Reservoir of Invasive Salmonellosis in Children, DRC

Study Overview
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Brief Summary
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Bloodstream infections caused by non-typhoid Salmonella (NTS) are a major killing disease in Sub-Saharan Africa. Despite the high case fatality rate, the main reservoir -human, zoonotic or environmental- for invasive NTS rests unknown. The main objective of this study is to assess the household environment (household member, cattle and pets, rats) for intestinal carriage of NTS and the household water supply for presence of NTS . Households of children with proven NTS invasive infection will be addressed.

Detailed Description
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This study will be a case-based microbiological assessment of the household environment of index patients presenting with NTS infection. Index patients with laboratory confirmed NTS bloodstream infections will be randomly addressed for the collection of samples from their household (household members, animals (domestic animals and rats) and water supply). The collection of those samples will be done as close as possible to the timing of diagnosis in the index patient. The sites of blood culture collection are the General Hospitals of Makiso and Kabondo and the Centre Hospitalier Village de Pédiatrie. Blood cultures will be drawn by nursing staff according to the standard procedures of the surveillance study. A total of 1500 blood cultures is expected with a positivity rate of 10% (Falay, 2016). According to previous prevalence data in DR Congo, the expected number of NTS in this sample group will be 50 isolates. The isolates of Salmonella sp. conserved on TSA agar will be shipped to ITM and the molecular identity of the isolates will be determined and pairs of isolates (index patient-household environment) will be compared for clonal identity, by whole genome sequencing or equivalent technique as appropriate. A database will be completed that contains the study data. Data that can have a link to the patient identity will be coded.

Official Title
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The Potential Role of the Household Environment as the Reservoir for Invasive Salmonellosis in Children, Kisangani, DR Congo.

Conditions
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Salmonella Infections, Infection of Bloodstream

Intervention / Treatment
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* Behavioral: Sample collection


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Households where at least one child is diagnosed with NTS bloodstream infection Willing to give informed consent Exclusion Criteria: Refusal of participation
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Household<br>Sample collection will be anticipated for 20 cases of NTS infections and household/environment in order to analyze 10 combinations of NTS strains in the index patient and its environment | Behavioral: Sample collection<br>* Stool samples will be collected from household members of children diagnosed with NTS infection. In addition stool samples of animals and rats will be collected as well as samples of the water supply of the household.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Environmental presence of NTS in household of index patients | Stool samples of rats,animals and household members as well as samples from household water sources will be collected to assess the presence of Salmonella spp. | 3 months | 
| Genetic relatedness of environmental/household and index patient results | Assessment of genetic relatedness/clonal identity of Salmonella isolates of index patients, household members and the household environment through whole genome sequencing or equivalent techniques. | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Potential demonstration of common source of Salmonella infections in the community by sampling of household environment for NTS, guided by the answers given to questionnaires | Questionnaires will be conducted in different household. The answers to the questions raised will guide the collection of samples (targeted to water, environment and animal species) | 3 months | 
| Public health knowledge for blood stream infections caused by NTS in DR Congo | As a result of targeted training of household members and the community, knowledge about the prevalence of NTS in the environment will increase, with the aim to avoid blood stream infections caused by NTS | 3 months | 
| Targeted control prevention measures for blood stream infections caused by NTS in DR Congo by training provided by health personnel | If the results of the study point to a common reservoir of Salmonella NTS in the community, targeted training will be given and control measures explained. The latter will largely depend on the source discovered (e.g. undercooked meat, water source) | 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Non-Typhoid Salmonella, Invasive blood stream infections, Reservoir, Household environment, Children