Molecular surveillance identifies multiple transmissions of typhoid in West Africa

Vanessa K Wong; Kathryn E Holt; Chinyere Okoro; Stephen Baker; Derek J Pickard; Florian Marks; Andrew J Page; Grace Olanipekun; Huda Munir; Roxanne Alter; Paul D Fey; Nicholas A Feasey; Francois-Xavier Weill; Simon Le Hello; Peter J Hart; Samuel Kariuki; Robert F Breiman; Melita A Gordon; Robert S Heyderman; Jan Jacobs; Octavie Lunguya; Chisomo Msefula; Calman A MacLennan; Karen H Keddy; Anthony M Smith; Robert S Onsare; Elizabeth De Pinna; Satheesh Nair; Ben Amos; Gordon Dougan; Stephen Obaro; International Typhoid Consortium

doi:10.1371/journal.pntd.0004781

Molecular surveillance identifies multiple transmissions of typhoid in West Africa

Vanessa K Wong, Kathryn E Holt, Chinyere Okoro, Stephen Baker, Derek J Pickard, Florian Marks, Andrew J Page, Grace Olanipekun, Huda Munir, Roxanne Alter, Paul D Fey, Nicholas A Feasey, Francois-Xavier Weill, Simon Le Hello, Peter J Hart, Samuel Kariuki, Robert F Breiman, Melita A Gordon, Robert S Heyderman, Jan JacobsOctavie Lunguya, Chisomo Msefula, Calman A MacLennan, Karen H Keddy, Anthony M Smith, Robert S Onsare, Elizabeth De Pinna, Satheesh Nair, Ben Amos, Gordon Dougan, Stephen Obaro, International Typhoid Consortium

Tropical Bacteriology

Research output: Contribution to journal › A1: Web of Science-article › peer-review

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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.

Original language	English
Article number	e0004781
Journal	PLoS Neglected Tropical Diseases
Volume	10
Issue number	9
Number of pages	22
ISSN	1935-2727
DOIs	https://doi.org/10.1371/journal.pntd.0004781
Publication status	Published - 2016

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Wong, V. K., Holt, K. E., Okoro, C., Baker, S., Pickard, D. J., Marks, F., Page, A. J., Olanipekun, G., Munir, H., Alter, R., Fey, P. D., Feasey, N. A., Weill, F.-X., Le Hello, S., Hart, P. J., Kariuki, S., Breiman, R. F., Gordon, M. A., Heyderman, R. S., ... International Typhoid Consortium (2016). Molecular surveillance identifies multiple transmissions of typhoid in West Africa. PLoS Neglected Tropical Diseases, 10(9), Article e0004781. https://doi.org/10.1371/journal.pntd.0004781

@article{ac0ff0f625fb4fe491de13d12654917a,

title = "Molecular surveillance identifies multiple transmissions of typhoid in West Africa",

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 = "Wong, {Vanessa K} and Holt, {Kathryn E} and Chinyere Okoro and Stephen Baker and Pickard, {Derek J} and Florian Marks and Page, {Andrew J} and Grace Olanipekun and Huda Munir and Roxanne Alter and Fey, {Paul D} and Feasey, {Nicholas A} and Francois-Xavier Weill and {Le Hello}, Simon and Hart, {Peter J} and Samuel Kariuki and Breiman, {Robert F} and Gordon, {Melita A} and Heyderman, {Robert S} and Jan Jacobs and Octavie Lunguya and Chisomo Msefula and MacLennan, {Calman A} and Keddy, {Karen H} and Smith, {Anthony M} and Onsare, {Robert S} and {De Pinna}, Elizabeth and Satheesh Nair and Ben Amos and Gordon Dougan and Stephen Obaro and {International Typhoid Consortium}",

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year = "2016",

doi = "10.1371/journal.pntd.0004781",

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Wong, VK, Holt, KE, Okoro, C, Baker, S, Pickard, DJ, Marks, F, Page, AJ, Olanipekun, G, Munir, H, Alter, R, Fey, PD, Feasey, NA, Weill, F-X, Le Hello, S, Hart, PJ, Kariuki, S, Breiman, RF, Gordon, MA, Heyderman, RS, Jacobs, J, Lunguya, O, Msefula, C, MacLennan, CA, Keddy, KH, Smith, AM, Onsare, RS, De Pinna, E, Nair, S, Amos, B, Dougan, G, Obaro, S & International Typhoid Consortium 2016, 'Molecular surveillance identifies multiple transmissions of typhoid in West Africa', PLoS Neglected Tropical Diseases, vol. 10, no. 9, e0004781. https://doi.org/10.1371/journal.pntd.0004781

TY - JOUR

T1 - Molecular surveillance identifies multiple transmissions of typhoid in West Africa

AU - Wong, Vanessa K

AU - Holt, Kathryn E

AU - Okoro, Chinyere

AU - Baker, Stephen

AU - Pickard, Derek J

AU - Marks, Florian

AU - Page, Andrew J

AU - Olanipekun, Grace

AU - Munir, Huda

AU - Alter, Roxanne

AU - Fey, Paul D

AU - Feasey, Nicholas A

AU - Weill, Francois-Xavier

AU - Le Hello, Simon

AU - Hart, Peter J

AU - Kariuki, Samuel

AU - Breiman, Robert F

AU - Gordon, Melita A

AU - Heyderman, Robert S

AU - Jacobs, Jan

AU - Lunguya, Octavie

AU - Msefula, Chisomo

AU - MacLennan, Calman A

AU - Keddy, Karen H

AU - Smith, Anthony M

AU - Onsare, Robert S

AU - De Pinna, Elizabeth

AU - Nair, Satheesh

AU - Amos, Ben

AU - Dougan, Gordon

AU - Obaro, Stephen

AU - International Typhoid Consortium

N1 - FTX; DOAJ

PY - 2016

Y1 - 2016

N2 - 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.

AB - 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.

U2 - 10.1371/journal.pntd.0004781

DO - 10.1371/journal.pntd.0004781

M3 - A1: Web of Science-article

C2 - 27657909

SN - 1935-2727

VL - 10

JO - PLoS Neglected Tropical Diseases

JF - PLoS Neglected Tropical Diseases

IS - 9

M1 - e0004781

ER -

Molecular surveillance identifies multiple transmissions of typhoid in West Africa

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