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Assessing the global risk of typhoid outbreaks caused by extensively drug resistant Salmonella Typhi

Author

Listed:
  • Joseph Walker

    (Yale School of Public Health)

  • Chrispin Chaguza

    (Yale School of Public Health
    Yale Institute for Global Health, Yale University)

  • Nathan D. Grubaugh

    (Yale School of Public Health
    Yale Institute for Global Health, Yale University
    Yale University)

  • Megan Carey

    (University of Cambridge School of Clinical Medicine
    Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine)

  • Stephen Baker

    (University of Cambridge School of Clinical Medicine
    Human Immunology Laboratory, International AIDS Vaccine Initiative)

  • Kamran Khan

    (University of Toronto
    BlueDot)

  • Isaac I. Bogoch

    (University of Toronto
    University Health Network)

  • Virginia E. Pitzer

    (Yale School of Public Health
    Yale Institute for Global Health, Yale University)

Abstract

Since its emergence in 2016, extensively drug resistant (XDR) Salmonella enterica serovar Typhi (S. Typhi) has become the dominant cause of typhoid fever in Pakistan. The establishment of sustained XDR S. Typhi transmission in other countries represents a major public health threat. We show that the annual volume of air travel from Pakistan strongly discriminates between countries that have and have not imported XDR S. Typhi in the past, and identify a significant association between air travel volume and the rate of between-country movement of the H58 haplotype of S. Typhi from fitted phylogeographic models. Applying these insights, we analyze flight itinerary data cross-referenced with model-based estimates of typhoid fever incidence to identify the countries at highest risk of importation and sustained onward transmission of XDR S. Typhi. Future outbreaks of XDR typhoid are most likely to occur in countries that can support efficient local S. Typhi transmission and have strong travel links to regions with ongoing XDR typhoid outbreaks (currently Pakistan). Public health activities to track and mitigate the spread of XDR S. Typhi should be prioritized in these countries.

Suggested Citation

  • Joseph Walker & Chrispin Chaguza & Nathan D. Grubaugh & Megan Carey & Stephen Baker & Kamran Khan & Isaac I. Bogoch & Virginia E. Pitzer, 2023. "Assessing the global risk of typhoid outbreaks caused by extensively drug resistant Salmonella Typhi," Nature Communications, Nature, vol. 14(1), pages 1-10, December.
    • Handle: RePEc:nat:natcom:v:14:y:2023:i:1:d:10.1038_s41467-023-42353-9
    DOI: 10.1038/s41467-023-42353-9
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    References listed on IDEAS

    as
    1. J. Parkhill & G. Dougan & K. D. James & N. R. Thomson & D. Pickard & J. Wain & C. Churcher & K. L. Mungall & S. D. Bentley & M. T. G. Holden & M. Sebaihia & S. Baker & D. Basham & K. Brooks & T. Chill, 2001. "Complete genome sequence of a multiple drug resistant Salmonella enterica serovar Typhi CT18," Nature, Nature, vol. 413(6858), pages 848-852, October.
    2. Se Eun Park & Duy Thanh Pham & Christine Boinett & Vanessa K. Wong & Gi Deok Pak & Ursula Panzner & Ligia Maria Cruz Espinoza & Vera Kalckreuth & Justin Im & Heidi Schütt-Gerowitt & John A. Crump & Ro, 2018. "The phylogeography and incidence of multi-drug resistant typhoid fever in sub-Saharan Africa," Nature Communications, Nature, vol. 9(1), pages 1-10, December.
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