Typhoid fever: Way forward

• Type of Material: Article
• Authors: Zulfiqar A. Bhutta, University of Toronto; Michelle F. Gaffey, Centre for Global Child Health; John A. Crump, University of Otago; Duncan Steele, Bill and Melinda Gates Foundation; Robert F Breiman, Emory University; Eric Mintz, Emory University; Robert F. Black, Johns Hopkins Bloomberg School of Public Health; Stephen P. Luby, Stanford University; Myron M. Levine, University of Maryland
• Language: English
• Date: 2018-01-01
• Publisher: American Society of Tropical Medicine and Hygiene
• Publication Version: Final Published Version
• Copyright Statement: © 2018 by The American Society of Tropical Medicine and Hygiene
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.4269/ajtmh.18-0111
• Title of Journal or Parent Work: American Journal of Tropical Medicine and Hygiene
• ISSN: 0002-9637
• Volume: 99
• Issue: 3
• Start Page: 89
• End Page: 96
• Grant/Funding Information: Financial support: Funding for this study (Grant # OPP1126230, Principal Investigator Zulfiqar A. Bhutta) to the Centre for Global Child Health, Hospital for Sick Children, Toronto, was provided by the Bill & Melinda Gates Foundation (https://www.gatesfoundation.org/).
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

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.