Volume 99, Issue 3_Suppl
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Typhoid and paratyphoid fever continue to significantly contribute to global morbidity and mortality. Disease burden is higher in low-and middle-income settings where surveillance programs are rare and little systematic information exists at population level. This review evaluates national, regional, and global trends in the incidence of typhoid fever and of related morbidity and mortality. A literature search in Medline, Embase, and Web of Science was conducted in June 2016, followed by screening and data extraction in duplicate. Studies reporting blood culture estimates of typhoid or paratyphoid morbidity and mortality were included in the analysis. Our search yielded 5,563 unique records, of which 1978 were assessed for relevance with 219 records meeting the eligibility criteria. serotype Typhi was the most commonly reported organism (91%), with the occurrence of typhoidal (either incidence or prevalence) being the most commonly reported outcome (78%), followed by typhoid fever mortality, ileal perforation morbidity, and perforation mortality, respectively. Fewer than 50% of studies stratified outcomes by age or urban/rural locality. Surveillance data were available from 29 countries and patient-focused studies were available from 32 countries. Our review presents a mixed picture with declines reported in many regions and settings but with large gaps in surveillance and published data. Regional trends show generally high incidence rates in South Asia, sub-Saharan Africa, and East Asia and Pacific where the disease is endemic in many countries. Significant increases have been reported in certain countries but should be explored in the context of long-term trends and underlying at-risk populations.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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  1. Buckle GC, Walker CL, Black RE, 2012. Typhoid fever and paratyphoid fever: systematic review to estimate global morbidity and mortality for 2010. J Glob Health 2: 010401.
    [Google Scholar]
  2. Mogasale V, Maskery B, Ochiai RL, Lee JS, Mogasale VV, Ramani E, Kim YE, Park JK, Wierzba TF, 2014. Burden of typhoid fever in low-income and middle-income countries: a systematic, literature-based update with risk-factor adjustment. Lancet Glob Health 2: e570e80.
    [Google Scholar]
  3. Global Burden of Disease, 2017. Global Burden of Disease Results Tool. GBD Results Tool | GHDx. Available at: http://ghdx.healthdata.org/gbd-results-tool. Accesssed June 1, 2018.
  4. Bhutta ZA, 1996. Salmonella. Nelson Textbook of Pediatrics. Philadelphia: Elsevier, 152.
  5. The World Bank, 2017. Poverty Headcount Ratio at $1.90 a Day (2011 PPP) (% of Population). Available at: http://data.worldbank.org/indicator/SI.POV.DDAY?locations=1W&start=1981&end=2013&view=chart. Accessed December 7, 2015.
  6. WHO/UNICEF, JMP, 2015. Annual Report: WHO/UNICEF Joint Monitoring Programmed for Water Supply and Sanitation 2015. Available at: https://www.wssinfo.org/fileadmin/user_upload/resources/JMP-2015-Annual-Report-Final.pdf. Accessed December 7, 2015.
  7. Institute for Health Metrics and Evaluation, 2017. GBD Compare: Typhoid Fever DALYs per 100,000 in 2015. Available at: https://vizhub.healthdata.org/gbd-compare/. Accessed December 7, 2015.
  8. Covidence, 2017. Covidence: Better Systematic Review Management. Available at: https://www.covidence.org/home. Accessed May 20, 2015.
  9. The World Bank, 2015. World Bank Country and Lending Groups. Available at: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519. Accessed May 20, 2015.
  10. Ministry of Health, 2005. Ministry of Health Cambodia–Annual Health Statistics Cambodia 2005. Available at: http://www.hiscambodia.org/public/health_statistic_en.php?m=6. Accessed May 17, 2016.
  11. Ministry of Health, 2006. Ministry of Health Cambodia–Annual Health Statistics Cambodia 2006. Available at: http://www.hiscambodia.org/public/health_statistic_en.php?m=62006. Accessed May 17, 2016.
  12. Ministry of Health, 2007. Ministry of Health Cambodia–Annual Health Statistics Cambodia 2007. Available at: http://www.hiscambodia.org/public/health_statistic_en.php?m=62007. Accessed May 17, 2016.
