among these 15 (83%) were multidrug-resistant (MDR), compared to 5% of 2009 isolates. Conclusions/Significance: Molecular and epidemiological evidence suggest that during a prolonged outbreak, typhoid spread from Kasese to Bundibugyo. MDR strains became prevalent. Lasting interventions, such as typhoid vaccination and improvements in drinking water infrastructure, should be considered to minimize the risk of prolonged outbreaks in the future.en_US
dc.identifier.citationWalters MS, Routh J, Mikoleit M, Kadivane S, Ouma C, et al. (2014) Shifts in Geographic Distribution and Antimicrobial Resistance during a Prolonged Typhoid Fever Outbreak — Bundibugyo and Kasese Districts, Uganda, 2009–2011. PLoS Negl Trop Dis 8(3): e2726. doi:10.1371/journal.pntd.0002726en_US
dc.identifier.other10.1371/journal.pntd.0002726
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/8985
dc.language.isoenen_US
dc.publisherPLoS Negl Trop Disen_US
dc.subjectGeographic Distributionen_US
dc.subjectAntimicrobial Resistanceen_US
dc.subjectTyphoid Fever Outbreaken_US
dc.titleShifts in Geographic Distribution and Antimicrobial Resistance during a Prolonged Typhoid Fever Outbreak — Bundibugyo and Kasese Districts, Uganda, 2009–2011en_US
dc.typeArticleen_US
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