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Cited by 835Salmonella and Campylobacter epidemiologyGlobal Health and EpidemiologyBacterial Infections and Vaccines

The global burden of typhoid and paratyphoid fevers: a systematic analysis for the Global Burden of Disease Study 2017

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Stanaway, Jeffrey D, Reiner, Robert C, Blacker, Brigette F., Goldberg, Ellen M, Khalil, Ibrahim A., Troeger, Christopher E, Andrews, Jason R, Bhutta, Zulfiqar A +75 more·2019·The Lancet Infectious Diseases
DOI 10.1016/s1473-3099(18)30685-6PMC PMC6437314
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Abstract

BACKGROUND: Efforts to quantify the global burden of enteric fever are valuable for understanding the health lost and the large-scale spatial distribution of the disease. We present the estimates of typhoid and paratyphoid fever burden from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, and the approach taken to produce them. METHODS: For this systematic analysis we broke down the relative contributions of typhoid and paratyphoid fevers by country, year, and age, and analysed trends in incidence and mortality. We modelled the combined incidence of typhoid and paratyphoid fevers and split these total cases proportionally between typhoid and paratyphoid fevers using aetiological proportion models. We estimated deaths using vital registration data for countries with sufficiently high data completeness and using a natural history approach for other locations. We also estimated disability-adjusted life-years (DALYs) for typhoid and paratyphoid fevers. FINDINGS: Globally, 14·3 million (95% uncertainty interval [UI] 12·5-16·3) cases of typhoid and paratyphoid fevers occurred in 2017, a 44·6% (42·2-47·0) decline from 25·9 million (22·0-29·9) in 1990. Age-standardised incidence rates declined by 54·9% (53·4-56·5), from 439·2 (376·7-507·7) per 100 000 person-years in 1990, to 197·8 (172·0-226·2) per 100 000 person-years in 2017. In 2017, Salmonella enterica serotype Typhi caused 76·3% (71·8-80·5) of cases of enteric fever. We estimated a global case fatality of 0·95% (0·54-1·53) in 2017, with higher case fatality estimates among children and older adults, and among those living in lower-income countries. We therefore estimated 135·9 thousand (76·9-218·9) deaths from typhoid and paratyphoid fever globally in 2017, a 41·0% (33·6-48·3) decline from 230·5 thousand (131·2-372·6) in 1990. Overall, typhoid and paratyphoid fevers were responsible for 9·8 million (5·6-15·8) DALYs in 2017, down 43·0% (35·5-50·6) from 17·2 million (9·9-27·8) DALYs in 1990. INTERPRETATION: Despite notable progress, typhoid and paratyphoid fevers remain major causes of disability and death, with billions of people likely to be exposed to the pathogens. Although improvements in water and sanitation remain essential, increased vaccine use (including with typhoid conjugate vaccines that are effective in infants and young children and protective for longer periods) and improved data and surveillance to inform vaccine rollout are likely to drive the greatest improvements in the global burden of the disease. FUNDING: Bill & Melinda Gates Foundation.

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  • In sub-Saharan Africa, approximately 1.5 million cases of typhoid fever are reported annually and 19,900 deaths, accounting for approximately 17% of global deaths.

    “In SSA, approximately 1.5 million cases are reported annually and 19,900 deaths, accounting for approximately 17% of global deaths.65”

    From Antimicrobial Resistance Rates and Surveillance in Sub-Saharan Africa: Where Are We Now? (2022) · cites this paper as [65]

    The Results report a substantial sub-Saharan African burden in 2017, but estimate 1.73 million cases and 21,600 deaths—15.9% of global deaths—rather than the cited figures. Those regional estimates combine typhoid and paratyphoid fever and are modelled estimates, not annually reported typhoid cases and deaths. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Lack of access to safe water, proper sanitation, and inadequate hygiene practices are linked with increased risk of transmitting infectious diseases like cholera, typhoid, hepatitis A, and other water-related diseases.

    “Lack of access to safe water, proper sanitation, and inadequate hygiene practices have been linked with the increased risk of transmitting infectious diseases like cholera, typhoid, hepatitis A, and many other water-related diseases [1, 2].”

