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Volume 32, Number 8—August 2026

Use of Salmonella enterica Serovar Typhi Hemolysin E and Lipopolysaccharide IgA to Identify Enteric Fever Cases, South Asia

Jessica C. Seidman¹

, Kristen Aiemjoy¹, Mehreen Adnan, Irum Fatima Dehraj, Junaid Iqbal, Khalid Iqbal, Seema Irfan, Nahidul Islam, Md. Shakiul Kabir, Nishan Katuwal, Noshi Maria, Muhammad Ashraf Memon, Sira Jam Munira, Shiva Ram Naga, Sailesh Pradhan, Anik Sarkar, Rajeev Shrestha, Sony Shrestha, Syed Muktadir Al Sium, Krista Vaidya, Douglas Ezra Morrison, Alice S. Carter, Senjuti Saha, Dipesh Tamrakar, Mohammad Tahir Yousafzai, Denise O. Garrett, Stephen P. Luby, Farah Naz Qamar, Samir Saha, Jason R. Andrews, and Richelle C. Charles

Author affiliation: Sabin Vaccine Institute, Washington, DC, USA (J.C. Seidman, A.S. Carter, D.O. Garrett); Mahidol University Faculty of Tropical Medicine, Bangkok, Thailand (K. Aiemjoy); University of California, Davis, California, USA (K. Aiemjoy, K. Vaidya, D.E. Morrison); Aga Khan University, Karachi, Pakistan (M. Adnan, I.F. Dehraj, J. Iqbal, S. Irfan, N. Maria, M.T. Yousafzai, F.N. Qamar); Kharadar General Hospital, Karachi (K. Iqbal, M.A. Memon); Child Health Research Foundation, Dhaka, Bangladesh (N. Islam, M.S. Kabir, S.J. Munira, A. Sarkar, S.M. Al Sium, Senjuti Saha, Samir Saha); Dhulikhel Hospital Kathmandu University Hospital, Kavrepalanchok, Nepal (N. Katuwal, S.R. Naga, R. Shrestha, S. Shrestha, D. Tamrakar); Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal (S. Pradhan); Bangladesh Council of Scientific and Industrial Research, Dhaka (S.M. Al Sium); Stanford University, Stanford, California, USA (S.P. Luby, J.R. Andrews); Massachusetts General Hospital, Boston, Massachusetts, USA (R.C. Charles); Harvard Medical School, Boston (R.C. Charles); Harvard T.H. Chan School of Public Health, Boston (R.C. Charles)

Main Article

Characteristics of laboratory-confirmed enteric fever cases and alternative etiology controls in study of the use of Salmonella Typhi hemolysin E and lipopolysaccharide IgA to identify enteric fever cases, South Asia*

Characteristic	Bangladesh		Nepal		Pakistan		All		p value
Characteristic	Case,  n = 411	Control,  n = 79	Case,  n = 155	Control,  n = 102	Case,  n = 84	Control,  n = 82	Case,  n = 650	Control,  n = 263	p value
Age
Median	5.4	3.0	19.4	28.0	9.0	29.5	7.0	22.0	<0.001
IQR, Q1–Q3	3.3–8.0	1.0–7.0	14.9–25.7	19.5–38.0	4.0–17.0	17.0–39.8	4.0–13.0	4.5–34.0
Age category, y, no. (%)
<5	180 (43.8)	50 (63.3)	4 (2.6)	7 (6.9)	24 (28.6)	9 (11.0)	208 (32.0)	66 (25.1)	<0.001
5–15	230 (56.0)	28 (35.4)	39 (25.2)	13 (12.7)	36 (42.9)	10 (12.2)	305 (46.9)	51 (19.4)
≥16	1 (0.2)	1 (1.3)	112 (72.3)	82 (80.4)	24 (28.6)	63 (76.8)	137 (21.1)	146 (55.5)
Sex, no. (%)
M	214 (52.1)	45 (57.0)	95 (61.3)	54 (52.9)	48 (57.1)	69 (84.1)	357 (54.9)	168 (63.9)	0.02
F	197 (47.9)	34 (43.0)	60 (38.7)	48 (47.1)	36 (42.9)	13 (15.9)	293 (45.1)	95 (36.1)
Days of fever at presentation
Median	4.0	3.0	4.0	3.0	6.0	5.0	4.0	4.0	0.15
IQR, Q1–Q3	3.0–6.0	2.0–4.0	3.0–5.0	3.0–6.0	4.8–8.0	4.0–7.0	3.0–6.0	3.0–6.0
HlyE IgA concentration
Median	27.6	2.1	19.2	4.7	36.5	3.0	26.4	3.4	<0.001
IQR, Q1–Q3	10.4–57.3	0.8–5.5	5.9–50.0	2.6–8.1	15.9–102.3	1.5–5.0	9.5–59.1	1.6–6.3
LPS IgA concentration
Median	82.3	2.3	106.1	4.5	162.6	6.6	98.0	4.5	<0.001
IQR, Q1–Q3	31.9–158.9	0.5–5.6	32.6–223.8	3.1–9.8	73.5–321.0	3.6–10.9	35.3–190.2	2.2–9.4

*p values estimated for the comparisons between all cases and controls. IQR, interquartile range; Q, quarter.

Main Article

¹These authors contributed equally to this article.

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Page updated: July 27, 2026

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