The Burden of Enteric Fever

Tulsi D Chugh,Atul Kothari,Amit Pruthi

doi:10.3855/jidc.218

Abstract

Enteric fever is a disease of developing countries associated with poor public health and low socio-economic indices. Cases of enteric fever occurring in travelers returning to the United States and the UK suggest that it is present across the developing world but that the Indian subcontinent represents a hotspot of disease activity. The best figures available for the global burden of enteric fever support this and suggest that Africa (50/ 100,000) has a far lower burden of disease than Asia (274/100,000). However these figures are based mainly on data for typhoid fever in Asia and the data for returning travelers is biased by preferred travel destinations. Given that most socio-economic indices, including known risk factors for enteric fever, such as provision of safe drinking water and sanitation, are much lower in most parts of Africa than in South-East and South-Central Asia it seems remarkable that Africa has such a low burden of disease. In such a scenario, rather than comparing whole continents, it may be more relevant to estimate region-specific burden of disease. It is clear is that there is an urgent need for more population-based studies of typhoid fever incidence in different parts of Africa to clarify the typhoid fever situation for the continent and so guide public health intervention.

Highlights

Typhoid fever was a major cause of morbidity and mortality in the United States and Europe in the 19th century [1]
Because there is scant reliable population-based data on the incidence of paratyphoid fever, an estimate of this incidence was extrapolated from the 1997 global survey of Salmonella serotyping practices and results, which was conducted by World Health Organization (WHO) and the United States Centers for Disease Control and Prevention, WHO Collaborating Center for Foodborne Disease Surveillance
This anomaly may be due to the lack of available data on typhoid fever incidence for Eastern, Central and Western Africa, as regional incidences were derived from extrapolation from 3 African incidence studies [2]

Summary

Introduction

Typhoid fever was a major cause of morbidity and mortality in the United States and Europe in the 19th century [1]. Global Burden of Disease Earlier estimates of the global burden of typhoid fever indicated there are at least 16 million new cases every year with 600,000 deaths [23] This data was first presented in 1984 and similar estimates were published around the same time [24, 25]. Because there is scant reliable population-based data on the incidence of paratyphoid fever, an estimate of this incidence was extrapolated from the 1997 global survey of Salmonella serotyping practices and results, which was conducted by World Health Organization (WHO) and the United States Centers for Disease Control and Prevention, WHO Collaborating Center for Foodborne Disease Surveillance. A conservative case-fatality rate of 1% was chosen on the basis of estimates from hospital-based typhoid fever studies, mortality data from countries with reliable national typhoid surveillance systems, and expert opinion. The rest were acquired domestically; 7% of these cases were part of recognised outbreaks [32]

Adjusted total

Urban slum

All ages

Findings

Conclusions