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May 2, 2015

First day update - 9th International Conference on Typhoid and Invasive NTS disease - Bali, Indonesia

The first day of the 9th International Conference on Typhpoid and Invasive NTS disease was very interactive. This conference has provided us with a tremendous learning opportunity the amount of work that has been put into understanding Typhoid fever and invasive non typhoid salmonesis.
The day stated with Florian’s (from IVI) talk that provided us the update that include challenges on TSAP project in Sub Saharan Countries. This was followed by Kashimira Date’s talk which also updated on Surveillance of Enteric Fever in Asia (SEFA) project (including in Nepal). I had chance to meet those involved in this project. CDC / GTA along with GON.

Namrata Prasad and  Aaron Jenkins talked on Fiji Typhoid fever study which included case control (CC) study in Fiji, 2014 and another study whose objective was to carve out determinants of typhoid fever in Fiji (multidisciplinary study). The interesting part was the assay work on Soil samples (from houses of cases) and also there was mention of localized behavior / household environments
  • Urban vs. Rural  (what is the key criteria that differentiate U vs. R)
  •  Geospatial analysis – water supply along with sanitation
  •  Soil sample - how long do the organism last in the soil? (7 to 10 days??)
  • Hand washing – behavior vs. education vs. introduction of bias??
  • Reported vs. observed hand washing practices
  • Does those sites selected (Africa / Asia) really represents the true picture?
  •  Larger geographic sites – could be a greater effort
  • Rapid assessment: cases – from all hospitals / age wise breakdown (? physician’s opinion/survey of sanitation led by governments/spotty / patchy distribution of typhoid fever in Africa (this is what they observed despite good lab facilities)
  • Rapid assessment tool (RAT) - real challenges??
  • Paratyphi
  • 20 % of total Africa population
  • Drug resistance – Ciprofloxacin
  • Vaccine acceptability??

The second session started with a presentation from University of Jakarta on clinical and demographic characteristics of TF in Indonesia. The below are some of the key messages:
  • 64 % TF in 3 – 19 yrs (Indonesia)
  • 3.1 to 10.4% - mortality in hospitalized patients
  • 2nd important infectious diseases
  • Less than 20 liter per day – cut off point

The second and third talks were on mathematical modeling. The first was more focused on the potential consequence of the H58 haplotype of Salmonella Typhii. The following are key messages:
  • Patan Hospital study – KTM Nepal compared to Malawi study
  •  Emergence of H58 haplotype
  • Why is typhoid incidence increasing in Malawi?
  • Bowles CC et al (in prep) – Patan hospital study
  • Infectiousness/ R0
  • usually 4  weeks shedding of bacteria
  • Transmission rate
  • Better diagnostics needed
  • Chronic carrier in the community   
  • ? natural immunity and its role
  •  Influx of susceptible migrant male workers form low incidence rural regions in the country

o   Increasing pop density
o   Cross immunity

The third study was from LSTM / University of Liverpool on modeling in relation to malaria / hiv / malnutrition. While the fourth talk was on Evaluation of a rapid real time molecular assay (S. typhi, paratyphi and S. spp.) from Foundation Merieux, France. The final talk was by Dr. Quadri on Typhoid in Bangladesh: from infection to protection. Some of the key points were on immune response in children (Ty21a) oral route and also about IgA / ALS
  • Widal tests
  • Blood c/s

This was also a panel discussion to discuss challenges and approaches in measuring typhoid fever disease burden. The following points were key point discussed:
  •  Research vs. public health mode – what is more important?
  • Generalibility  of what so far we have scientific data
  • Rapid Assessment approach – e.g. used for Pneumo vaccine introduction ( may be based on serology)
  •  It seems – typhoid organism does not survive much in environment!!
  • Shousun Szu – vaccination is important for protection
  • Government’s role and opinion is important
  • Importance of severity study is more study as government policy makers interests in mortality data
  • Policy and global / local investment – data / data / data that represent across geography and age group
  • Partnership across various groups / researchers
  • HiB rat
  • WHO: visibility of the disease – evidence / measures / advocacy

The discussion was followed by symposium on water, Sanitation and hygiene (WASH) interventions for enteric fever control. The key points that were discussed as follows:
  • WASH interventions for enteric fever control ( a ppt. by Standard University)
  • Linking typhoid transmission to the water distribution with water system
  •  main factors for transmission
  •  live change and your risk
  • specific haplotypes circulation and how
  • GPS mapping
  • “Water quality in KTM is poor
  • Typhoid fever, cholera and hepatitis
  • Municipality water supply
  • Surveillance will be the way we will control infectious disease / sort our antimicrobial resistance (AMR) 
  • Why is the H58 lineage so successful? 
  • S. Typhi in the Pacific region are generally island specifics
  • Is this an opportunity for an eradication program?
  • Bring a solution in front of Politician’s nose and hammer it

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Anuj in Himalayas

Hi i am connecting disqus with my blog for healthy interaction and open dialogue