title: Invasive Salmonella Infections Among Children From Rural Mozambique, 2001-2014.
abstract: BACKGROUND
  Invasive nontyphoidal Salmonella (iNTS) has emerged as a cause of bacteremia in African children and HIV-infected adults, which is associated with high mortality. Epidemiological data and burden of iNTS infections in resource-constrained settings are needed to better define preventive and curative strategies.
  
  
  METHODS
  Blood and, if appropriate, cerebrospinal fluid, were collected from children <15 years of age with fever or severe disease admitted to the Manhiça District Hospital and cultured for NTS; isolates were then characterized.
  
  
  RESULTS
  From January 2001 to December 2014, 41,668 of the 51,878 admitted children had a blood culture performed. Invasive NTS was isolated from 670 (1.6%) specimens collected from 41,668 patients; 69 (10.3% died). Salmonella enterica subspecies enterica serovar Typhi or Salmonella enterica subspecies enterica serovar Paratyphi A or C were only isolated in 14 (0.03%) patients. A total of 460 of 620 (74.2%) NTS isolates serotyped were Salmonella enterica subspecies enterica serovar Typhimurium (45% [116/258] of which were multilocus sequence type 313). The incidence of iNTS was 61.8 (95% confidence interval, 55.4-68.9) cases per 100,000 child-years, being highest among infants (217.7 cases/100,000 child-years). The incidence of iNTS declined significantly (P < .0001) over time, but the case fatality ratio remained constant at approximately 10%. Antimicrobial resistance of iNTS against most available antimicrobials has steadily increased, with a predominance of multidrug-resistant strains.
  
  
  CONCLUSIONS
  The decreasing but still high incidence of iNTS, its high associated case fatality ratio, and the common detection of multidrug-resistant strains call for a need to improve treatment and prevention strategies for iNTS.
authors.affiliation: Centro de Investigação em Saúde da Manhiça Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique.
authors.forename: Inácio
authors.initials: I
authors.lastname: Mandomando
authors.affiliation: Centro de Investigação em Saúde da Manhiça ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Spain.
authors.forename: Quique
authors.initials: Q
authors.lastname: Bassat
authors.affiliation: Centro de Investigação em Saúde da Manhiça Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique.
authors.forename: Betuel
authors.initials: B
authors.lastname: Sigaúque
authors.affiliation: Centro de Investigação em Saúde da Manhiça.
authors.forename: Sérgio
authors.initials: S
authors.lastname: Massora
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Spain.
authors.forename: Llorenç
authors.initials: L
authors.lastname: Quintó
authors.affiliation: Centro de Investigação em Saúde da Manhiça Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique.
authors.forename: Sozinho
authors.initials: S
authors.lastname: Ácacio
authors.affiliation: Centro de Investigação em Saúde da Manhiça Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique.
authors.forename: Tacilta
authors.initials: T
authors.lastname: Nhampossa
authors.affiliation: Centro de Investigação em Saúde da Manhiça.
authors.forename: Delfino
authors.initials: D
authors.lastname: Vubil
authors.affiliation: Centro de Investigação em Saúde da Manhiça.
authors.forename: Marcelino
authors.initials: M
authors.lastname: Garrine
authors.affiliation: Centro de Investigação em Saúde da Manhiça Direcção Nacional de Saúde Pública, Ministério da Saúde, Maputo, Mozambique.
authors.forename: Eusébio
authors.initials: E
authors.lastname: Macete
authors.affiliation: Centro de Investigação em Saúde da Manhiça Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique.
authors.forename: Pedro
authors.initials: P
authors.lastname: Aide
authors.affiliation: Centro de Investigação em Saúde da Manhiça.
authors.forename: Charfudin
authors.initials: C
authors.lastname: Sacoor
authors.affiliation: Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Herrera-León
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Spain.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Ruiz
authors.affiliation: Center for Vaccine Development and Department of Medicine, University of Maryland School of Medicine, Baltimore.
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Tennant
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Spain.
authors.forename: Clara
authors.initials: C
authors.lastname: Menéndez
authors.affiliation: Centro de Investigação em Saúde da Manhiça ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Spain.
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Alonso
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D009073:Mozambique / Q000453:epidemiology; D012424:Rural Population; D012480:Salmonella Infections / Q000097:blood / Q000134:cerebrospinal fluid / Q000453:epidemiology* / Q000382:microbiology*; D019779:Salmonella enterica / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D012482:Salmonella paratyphi A / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D012486:Salmonella typhimurium / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D012703:Serotyping
chemical_list: D000900:Anti-Bacterial Agents
keywords: Salmonella; bacteremia; burden of disease; incidence; invasive nontyphoidal Salmonella