The increasing healthcare burden of enteric fever in a low-incidence setting

Seung Y Lee; Annaleise R Howard-Jones; Venkata Ln Lavu; Sophie Norton; Vitali Sintchenko; Philip N Britton; Shopna Bag; Ameneh Khatami

doi:10.1016/j.idnow.2024.104919

The increasing healthcare burden of enteric fever in a low-incidence setting

Infect Dis Now. 2024 Apr 21;54(4):104919. doi: 10.1016/j.idnow.2024.104919. Online ahead of print.

Authors

Seung Y Lee¹, Annaleise R Howard-Jones², Venkata Ln Lavu³, Sophie Norton⁴, Vitali Sintchenko⁵, Philip N Britton⁶, Shopna Bag⁴, Ameneh Khatami⁶

Affiliations

¹ Department of General Paediatrics, The Children's Hospital at Westmead, Westmead NSW 2145 Australia. Electronic address: seung.lee@health.nsw.gov.au.
² The Children's Hospital at Westmead Clinical School, University of Sydney, Westmead NSW 2145 Australia; New South Wales Health Pathology - Institute for Clinical Pathology and Medical Research, Westmead Hospital, Westmead NSW 2145 Australia.
³ Western Sydney Public Health Unit, Centre for Population Health, North Parramatta, NSW 2150 Australia.
⁴ Western Sydney Public Health Unit, Centre for Population Health, North Parramatta, NSW 2150 Australia; Faculty of Medicine and Health, Westmead Clinical School, University of Sydney, Westmead NSW 2145 Australia.
⁵ New South Wales Health Pathology - Institute for Clinical Pathology and Medical Research, Westmead Hospital, Westmead NSW 2145 Australia; Faculty of Medicine and Health, Westmead Clinical School, University of Sydney, Westmead NSW 2145 Australia; Sydney Institute for Infectious Diseases, The University of Sydney, Westmead NSW 2145 Australia.
⁶ The Children's Hospital at Westmead Clinical School, University of Sydney, Westmead NSW 2145 Australia; Department of Infectious Diseases & Microbiology, The Children's Hospital at Westmead, Westmead NSW 2145 Australia.

PMID: 38643864
DOI: 10.1016/j.idnow.2024.104919

Abstract

Objectives: Enteric fever carries appreciable morbidity in non-endemic settings, particularly in returned travelers. This study aimed to characterize the healthcare burden of enteric fever in a low-incidence setting and to identify risk factors and opportunities for preventative interventions.

Methods: Analysis of a retrospective case series from a tertiary pediatric center (2015-2019), augmented by public health notification and microbiological laboratory data (2018-2019), from Western Sydney, Australia, a region with frequent travel links to South Asia.

Results: Eighty-nine (89) patients were diagnosed with enteric fever, including 43 children with complete demographic and travel data. Enteric fever cases increased over time (by 4.9 % per year) and incidence was three times higher in the pediatric population (<15 years old) compared to adults. Travel to India and visiting friends and relatives (VFR) travel were risk factors. Few children received enteric fever vaccination prior to travel, as pre-travel advice most commonly was not sought.

Conclusions: Children visiting relatives in high-incidence countries are increasingly at risk for enteric fever, particularly when travelling to South Asia. Targeted health advice to travelers visiting friends and relatives is warranted to mitigate the healthcare burden of enteric fever in low-incidence settings.

Keywords: Enteric Fever; Salmonella Typhi Infection; Typhoid Fever.