Typhoid fever: Way forward

As several articles in this series have shown, despite much historical progress globally, typhoid fever remains a major problem in several parts of the world. Although the burden has declined in many countries, the disease is still widespread, notably in South Asia and sub-Saharan Africa, and a source of much morbidity,1 loss in income and economic productivity,2 and, in many instances, severe disease requiring hospitalization. Although accurate estimates are difficult to come by, 200,000 global deaths may be associated with typhoid, predominantly in certain impoverished settings where incidence can be as high as one in five children experiencing typhoid fever by the age of 10.3,4 In recent years, the emergence of drug resistance, especially multidrug resistant– and fluoroquinolone- resistant strains of Salmonella Typhi (S. Typhi) and Salmonella Paratyphi A (S. Paratyphi A), has been shown to be associated with more severe disease and potentially adverse outcomes, posing challenges for clinical management and further increasing disease burden.5 Control measures should include investments in water and sanitation services, food safety, and optimal immunization strategies that countries can implement.6 Despite some specific global recommendations on the use of currently available typhoid vaccines in school age children, there are very few examples of systematic implementation; furthermore, currently available vaccines do not address the burden of Salmonella Paratyphi A disease. Similarly, attempts to expand access to potable water and to improve sanitation in many locales have been unable to keep pace with population growth and migration.