  13. Ministry of Health, 2008. Ministry of Health Cambodia–Annual Health Statistics Cambodia 2008. Available at: http://www.hiscambodia.org/public/health_statistic_en.php?m=62008. Accessed May 17, 2016.
  14. Ministry of Health, 2010. Ministry of Health Cambodia–Annual Health Statistics Cambodia 2010. Available at: http://www.hiscambodia.org/public/health_statistic_en.php?m=62010.
  15. Ministry of Health, 2011. Ministry of Health Cambodia–Annual Health Statistics Cambodia 2011. Available at: http://www.hiscambodia.org/public/health_statistic_en.php?m=62011. Accessed May 17, 2016.
  16. Hatta M, Ratnawati, 2008. Enteric fever in endemic areas of Indonesia: an increasing problem of resistance. J Infect Dev Ctries 2: 279282.
    [Google Scholar]
  17. Azmatullah A, Qamar FN, Thaver D, Zaidi AK, Bhutta ZA, 2015. Systematic review of the global epidemiology, clinical and laboratory profile of enteric fever. J Glob Health 5: 020407.
    [Google Scholar]
  18. Walia M, Gaind R, Paul P, Mehta R, Aggarwal P, Kalaivani M, 2006. Age-related clinical and microbiological characteristics of enteric fever in India. Trans R Soc Trop Med Hyg 100: 942948.
    [Google Scholar]
  19. Bhutta ZA, Naqvi SH, Razzaq RA, Farooqui BJ, 1991. Multidrug-resistant typhoid in children: presentation and clinical features. Rev Infect Dis 3: 832836.
    [Google Scholar]
  20. Brooks WA, Hossain A, Goswami D, Nahar K, Alam K, Ahmed N, Naheed A, Nair GB, Luby S, Breiman RF, 2005. Bacteremic typhoid fever in children in an urban slum, Bangladesh. Emerg Infect Dis 11: 326329.
    [Google Scholar]
  21. Sinha A, Sazawal S, Kumar R, Sood S, Reddaiah VP, Singh B, Rao M, Naficy A, Clemens JD, Bhan MK, 1999. Typhoid fever in children aged less than 5 years. Lancet 354: 734737.
    [Google Scholar]
  22. Aggarwal A, Vij AS, Oberoi A, 2007. A three-year retrospective study on the prevalence, drug susceptibility pattern, and phage types of Salmonella enterica subspecies Typhi and Paratyphi in Christian Medical College and Hospital, Ludhiana, Punjab. J Indian Acad Clin Med 8: 3235.
    [Google Scholar]
  23. Gautam V, Gupta NK, Chaudhary U, Arora DR, 2002. Sensitivity pattern of Salmonella serotypes in northern India. Braz J Infect Dis 6: 281287.
    [Google Scholar]
  24. Wormser GP, 2008. Control of Communicable Diseases Manual, 19th edition. Washington, DC: American Public Health Association.
  25. Khan MI et al., 2012. Epidemiology, clinical presentation, and patterns of drug resistance of Salmonella typhi in Karachi, Pakistan. J Infect Dev Ctries 6: 704714.
    [Google Scholar]
  26. Bhutta ZA, 1996. Impact of age and drug resistance on mortality in typhoid fever. Arch Dis Child 75: 214217.
    [Google Scholar]
  27. Brusch JL, 2010. Typhoid fever. eMedicine.
    [Google Scholar]
  28. Ochiai RL et al., 2007. The use of typhoid vaccines in Asia: the DOMI experience. Clin Infect Dis 45 (Suppl 1): S34S38.
    [Google Scholar]
  29. WHO, 2003. Background Document: the Diagnosis, Treatment and Prevention of Typhoid Fever. Geneva, Switzerland: World Health Organization.
  30. Siddiqui FJ, Rabbani F, Hasan R, Nizami SQ, Bhutta ZA, 2006. Typhoid fever in children: some epidemiological considerations from Karachi, Pakistan. Int J Infect Dis 10: 215222.
    [Google Scholar]

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  • Received : 15 Jan 2018
  • Accepted : 08 Jun 2018
  • Published online : 25 Jul 2018
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