The phylogeography and incidence of multi-drug resistant typhoid fever in sub-Saharan Africa

Nat Commun. 2018 Nov 30;9(1):5094. doi: 10.1038/s41467-018-07370-z.

Abstract

There is paucity of data regarding the geographical distribution, incidence, and phylogenetics of multi-drug resistant (MDR) Salmonella Typhi in sub-Saharan Africa. Here we present a phylogenetic reconstruction of whole genome sequenced 249 contemporaneous S. Typhi isolated between 2008-2015 in 11 sub-Saharan African countries, in context of the 2,057 global S. Typhi genomic framework. Despite the broad genetic diversity, the majority of organisms (225/249; 90%) belong to only three genotypes, 4.3.1 (H58) (99/249; 40%), 3.1.1 (97/249; 39%), and 2.3.2 (29/249; 12%). Genotypes 4.3.1 and 3.1.1 are confined within East and West Africa, respectively. MDR phenotype is found in over 50% of organisms restricted within these dominant genotypes. High incidences of MDR S. Typhi are calculated in locations with a high burden of typhoid, specifically in children aged <15 years. Antimicrobial stewardship, MDR surveillance, and the introduction of typhoid conjugate vaccines will be critical for the control of MDR typhoid in Africa.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Africa South of the Sahara
  • Anti-Bacterial Agents / therapeutic use
  • Drug Resistance, Multiple, Bacterial / genetics
  • Genetic Variation / genetics
  • Genotype
  • Humans
  • Incidence
  • Phylogeny
  • Phylogeography
  • Salmonella Infections / drug therapy*
  • Salmonella Infections / genetics
  • Salmonella Infections / metabolism
  • Salmonella typhi / classification
  • Salmonella typhi / pathogenicity
  • Typhoid Fever / drug therapy
  • Typhoid Fever / genetics
  • Typhoid Fever / metabolism

Substances

  • Anti-Bacterial Agents