Environmental Transmission of Typhoid Fever in an Urban Slum.

• Main Authors: Adam Akullian (Author), Eric Ng'eno (Author), Alastair I Matheson (Author), Leonard Cosmas (Author), Daniel Macharia (Author), Barry Fields (Author), Godfrey Bigogo (Author), Maina Mugoh (Author), Grace John-Stewart (Author), Judd L Walson (Author), Jonathan Wakefield (Author), Joel M Montgomery (Author)
• Format: Book
• Published: Public Library of Science (PLoS), 2015-12-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.

Summary

BACKGROUND:Enteric fever due to Salmonella Typhi (typhoid fever) occurs in urban areas with poor sanitation. While direct fecal-oral transmission is thought to be the predominant mode of transmission, recent evidence suggests that indirect environmental transmission may also contribute to disease spread. METHODS:Data from a population-based infectious disease surveillance system (28,000 individuals followed biweekly) were used to map the spatial pattern of typhoid fever in Kibera, an urban informal settlement in Nairobi Kenya, between 2010-2011. Spatial modeling was used to test whether variations in topography and accumulation of surface water explain the geographic patterns of risk. RESULTS:Among children less than ten years of age, risk of typhoid fever was geographically heterogeneous across the study area (p = 0.016) and was positively associated with lower elevation, OR = 1.87, 95% CI (1.36-2.57), p <0.001. In contrast, the risk of typhoid fever did not vary geographically or with elevation among individuals more than ten years of age [corrected]. CONCLUSIONS:Our results provide evidence of indirect, environmental transmission of typhoid fever among children, a group with high exposure to fecal pathogens in the environment. Spatially targeting sanitation interventions may decrease enteric fever transmission.

Item Description

1935-2727
1935-2735
10.1371/journal.pntd.0004212