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Ofad 120
Ofad 120
SUPPLEMENT ARTICLE
Regional estimates of the burden of typhoid fever cannot be for typhoid and explore new technological and access develop
measured accurately without improved disease diagnostics; ments that could improve the diagnostic landscape in the fu
this lack of diagnostics and data impacts the ability of govern ture and in the context of existing target product profile
ments to plan and appropriately intervene. Given the need for drafts. We explore different areas of typhoid diagnostic chal
disease control, funding typhoid diagnostic capacity, including lenges, including current shortcomings in an example setting,
availability and use of improved typhoid test kits, should be in expanding understanding of existing rapid diagnostic tests
creased, especially where the incidence of typhoid is unknown (RDTs), the future of diagnostics as part of surveillance, and
[1]. Challenges regarding typhoid diagnostics may also impact access-related considerations that aim to improve the availabil
the implementation of new-generation typhoid vaccines ity of quality diagnostic tests in the future.
in endemic regions due to lack of surveillance tools [2].
Multidrug resistance (MDR) has been spread intercontinen
tally due to an increase in travel connectivity, affecting those CHALLENGES IN TYPHOID DIAGNOSIS: EXAMPLE
living in endemic regions and travelers alike [3, 4]. Notably, FROM LAOS
multidrug-resistant and fluoroquinolone-resistant variants The Lao People’s Democratic Republic (Laos) is a landlocked
of Salmonella enterica subspecies enterica serovar Typhi country in Southeast Asia with a population of approximately
(S. Typhi) may be associated with more severe disease with po 7 million people [5]. Typhoid fever is endemic in Laos, but
tentially adverse outcomes, therefore creating clinical manage there are limited epidemiological data. In a hospital-based
ment challenges [3]. The spread of drug-resistant organisms as study examining blood cultures at Mahosot hospital in the cap
well as an expected reemergence of typhoid in currently nonen ital, Vientiane, between 2000 and 2018, there were a total of 913
demic settings due to climate change make improved diagnos culture-confirmed typhoid cases from just over 60 000 blood
tics key for tracking incidence to inform public health policy in cultures (∼1.5% positivity). Most cases originated in rural areas
additional to ensuring individual patients get appropriate treat with the majority of patients recruited into research studies;
ment. Here, we aim to review gaps in the diagnostic landscape there were limited specimen requests outside of these studies,
particularly outside of the capital city [6].
These data suggest that the amount of typhoid in Laos is un
Correspondence: Jyotshna Sapkota, MD, Scientist, Malaria and Fever Team, FIND, the
Global Alliance for Diagnostics, Campus Biotech, Chemin des Mines 9, 1202, Geneva,
derestimated; detection relies on blood culture, with the labora
Switzerland. tory capacity to process blood cultures being limited outside of
Open Forum Infectious Diseases® Vientiane (capacity is increasing as a consequence of a UK
© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases
Society of America. This is an Open Access article distributed under the terms of the Fleming Fund grant). Provincial hospital laboratories in the
Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which network perform manual blood cultures in-house and then
permits unrestricted reuse, distribution, and reproduction in any medium, provided the original
work is properly cited.
send positive cultures, including suspected S. Typhi, to a
https://doi.org/10.1093/ofid/ofad120 central government or reference laboratory in Vientiane for