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Rainfall anomalies and typhoid fever in Blantyre, Malawi.

Title: Rainfall anomalies and typhoid fever in Blantyre, Malawi.
Authors: Gauld JS; Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, Washington, USA.; Centre for Health Informatics, Computing, and Statistics, Lancaster University, Lancaster, UK.; Bilima S; Malawi-Liverpool Wellcome Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi.; Diggle PJ; Centre for Health Informatics, Computing, and Statistics, Lancaster University, Lancaster, UK.; Feasey NA; Malawi-Liverpool Wellcome Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi.; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.; Read JM; Centre for Health Informatics, Computing, and Statistics, Lancaster University, Lancaster, UK.
Source: Epidemiology and infection [Epidemiol Infect] 2022 May 10; Vol. 150, pp. e122. Date of Electronic Publication: 2022 May 10.
Publication Type: Journal Article; Research Support, Non-U.S. Gov't
Language: English
Journal Info: Publisher: Cambridge University Press Country of Publication: England NLM ID: 8703737 Publication Model: Electronic Cited Medium: Internet ISSN: 1469-4409 (Electronic) Linking ISSN: 09502688 NLM ISO Abbreviation: Epidemiol Infect Subsets: MEDLINE
Imprint Name(s): Original Publication: Cambridge Eng : Cambridge University Press
MeSH Terms: Rain*; Typhoid Fever/*epidemiology; Malawi/epidemiology ; Typhoid Fever/prevention & control ; Drug Resistance, Multiple ; Humans ; Incidence ; Poisson Distribution ; Poverty ; Sanitation ; Social Class
Abstract: Typhoid fever is a major cause of illness and mortality in low- and middle-income settings. We investigated the association of typhoid fever and rainfall in Blantyre, Malawi, where multi-drug-resistant typhoid has been transmitting since 2011. Peak rainfall preceded the peak in typhoid fever by approximately 15 weeks [95% confidence interval (CI) 13.3, 17.7], indicating no direct biological link. A quasi-Poisson generalised linear modelling framework was used to explore the relationship between rainfall and typhoid incidence at biologically plausible lags of 1-4 weeks. We found a protective effect of rainfall anomalies on typhoid fever, at a two-week lag (P = 0.006), where a 10 mm lower-than-expected rainfall anomaly was associated with up to a 16% reduction in cases (95% CI 7.6, 26.5). Extreme flooding events may cleanse the environment of S. Typhi, while unusually low rainfall may reduce exposure from sewage overflow. These results add to evidence that rainfall anomalies may play a role in the transmission of enteric pathogens, and can help direct future water and sanitation intervention strategies for the control of typhoid fever.
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Grant Information: United Kingdom WT_ Wellcome Trust
Contributed Indexing: Keywords: Typhoid fever; rainfall; statistical analysis; weather
Entry Date(s): Date Created: 20220510 Date Completed: 20220704 Latest Revision: 20220726
Update Code: 20260130
PubMed Central ID: PMC9254155
DOI: 10.1017/S0950268822000759
PMID: 35535751
Database: MEDLINE

Journal Article; Research Support, Non-U.S. Gov't