title: Invasive Nontyphoidal Salmonella Infections Among Children in Mali, 2002-2014: Microbiological and Epidemiologic Features Guide Vaccine Development.
abstract: BACKGROUND
  In 2002, following establishment of a clinical microbiology laboratory in the government hospital that admits children with severe illnesses in Bamako, Mali, surveillance to identify pathogens causing invasive bacterial infections (septicemia, bacteremia, meningitis, etc) was initiated.
  
  
  METHODS
  Parents/guardians of children aged <16 years admitted to l'Hôpital Gabriel Touré with high fever or clinical syndromes compatible with focal invasive bacterial disease were asked for consent to culture their child's blood/body fluid. Standard bacteriologic techniques speciated isolates; Salmonella serovars were determined.
  
  
  RESULTS
  From July 2002 through June 2014, 687 nontyphoidal Salmonella (NTS) isolates were obtained from 667 children; 667 yielded a single serovar and 20 grew 2 Salmonella serovars, 1 being NTS. Four serovars accounted for 87% of the 687 NTS isolates, including Salmonella Enteritidis (n = 244 [35.5%]), Salmonella Typhimurium (n = 221 [32.2%]), I:4,[5],12:i:- (n = 42 [6.1%]), and Salmonella Dublin (n = 89 [13.0%]). Of 553 patients with invasive NTS from whom 1 of the 4 predominant serovars was isolated in pure culture, 448 (81.0%) were aged <5 years and case fatality was 20.3%; Salmonella Enteritidis case fatality (27.8%) was higher than for other serovars (P = .0009). NTS disease showed a seasonal peak following the rainy season and into the cool, dry season. Since 2010, Salmonella Enteritidis cases have risen and Salmonella Typhimurium fallen.
  
  
  CONCLUSIONS
  NTS has become the predominant invasive pathogen as Haemophilus influenzae type b and pneumococcal vaccine use in Mali has diminished invasive disease due to those pathogens. The age distribution and limited serovars involved make control of NTS disease by vaccines epidemiologically feasible, if products under development prove safe and efficacious.
authors.affiliation: Center for Vaccine Development.
authors.forename: Milagritos D
authors.initials: MD
authors.lastname: Tapia
authors.affiliation: Center for Vaccine Development.
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Tennant
authors.affiliation: Center for Vaccine Development Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore.
authors.forename: Kristin
authors.initials: K
authors.lastname: Bornstein
authors.affiliation: Center for Vaccine Development-Mali, Bamako.
authors.forename: Uma
authors.initials: U
authors.lastname: Onwuchekwa
authors.affiliation: Center for Vaccine Development-Mali, Bamako.
authors.forename: Boubou
authors.initials: B
authors.lastname: Tamboura
authors.affiliation: Center for Vaccine Development-Mali, Bamako.
authors.forename: Almoustapha
authors.initials: A
authors.lastname: Maiga
authors.affiliation: Center for Vaccine Development-Mali, Bamako.
authors.forename: Mamadou B
authors.initials: MB
authors.lastname: Sylla
authors.affiliation: Center for Vaccine Development-Mali, Bamako.
authors.forename: Seydou
authors.initials: S
authors.lastname: Sissoko
authors.affiliation: Center for Vaccine Development-Mali, Bamako.
authors.forename: Nana
authors.initials: N
authors.lastname: Kourouma
authors.affiliation: Center for Vaccine Development-Mali, Bamako.
authors.forename: Aliou
authors.initials: A
authors.lastname: Toure
authors.affiliation: Center for Vaccine Development-Mali, Bamako.
authors.forename: Dramane
authors.initials: D
authors.lastname: Malle
authors.affiliation: Center for Vaccine Development.
authors.forename: Sofie
authors.initials: S
authors.lastname: Livio
authors.affiliation: Center for Vaccine Development-Mali, Bamako.
authors.forename: Samba O
authors.initials: SO
authors.lastname: Sow
authors.affiliation: Center for Vaccine Development.
authors.forename: Myron M
authors.initials: MM
authors.lastname: Levine
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D021821:Communicable Diseases, Emerging; D055808:Drug Discovery; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008302:Mali / Q000453:epidemiology; D012480:Salmonella Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality / Q000517:prevention & control; D022562:Salmonella Vaccines; D019779:Salmonella enterica / Q000145:classification / Q000302:isolation & purification*; D012477:Salmonella enteritidis / Q000302:isolation & purification; D012486:Salmonella typhimurium / Q000302:isolation & purification; D012621:Seasons; D065288:Serogroup
chemical_list: D022562:Salmonella Vaccines
keywords: Mali; emerging infections; invasive bacterial infections; nontyphoidal Salmonella; surveillance