    From Water, Sanitation, and Hygiene Practices in Urban Slums of Eastern India (2021) · cites this paper as [2]

    The Introduction (page not provided) links typhoid and paratyphoid infections to poor water supply and sanitation, and the Methods identify unsafe drinking water as a known typhoid risk factor. The paper does not establish the claimed links for inadequate hygiene, cholera, hepatitis A, or other water-related diseases. (LLM, conf=0.88)

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Research works printed but not linked: 25

  1. [1]Harris JB Brooks WA Typhoid and paratyphoid (enteric) fever Magill AJ Ryan ET Hill DR Solomon T Hunter's tropical medicine and emerging infectious diseases 9th edn. 2013 Elsevier Philadelphia, PA 568 576
  2. [2]Verghese A The ‘typhoid state’ revisited Am J Med 79 1985 370 372 3898837
  3. [3]Bhutta ZA Impact of age and drug resistance on mortality in typhoid fever Arch Dis Child 75 1996 214 217 8976660 PMC1511710
  4. [4]GBD 2016 Disease and Injury Incidence and Prevalence Collaborators Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 Lancet 390 2017 1211 1259 28919117 PMC5605509
  5. [5]Buckle GC Walker CLF Black RE Typhoid fever and paratyphoid fever: systematic review to estimate global morbidity and mortality for 2010 J Glob Health 2 2012 010401 23198130 PMC3484760
  6. [6]Crump JA Luby SP Mintz ED The global burden of typhoid fever Bull World Health Organ 82 2004 346 353 15298225 PMC2622843
  7. [7]Mogasale V Maskery B Ochiai RL Burden of typhoid fever in low-income and middle-income countries: a systematic, literature-based update with risk-factor adjustment Lancet Glob Health 2 2014 e570 e580 25304633
  8. [9]Jin C Gibani MM Moore M Efficacy and immunogenicity of a Vi-tetanus toxoid conjugate vaccine in the prevention of typhoid fever using a controlled human infection model of Salmonella Typhi: a randomised controlled, phase 2b trial Lancet 390 2017 2472 2480 28965718 PMC5720597
  9. [10]Antillón M Warren JL Crawford FW The burden of typhoid fever in low- and middle-income countries: a meta-regression approach PLoS Negl Trop Dis 11 2017 e0005376 28241011 PMC5344533
  10. [11]Kim J-H Mogasale V Im J Ramani E Marks F Updated estimates of typhoid fever burden in sub-Saharan Africa Lancet Glob Health 5 2017 e969 28911760
  11. [13]GBD 2016 DALYs and HALE Collaborators Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 Lancet 390 2017 1260 1344 28919118 PMC5605707
  12. [16]Murray CJL Barber RM Foreman KJ Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition Lancet 386 2015 2145 2191 26321261 PMC4673910
  13. [17]Hoffman SL Edman DC Punjabi NH Bone marrow aspirate culture superior to streptokinase clot culture and 8 ml 1:10 blood-to-broth ratio blood culture for diagnosis of typhoid fever Am J Trop Med Hyg 35 1986 836 839 3089041
  14. [18]Gilman RH Terminel M Levine MM Hernandez-Mendoza P Hornick RB Relative efficacy of blood, urine, rectal swab, bone-marrow, and rose-spot cultures for recovery of Salmonella Typhi in typhoid fever Lancet 1 1975 1211 1213 48834
  15. [19]Watson KC Laboratory and clinical investigation of recovery of Salmonella Typhi from blood J Clin Microbiol 7 1978 122 126 632343 PMC274877
  16. [20]Flaxman AD Vos T Murray CJL An integrative metaregression framework for descriptive epidemiology 2015 University of Washington Press Seattle, WA
  17. [21]GBD 2017 Risk Factor Collaborators Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 Lancet 392 2018 1923 1994 30496105 PMC6227755
  18. [22]Ramage CS Monsoon meteorology 1971 Academic Press New York, NY, USA
  19. [23]Dewan AM Corner R Hashizume M Ongee ET Typhoid fever and its association with environmental factors in the Dhaka Metropolitan Area of Bangladesh: a spatial and time-series approach PLoS Negl Trop Dis 7 2013 e1998 23359825 PMC3554574
  20. [27]Azmatullah A Qamar FN Thaver D Zaidi AK Bhutta ZA Systematic review of the global epidemiology, clinical and laboratory profile of enteric fever J Glob Health 5 2015 020407 26649174 PMC4672836
  21. [28]Poulos C Riewpaiboon A Stewart JF Cost of illness due to typhoid fever in five Asian countries Trop Med Int Health 16 2011 314 323 21223462
  22. [29]Riewpaiboon A Piatti M Ley B Cost of illness due to typhoid fever in Pemba, Zanzibar, East Africa J Health Popul Nutr 32 2014 377 385 25395900 PMC4221443
  23. [30]Bahl R Sinha A Poulos C Costs of illness due to typhoid fever in an Indian urban slum community: implications for vaccination policy J Health Popul Nutr 22 2004 304 310 15609783
  24. [31]Stuart BM Pullen RL Typhoid; clinical analysis of 360 cases Arch Intern Med 78 1946 629 661 20278487
  25. [32]Nagaraja V Eslick GD Systematic review with meta-analysis: the relationship between chronic Salmonella Typhi carrier status and gall-bladder cancer Aliment Pharmacol Ther 39 2014 745 750 24612190

