The Severe Typhoid Fever in Africa program: study design and methodology to assess disease severity, host immunity, and carriage associated with invasive salmonellosis

Se Eun Park, Trevor Toy, Ligia Maria Cruz Espinoza, Ursula Panzner, Ondari D. Mogeni, Justin Im, Nimesh Poudyal, Gi Deok Pak, Hyeongwon Seo, Yun Chon, Heidi Schutt-Gerowitt, Vittal Mogasale, Enusa Ramani, Ayan Dey, Ju Yeong Park, Jong-Hoon Kim, Hye Jin Seo, Hyon Jin Jeon, Andrea Haselbeck, Keriann Conway RoyWilliam MacWright, Yaw Adu-Sarkodie, Ellis Owusu-Dabo, Isaac Osei, Michael Owusu, Raphael Rakotozandrindrainy, Abdramane Bassiahi Soura, Leon Parfait Kabore, Mekonnen Teferi, Iruka N. Okeke, Aderemi Kehinde, Oluwafemi Popoola, Jan Jacobs, Octavie Lunguya Metila, Christian G. Meyer, John A. Crump, Sean Elias, Calman A. Maclennan, Christopher M. Parry, Stephen Baker, Eric D. Mintz, Robert F. Breiman, John D. Clemens, Florian Marks

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Background: Invasive salmonellosis is a common community-acquired bacteremia in persons residing in sub-Saharan Africa. However, there is a paucity of data on severe typhoid fever and its associated acute and chronic host immune response and carriage. The Severe Typhoid Fever in Africa (SETA) program, a multicountry surveillance study, aimed to address these research gaps and contribute to the control and prevention of invasive salmonellosis.

Methods: A prospective healthcare facility-based surveillance with active screening of enteric fever and clinically suspected severe typhoid fever with complications was performed using a standardized protocol across the study sites in Burkina Faso, the Democratic Republic of Congo (DRC), Ethiopia, Ghana, Madagascar, and Nigeria. Defined inclusion criteria were used for screening of eligible patients for enrollment into the study. Enrolled patients with confirmed invasive salmonellosis by blood culture or patients with clinically suspected severe typhoid fever with perforation were eligible for clinical follow-up. Asymptomatic neighborhood controls and immediate household contacts of each case were enrolled as a comparison group to assess the level of Salmonella-specific antibodies and shedding patterns. Healthcare utilization surveys were performed to permit adjustment of incidence estimations. Postmortem questionnaires were conducted in medically underserved areas to assess death attributed to invasive Salmonella infections in selected sites.

Results: Research data generated through SETA aimed to address scientific knowledge gaps concerning the severe typhoid fever and mortality, long-term host immune responses, and bacterial shedding and carriage associated with natural infection by invasive salmonellae.

Conclusions: SETA supports public health policy on typhoid immunization strategy in Africa.

Original languageEnglish
JournalClinical Infectious Diseases
Issue numberSupplement 6
Pages (from-to)S422-S434
Number of pages13
Publication statusPublished - 2019


  • Severe typhoid fever
  • invasive Salmonellosis
  • host immunity and carriage
  • surveillance protocol
  • sub-Saharan Africa


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