Typhoid Fever: Way Forward

Abstract

The Tackling Typhoid supplement shows that typhoid fever continues to be a problem globally despite socioeconomic gains in certain settings. Morbidity remains high in many endemic countries, notably in sub-Saharan Africa and South Asia. In addition, antimicrobial resistance is a growing issue that poses a challenge for clinical management. The findings from this supplement revealed that outside of high-income countries, there were few reliable population-based estimates of typhoid and paratyphoid fever derived from surveillance systems. This indicates the need for monitoring systems that can also characterize the effectiveness of interventions, particularly in low- and middle-income settings. The country case studies indicated that gains in economic conditions, education, and environmental health may be associated with reductions in typhoid fever burden. Over the study period, the effect is mainly notable in countries with higher baseline levels of economic development, female literacy, and investments in public sanitation. High burden countries must continue to invest in strategies at the local level to address environmental factors such as access to safe drinking water and improved public sanitation that are known to interrupt transmission or diminish the risk of acquiring typhoid. Developing more effective vaccines and incorporating appropriate immunization strategies that target populations with the greatest risk could potentially alleviate disease burden.

Figure 1.

Average annual rate of reduction across eight case countries with subnational estimates. This figure shows the percentage for the average annual relative reduction in typhoid in Bangladesh, Chile, India, Nigeria, Pakistan, and Vietnam. The color gradient ranges from −24.43, shown in dark green, indicating reduction in typhoid to 33.31, shown in dark red, indicating an increase in typhoid incidence. In South Africa the gradient ranges from −17.07 (dark blue) to 63.91 (brown) sub-nationally. In Thailand the gradient ranges from −94.39 (dark blue) to 31.63 (brown) sub-nationally.