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Authors
Stanaway, J. D., Reiner, R. C., Blacker, B. F., Goldberg, E. M., Khalil, I. A., Troeger, C. E., Andrews, J. R., Bhutta, Z. A., Crump, J. A., Im, J., Marks, F., Mintz, E., Park, S. E., Zaidi, A. K. M., Abebe, Z., Abejie, A. N., Adedeji, I. A., Ali, B. A., Amare, A. T., Atalay, H. T., Avokpaho, E. F. G. A., Bacha, U., Barac, A., Bedi, N., Berhane, A., Browne, A. J., Chirinos, J. L., Chitheer, A., Dolecek, C., El Sayed Zaki, M., Eshrati, B., Foreman, K. J., Gemechu, A., Gupta, R., Hailu, G. B., Henok, A., Hibstu, D. T., Hoang, C. L., Ilesanmi, O. S., Iyer, V. J., Kahsay, A., Kasaeian, A., Kassa, T. D., Khan, E. A., Khang, Y.-H., Magdy Abd El Razek, H., Melku, M., Mengistu, D. T., Mohammad, K. A., Mohammed, S., Mokdad, A. H., Nachega, J. B., Naheed, A., Nguyen, C. T., Nguyen, H. L. T., Nguyen, L. H., Nguyen, N. B., Nguyen, T. H., Nirayo, Y. L., Pangestu, T., Patton, G. C., Qorbani, M., Rai, R. K., Rana, S. M., Ranabhat, C. L., Roba, K. T., Roberts, N. L. S., Rubino, S., Safiri, S., Sartorius, B., Sawhney, M., Shiferaw, M. S., Smith, D. L., Sykes, B. L., Tran, B. X., Tran, T. T., Ukwaja, K. N., Vu, G. T., Vu, L. G., Weldegebreal, F., Yenit, M. K., Murray, C. J. L., & Hay, S. I.
Affiliations
University of Washington (US)
Corresponding author
Stanaway, Jeffrey D
ORCID
Venue
The Lancet Infectious Diseases
Publisher
Elsevier BV
Published
2019-04
Volume
19
Issue
4
Pages
369-381
ISSN
1473-3099 (ISSN-L)
DOI
10.1016/s1473-3099(18)30685-6
PMC
PMC6437314
OpenAlex
W2917067204
Cited by
835
References
5
Citations by year
2026: 85 · 2025: 120 · 2024: 146 · 2023: 130 · 2022: 102 · 2021: 116 · 2020: 107 · 2019: 29
FWCI
68.30
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Infectious Diseases (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • UnissResearch (Università degli Studi di Sassari) (submittedVersion, other-oa)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, other-oa)
  • Seoul National University Open Repository (Seoul National University) (submittedVersion)
Funders
  • Bill & Melinda Gates Foundation (OPP1125993, OPP1151153, OPP1158210, OPPGH5321, OPP1127988)
  • US National Institutes for Health (R01AI121378)
Topics
  • Life Sciences › Agricultural and Biological Sciences › Food Science › Salmonella and Campylobacter epidemiology
  • Health Sciences › Health Professions › Health Information Management › Global Health and Epidemiology
  • Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
Keywords
typhoid fever, paratyphoid fever, enteric fever, Salmonella typhi, Salmonella paratyphi, global burden of disease, disability-adjusted life years, incidence trends, mortality, case fatality, vital registration data, age-standardized incidence rate, low-income countries, children and elderly, spatial distribution of disease
MeSH terms
Global Burden of Disease, Adolescent, Adult, Aged, Aged, 80 and over, Cause of Death, Child, Child, Preschool, Female, Disabled Persons, Persons with Disabilities, Humans, Infant, Life Expectancy, Male, Middle Aged, Paratyphoid Fever, Risk Factors, Sanitation, Typhoid Fever, Typhoid-Paratyphoid Vaccines, Incidence, Quality-Adjusted Life Years, Salmonella enterica, Mass Vaccination, Young Adult

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