Why CDC is Involved with Global Typhoid Fever

Health Costs: The Typhoid Fever Burden is Highest Among Children

In 2019, over 9 million typhoid fever cases occurred globally, causing over 110,000 deaths. Children are at highest risk for severe illness and death from typhoid fever with more than 50% of typhoid fever cases and deaths occurring in children less than 15 years old.

Monetary Costs: The Economic Burden of Typhoid Fever is High for Patients

A young boy recovering from typhoid fever with his mother at a hospital in Bangladesh, 2016. Credit: Sabin Vaccine Institute/Das.

The Surveillance for Enteric Fever (typhoid fever and paratyphoid fever) in Asia Project was a multi-country, multi-site population-based surveillance study aimed at characterizing the burden of enteric fever in South Asia. The project showed how typhoid fever created economic hardships for patients, especially when compared to what they might normally spend on healthcare. The median cost of the illness (treatment associated costs and time lost from work or school) for study participants who were not hospitalized was about $39 in Nepal, $45 in Bangladesh, and $157 in Pakistan, as much as or more than a person in those countries might spend on medical care over an entire year ($49 in Nepal, $37 in Bangladesh, and $43 in Pakistan).

Ongoing Challenges: The Need for Typhoid Fever Vaccines is Growing

Although improvements in water and sanitation are essential to preventing typhoid fever, vaccines are increasingly becoming more necessary, as multidrug resistant strains of S. Typhi (the bacterium that causes typhoid fever) have been emerging since the 1980s. Multidrug resistant strains mean that some antibiotics are not an effective treatment. Fully resistant strains to fluoroquinolones (a group of antibiotics) are common in South Asia and sub-Saharan Africa. Strains resistant to other antibiotics are starting to emerge.

Growing antibiotic resistance makes the need for vaccines even greater. Typhoid conjugate vaccines (TCV) prevent typhoid fever, which could help decrease the use of antibiotics and may limit the emergence of new S. Typhi drug resistant strains. TCV also protect infants and children against typhoid fever for 5 years or longer.

In 2018, the World Health Organization (WHO) recommended that TCV be included in childhood vaccination programs in countries where typhoid fever is endemic (local transmission) or causes recurrent outbreaks. WHO recommends that TCV be administered at 9 months of age or up to 2 years of age, and that catch-up campaigns for children up to 15 years of age occur when TCV is introduced. By the end of 2022, TCV had been introduced into the childhood vaccination program in five countries: Liberia, Nepal, Pakistan, Samoa, and Zimbabwe. Introduction in Malawi is planned for 2023.

Actions: CDC Works to Support TCV Activities Worldwide

CDC works with partners to support TCV activities worldwide to help control typhoid.