title: The Typhoid Fever Surveillance in Africa Program (TSAP): Clinical, Diagnostic, and Epidemiological Methodologies.
abstract: BACKGROUND
  New immunization programs are dependent on data from surveillance networks and disease burden estimates to prioritize target areas and risk groups. Data regarding invasive Salmonella disease in sub-Saharan Africa are currently limited, thus hindering the implementation of preventive measures. The Typhoid Fever Surveillance in Africa Program (TSAP) was established by the International Vaccine Institute to obtain comparable incidence data on typhoid fever and invasive nontyphoidal Salmonella (iNTS) disease in sub-Saharan Africa through standardized surveillance in multiple countries.
  
  
  METHODS
  Standardized procedures were developed and deployed across sites for study site selection, patient enrolment, laboratory procedures, quality control and quality assurance, assessment of healthcare utilization and incidence calculations.
  
  
  RESULTS
  Passive surveillance for bloodstream infections among febrile patients was initiated at thirteen sentinel sites in ten countries (Burkina Faso, Ethiopia, Ghana, Guinea-Bissau, Kenya, Madagascar, Senegal, South Africa, Sudan, and Tanzania). Each TSAP site conducted case detection using these standardized methods to isolate and identify aerobic bacteria from the bloodstream of febrile patients. Healthcare utilization surveys were conducted to adjust population denominators in incidence calculations for differing healthcare utilization patterns and improve comparability of incidence rates across sites.
  
  
  CONCLUSIONS
  By providing standardized data on the incidence of typhoid fever and iNTS disease in sub-Saharan Africa, TSAP will provide vital input for targeted typhoid fever prevention programs.
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Vera
authors.initials: V
authors.lastname: von Kalckreuth
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Frank
authors.initials: F
authors.lastname: Konings
authors.affiliation: Bandim Health Project, Bissau, Guinea-Bissau.
authors.forename: Peter
authors.initials: P
authors.lastname: Aaby
authors.affiliation: Kumasi Centre for Collaborative Research in Tropical Medicine School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Yaw
authors.initials: Y
authors.lastname: Adu-Sarkodie
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ali
authors.affiliation: Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
authors.forename: Abraham
authors.initials: A
authors.lastname: Aseffa
authors.affiliation: Oxford University Clinical Resarch Unit, Ho Chi Minh City, Vietnam.
authors.forename: Stephen
authors.initials: S
authors.lastname: Baker
authors.affiliation: Centers for Disease Control and Prevention, Nairobi, Kenya Global Health Institute, Emory University, Atlanta, Georgia.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Breiman
authors.affiliation: Bandim Health Project, Bissau, Guinea-Bissau Research Center for Vitamins and Vaccines, Copenhagen, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Bjerregaard-Andersen
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea International Centre for Diarrheal Disease Research, Dhaka, Bangladesh.
authors.forename: John D
authors.initials: JD
authors.lastname: Clemens
authors.affiliation: Division of Infectious Diseases and International Health, Duke University Medical Center Duke Global Health Institute, Duke University, Durham, North Carolina Kilimanjaro Christian Medical Centre, Moshi, Tanzania Centre for International Health, University of Otago, Dunedin, New Zealand.
authors.forename: John A
authors.initials: JA
authors.lastname: Crump
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Ligia Maria
authors.initials: LM
authors.lastname: Cruz Espinoza
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Jessica Fung
authors.initials: JF
authors.lastname: Deerin
authors.affiliation: University of Gezira, Wad Medani, Sudan.
authors.forename: Nagla
authors.initials: N
authors.lastname: Gasmelseed
authors.affiliation: Institute Pasteur Senegal Université Cheikh Anta Diop de Dakar, Senegal.
authors.forename: Amy Gassama
authors.initials: AG
authors.lastname: Sow
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Justin
authors.initials: J
authors.lastname: Im
authors.affiliation: National Institute for Communicable Diseases School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Karen H
authors.initials: KH
authors.lastname: Keddy
authors.affiliation: Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Leonard
authors.initials: L
authors.lastname: Cosmas
authors.affiliation: Department of Infection Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg.
authors.forename: Jürgen
authors.initials: J
authors.lastname: May
authors.affiliation: Institute of Tropical Medicine, Eberhard-Karls University Tübingen, Germany.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Meyer
authors.affiliation: National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Mintz
authors.affiliation: Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Montgomery
authors.affiliation: Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Olack
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Gi Deok
authors.initials: GD
authors.lastname: Pak
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Ursula
authors.initials: U
authors.lastname: Panzner
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Se Eun
authors.initials: SE
authors.lastname: Park
authors.affiliation: University of Antananarivo, Madagascar.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Rakotozandrindrainy
authors.affiliation: Institute of Medical Microbiology, University of Cologne, Germany.
authors.forename: Heidi
authors.initials: H
authors.lastname: Schütt-Gerowitt
authors.affiliation: Institut Supérieur des Sciences de la Population, University of Ouagadougou, Burkina Faso.
authors.forename: Abdramane Bassiahi
authors.initials: AB
authors.lastname: Soura
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Warren
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Wierzba
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Florian
authors.initials: F
authors.lastname: Marks
mesh_terms: D000293:Adolescent; D017954:Africa South of the Sahara / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D062486:Public Health Surveillance; D014435:Typhoid Fever / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control
keywords: Africa; invasive Salmonella disease; methodology; surveillance; typhoid fever