Abstract
Enteric fever, caused by Salmonella enterica serovars Typhi and Paratyphi, causes significant morbidity and mortality globally. Surveillance is limited by the lack of reliable diagnostic assays, leading to major gaps in understanding the population-level burden in low- and middle-income countries. We applied a novel serologic tool measuring anti-IgG responses to Hemolysin E (HlyE) to assess infection rates in Kenyan children from four communities: two in western Kenya (Kisumu and Chulaimbo) and two in coastal Kenya (Ukunda and Msambweni). We found a substantially higher enteric fever seroincidence rate in coastal Kenya (37/100 person-years) than in western Kenya (3.6/100 person-years). We found a higher seroincidence rate in households with non-piped water, lower income, and neighborhoods with higher population density. These findings contribute to Kenya's limited on enteric fever surveillance data, especially in the coastal regions. Such information underscores the need for public health interventions such as typhoid conjugate vaccine introduction in Kenya.