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Volume 31, Number 10—October 2025

Research

Comparative Epidemiology of Salmonella enterica Serovers Paratyphi A and Typhi Causing Enteric Fever, Bangladesh, 2018–2020

Sadia Isfat Ara Rahman1Comments to Author , Md Golam Firoj1, Se Eun Park1, Farhana Khanam1, Suneth Agampodi1, Kassa Haile1, Edilawit Mesfin, Faisal Ahmmed, Md Taufiqul Islam, Ashraful Islam Khan, Fahima Chowdhury, Afroza Akter, Martin Bundi Mwebia, Justin Im, Natasha Y. Rickett, Cecilia Kathure Mbae, Asma Binte Aziz, Beatrice Ongadi, Moses Mwangi, Benjamin Ngugi, Meseret Gebre Behute, Kelvin Kering, Suman Kanungo, Xinxue Liu, Deok Ryun Kim, Andrew J. Pollard, K Zaman2, Samuel Kariuki2, Firdausi Qadri2, and John D. Clemens2
Author affiliation: icddr,b, Dhaka, Bangladesh (S.I.A. Rahman, M.G. Firoj, F. Khanam, F. Ahmmed, M.T. Islam, A.I. Khan, F. Chowdhury, A. Akter, K. Zaman, F. Qadri, J.D. Clemens); Yonsei University Graduate School of Public Health, Seoul, South Korea (S.E. Park); International Vaccine Institute, Seoul (S.E. Park, S. Agampodi, N.Y. Rickett, A.B. Aziz, M.G. Behute, D.R. Kim, J.D. Clemens); Armauer Hansen Research Institute, Addis Ababa, Ethiopia (K. Haile, E. Mesfin); Kenya Medical Research Institute, Nairobi, Kenya (M.B. Mwebia, C.K. Mbae, B. Ongadi, M. Mwangi, B. Ngugi, K. Kering, S. Kariuki); RIGHT Foundation, Seoul (J. Im); ICMR, National Institute of Cholera and Enteric Diseases, Kolkata, India (S. Kanungo); University of Oxford, Oxford, UK (X. Liu, A.J. Pollard); NIHR Oxford Biomedical Research Centre and Oxford University Hospitals NHS Foundation Trust, Oxford (A.J. Pollard); UCLA Fielding School of Public Health, Los Angeles, California, USA (J.D. Clemens); Korea University Vaccine Innovation Center, Seoul (J.D. Clemens)

Main Article

Table 2

Associations between sociodemographic and WaSH characteristics and the occurrence of Salmonella Paratyphi A disease in closed cohort in epidemiologic study of Salmonella Paratyphi A and Salmonella Typhi, Bangladesh, 2018–2020*

Characteristic No. participants PY No. cases IR (95% CI) Crude HR p value Adjusted HR† p value
Religion
Muslim 203,593 316,714 86 27 (22–33) Referent NA Referent NA
Other
2,472
3,772
1
27 (2–124)
0.98 (0.14–7.06)
0.986
1.04 (0.14–7.43)
0.973
Monthly expenditure
Below median 100,505 153,458 46 30 (22–40) Referent NA Referent NA
Median or above
105,560
167,028
41
25 (18–33)
0.83 (0.54–1.26)
0.381
0.81 (0.53–1.24)
0.332
Toilet facility: private
Y 85,915 141,424 18 13 (8–20) Referent NA Referent NA
N
120,150
179,062
69
39 (30–48)
2.88 (1.71–4.84)
<0.001
2.77 (1.65–4.66)
<0.001
Adult toilet: flush toilet
Y 10,374 16,489 4 24 (8–58) Referent NA Referent NA
N
195,691
303,997
83
27 (22–34)
1.09 (0.4–2.96)
0.871
1.03 (0.38–2.81)
0.952
Child toilet: flush toilet
Y 853 1,386 0 0 (0–178) Referent NA Referent NA
N
205,212
319,099
87
27 (22–33)
1,210,612.65 (0–∞)
0.994
1,393,520.45 (0–∞)
0.994
Source of drinking water: private tap, well, or pump; bottled water and water vendor
Y 61,017 99,004 14 14 (8–23) Referent NA Referent NA
N
145,048
221,482
73
33 (26–41)
2.24 (1.26–3.96)
0.006
2.1 (1.19–3.72)
0.011
Treated cleaning water
Y 889 1,387 0 0 (0–178) Referent NA Referent NA
N
205,176
319,098
87
27 (22–33)
1,210,682.57 (0–∞)
0.994
1,132,383.86 (0–∞)
0.994
Hand wash before taking meal
Y 145,554 227,911 54 24 (18–31) Referent NA Referent NA
N
60,511
92,575
33
36 (25–49)
1.49 (0.96–2.29)
0.072
1.45 (0.94–2.24)
0.090
Hand wash after defecation
Y 200,637 312,047 87 28 (22–34) Referent NA Referent NA
N
5,428
8,439
0
0 (0–29)
0 (0–∞)
0.994
0 (0–∞)
0.993
Handwashing water available in household
Y 200,101 311,181 82 26 (21–33) Referent NA Referent NA
N
5,964
9,305
5
54 (20–118)
2.02 (0.82–4.99)
0.126
2.02 (0.82–4.99)
0.126
Handwashing soap available in household
Y 202,351 314,711 87 28 (22–34) Referent NA Referent NA
N
3,714
5,775
0
0 (0–43)
0 (0–∞)
0.992
0 (0–∞)
0.992
Waste disposal place: fixed disposal
Y 193,217 300,307 84 28 (22–34) Referent NA Referent NA
N
12,848
20,179
3
15 (4–40)
0.53 (0.17–1.67)
0.278
0.49 (0.16–1.56)
0.227
Distance to drinking water source: shorter than median distance
Y 101,145 156,461 42 27 (20–36) Referent NA Referent NA
N
104,920
164,025
45
27 (20–36)
1.02 (0.67–1.56)
0.921
0.99 (0.65–1.51)
0.964
Water filter available in household
Y 23,196 37,234 9 24 (12–44) Referent NA Referent NA
N 182,869 283,252 78 28 (22–34) 1.11 (0.56–2.21) 0.770 1.08 (0.54–2.15) 0.834

*HR, hazard ratio; IR, incidence rate, cases/100,000 persons/y; NA, not applicable; PY, person-years; WASH, water sanitation and hygiene. †Adjusted by age and sex.

Main Article

1These first authors contributed equally to this article.

2Thes authors contributed as joint senior authors.

Page created: August 12, 2025
Page updated: September 25, 2025
Page reviewed: September 25, 2025
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