Burden of Typhoid and Paratyphoid Fever in India
Jacob John, Ashish Bavdekar, Temsunaro Rongsen‐Chandola, Shanta Dutta, Madhu Gupta, Suman Kanungo, Bireshwar Sinha, Manikandan Srinivasan, Ankita Shrivastava, Adarsh Bansal, Ashita Singh, Roshine Mary Koshy, Dasharatha R. Jinka, M. Thomas, Anna P. Alexander, Shajin Thankaraj, Sheena Evelyn Ebenezer, Arun S Karthikeyan, Dilesh Kumar, Swathi Krishna Njarekkattuvalappil, Reshma Raju, Nikhil Sahai, Balaji Veeraraghavan, Manoj Murhekar, Venkata Raghava Mohan, Sindhu K. Natarajan, Karthikeyan Ramanujam, Prasanna Samuel, Nathan C. Lo, Jason R. Andrews, Nicholas C. Grassly, Gagandeep Kang
Abstract
BACKGROUND: In 2017, more than half the cases of typhoid fever worldwide were projected to have occurred in India. In the absence of contemporary population-based data, it is unclear whether declining trends of hospitalization for typhoid in India reflect increased antibiotic treatment or a true reduction in infection. METHODS: From 2017 through 2020, we conducted weekly surveillance for acute febrile illness and measured the incidence of typhoid fever (as confirmed on blood culture) in a prospective cohort of children between the ages of 6 months and 14 years at three urban sites and one rural site in India. At an additional urban site and five rural sites, we combined blood-culture testing of hospitalized patients who had a fever with survey data regarding health care use to estimate incidence in the community. RESULTS: serovar Paratyphi was isolated from 33 children, for an overall incidence of 68 cases per 100,000 child-years after adjustment for age. CONCLUSIONS: The incidence of typhoid fever in urban India remains high, with generally lower estimates of incidence in most rural areas. (Funded by the Bill and Melinda Gates Foundation; NSSEFI Clinical Trials Registry of India number, CTRI/2017/09/009719; ISRCTN registry number, ISRCTN72938224.).