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

Joseph Walker (), Chrispin Chaguza, Nathan D. Grubaugh, Megan Carey, Stephen Baker, Kamran Khan, Isaac I. Bogoch and Virginia E. Pitzer
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Joseph Walker: Yale School of Public Health
Chrispin Chaguza: Yale School of Public Health
Nathan D. Grubaugh: Yale School of Public Health
Megan Carey: University of Cambridge School of Clinical Medicine
Stephen Baker: University of Cambridge School of Clinical Medicine
Kamran Khan: University of Toronto
Isaac I. Bogoch: University of Toronto
Virginia E. Pitzer: Yale School of Public Health

Nature Communications, 2023, vol. 14, issue 1, 1-10

Abstract: 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.

Date: 2023
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DOI: 10.1038/s41467-023-42353-9

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