The phylogeography and incidence of multi-drug resistant typhoid fever in sub-Saharan Africa
Park SE., Pham DT., Boinett C., Wong VK., Pak GD., Panzner U., Espinoza LMC., von Kalckreuth V., Im J., Schütt-Gerowitt H., Crump JA., Breiman RF., Adu-Sarkodie Y., Owusu-Dabo E., Rakotozandrindrainy R., Soura AB., Aseffa A., Gasmelseed N., Keddy KH., May J., Sow AG., Aaby P., Biggs HM., Hertz JT., Montgomery JM., Cosmas L., Olack B., Fields B., Sarpong N., Razafindrabe TJL., Raminosoa TM., Kabore LP., Sampo E., Teferi M., Yeshitela B., El Tayeb MA., Sooka A., Meyer CG., Krumkamp R., Dekker DM., Jaeger A., Poppert S., Tall A., Niang A., Bjerregaard-Andersen M., Løfberg SV., Seo HJ., Jeon HJ., Deerin JF., Park J., Konings F., Ali M., Clemens JD., Hughes P., Sendagala JN., Vudriko T., Downing R., Ikumapayi UN., Mackenzie GA., Obaro S., Argimon S., Aanensen DM., Page A., Keane JA., Duchene S., Dyson Z., Holt KE., Dougan G., Marks F., Baker S.
AbstractThere 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.