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Enteric fever, an infection caused by either Salmonella typhi or Salmonella paratyphi, has been eliminated in most industrialised countries but is an increasing burden in developing countries, particularly in South East Asia. Antibiotics resistance limits safe and affordable treatment options. Training the next generation of doctors and scientists in the worst hit countries will help develop a successful and sustainable partnership.

Q: How common is enteric fever?

Christiane Dolecek: Enteric fever is common in developing countries, especially in children and young adults. We don't know the exact numbers but it is estimated that worldwide there are approximately 21 million infections per year. It causes approximately 200,000 deaths each year. This disease has been eliminated in most industrialised countries through water and sewage treatment, and education about better food hygiene. It is an infection caused by one of two bacteria: Salmonella tyhpi and Salmonella paratyphi. These bacteria are ingested through contaminated water or food and then via the gut enter the blood, causing a severe bloodstream infection. What is interesting is that this disease only infects humans so we have the possibility to eradicate it.

Q: How is enteric fever treated?

CD: Enteric fever is treated with a course of antibiotics, from several days to two weeks. We see that the bacteria have evolved and developed drug resistance so the big problem now is that the treatments that we used 5 or 10 years ago are not effective any longer. The number of treatments options that are safe and affordable is very limited.

Q: Why work on enteric fever in Asia?

CD: South East Asia has the biggest burden of enteric fever. Our research is based in Nepal, a country that has a very high burden. We work there at two major hospitals but we also have collaborations and share information and work with other hospitals in Asia and Africa, where this disease is of increasing importance.

Q: What are the most important lines of research that have developed in the last 5 or 10 years?

CD: Our work focuses on identifying the best treatment for the patient, to cure the symptoms the quickest. It also stops transmission because when a patient is sick they shed the bacteria in their stools and this is how their family members and relatives get infected. By treating the patient we can stop this part of this disease and reduce the burden of this disease. One of our major targets is to see how to use the current available antibiotics in the best way. There is also a problem with diagnostics as there are no rapid tests. In order to make the diagnosis you need a blood culture and those facilities are not available in many countries in Asia or Africa.

Q: Why does your line of research matter, why should we invest in it?

CD: Enteric fever is a neglected disease so there is no commercial interest but it is still an important disease that causes huge suffering. It is very important that the University of Oxford works where the burden is the biggest and tries to make a difference.

Q: How does your research fit into Translational Medicine within the Department?

CD: In the sense that translational medicine means that using the best science to benefit the biggest number of patients, then it is an excellent example. Our studies are based on clinical trials, so we learn from the patients. We ask very practical questions and we also train the next generation of doctors and scientists at the Oxford University Clinical Research Unit in Nepal, lead by Professor Buddha Basnyat. We hope that this is a successful and sustainable partnership and that it makes a real difference to the disease.

Note: This interview was recorded in November 2014, a few months before devastating earthquakes struck Nepal in April and May 2015.

Emergency Health Care in Nepal

The 2015 earthquakes in Nepal have caused a tragic loss of life and had a devastating impact on infrastructure. The challenges are enormous and include risks of major epidemics, particularly of water born disease.
The Oxford University Clinical Research Unit Nepal, based at Patan Hospital, focuses on enteric fever and other causes of febrile illness such as typhus and Hepatitis E.

Christiane Dolecek

Dr Christiane Dolecek's clinical research focuses on tropical diseases, in particular enteric fever and malaria. She has led enteric fever clinical trials in Vietnam and Nepal with the aim to systematically assess the current WHO recommendations as well as new treatment options.

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