Acquisition and Clearance Dynamics ofCampylobacterin Children in Low- and Middle-Income Countries

Abstract

SummaryBackgroundThe burden ofCampylobacterinfection is high in children under five years of age in low- and middle-income countries (LMIC), but its acquisition and clearance process is understudied due to scarcity of longitudinal data. We aim to quantify this process using a statistical modeling approach, leveraging data from a multi-nation study.MethodsMotivated by the MAL-ED study in which children from eight low- and middle- income countries were followed up for enteric infections during their first two years of life, we developed a two-stage Markov model to compare the dynamics of acquisition and clearance ofCampylobacterin children across countries and to explore antibiotic effectiveness onCampylobacterclearance. This model was validated using simulations and applied to the longitudinal data from MAL-ED.FindingsThe clearance rate was higher than the acquisition rate at most sites and times, but the temporal trend of these rates varied across countries. ForCampylobacter jejuni/coli, clearance was faster than acquisition under two years of age at all sites. ForCampylobacterspp., the acquisition rate surpassed the clearance rate in the second half of the first year in Bangladesh, Pakistan and Tanzania, leading to high prevalence in these countries. Bangladesh had the shortest (28 and 57 days) while Brazil had the longest (328 and 306 days) mean times to acquisition forCampylobacterspp. andC. jejuni/coli, respectively. South Africa had the shortest (10 and 8 days) while Tanzania had the longest (53 and 41 days) mean times to clearance forCampylobacterspp. andC. jejuni/colrespectively. The use of macrolides was associated with accelerated clearance ofC. jejuni/coliin Bangladesh and Peru and ofCampylobacterspp. in Bangladesh and Pakistan. The use of fluoroquinolones showed statistically meaningful effectiveness only in Bangladesh but for bothC. jejuni/coliandCampylobacterspp.InterpretationHigher burden ofCampylobacterinfection was mainly driven by high acquisition rate that was close to or surpassing the clearance rate. Acquisition usually peaked in 11-17 months in the LMIC setting, indicating the importance of targeting the first year of life for effective intervention.FundingBill & Melinda Gates Foundation.