https://www.who.int/immunization/diseases/pneumococcal/GBD_pneumococcus.pdf

Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates

Objective To inform policy-makers about introduction of preventive interventions against typhoid, including vaccination. Methods A population-based prospective surveillance design was used. Study sites where typhoid was considered a problem by local authorities were established in China, India, Indonesia, Pakistan and Viet Nam. Standardized clinical, laboratory, and surveillance methods were used to investigate cases of fever of ³ 3 days’ duration for a one-year period. A total of 441 435 persons were under surveillance, 159 856 of whom were aged 5–15 years. Findings A total of 21 874 episodes of fever were detected. Salmonella typhi was isolated from 475 (2%) blood cultures, 57% (273/475) of which were from 5–15 year-olds. The annual typhoid incidence (per 100 000 person years) among this age group varied from 24.2 and 29.3 in sites in Viet Nam and China, respectively, to 180.3 in the site in Indonesia; and to 412.9 and 493.5 in sites in Pakistan and India, respectively. Altogether, 23% (96/413) of isolates were multidrug resistant (chloramphenicol, ampicillin and trimethoprim-sulfamethoxazole). Conclusion The incidence of typhoid varied substantially between sites, being high in India and Pakistan, intermediate in Indonesia, and low in China and Viet Nam. These findings highlight the considerable, but geographically heterogeneous, burden of typhoid fever in endemic areas of Asia, and underscore the importance of evidence on disease burden in making policy decisions about interventions to control this disease.

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A study of typhoid fever in five asian countries: disease burden and implications for controls

https://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(14)70301-8.pdf

Burden of typhoid fever in low-income and middle-income countries: a systematic, literature-based update with risk-factor adjustment

Background
Typhoid and paratyphoid fever remain important causes of morbidity worldwide. Accurate disease burden estimates are needed to guide policy decisions and prevention and control strategies.

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Typhoid fever and paratyphoid fever: Systematic review to estimate global morbidity and mortality for 2010

Although advances in public health and hygiene have led to the virtual disappearance of enteric fever (more commonly termed typhoid fever) from much of the developed world, the disease remains endemic in many developing countries. Typhoid fever is caused by Salmonella enterica serovar Typhi ( S typhi ), a Gram negative bacterium. A similar but often less severe disease is caused by S paratyphi A and, less commonly, by S paratyphi B (Schotmulleri) and S paratyphi C (Hirschfeldii). The common mode of infection is by ingestion of an infecting dose of the organism, usually through contaminated water or food. Although the source of infection may vary, person to person transmission through poor hygiene and sewage contamination of water supply are the most important.

Few established surveillance systems for typhoid exist in the developing world, especially in community settings, so the true burden is difficult to estimate. This is shown by recent revisions in the global estimates of the true burden of typhoid. In contrast to previous estimates, which were 60% higher,1 investigators from the US Centers for Disease Control and Prevention estimate that there are 21.6 million typhoid cases annually, with the annual incidence varying from 100 to 1000 cases per 100 000 population.2 The global mortality estimates from typhoid have also been revised downwards from 600 000 to 200 000, largely on the basis of regional extrapolations.2 Recent population based studies from South Asia suggest that the incidence is highest in children aged less than 5 years, with higher rates of complications and hospitalisation, and may indicate risk of early exposure to relatively large infecting doses of the organisms in these populations.3–5 These findings contrast with previous studies from Latin Americaw1 and Africa,w2 which suggested that S typhi infection caused a mild disease …

/pdf/current-concepts-in-the-diagnosis-and-treatment-of-typhoid-2frfsnzg1x.pdf

Current concepts in the diagnosis and treatment of typhoid fever

We confirmed a bacteremic typhoid fever incidence of 3.9 episodes/1,000 person-years during fever surveillance in a Dhaka urban slum. The relative risk for preschool children compared with older persons was 8.9. Our regression model showed that these children were clinically ill, which suggests a role for preschool immunization.

Bacteremic typhoid fever in children in an urban slum, Bangladesh.

We undertook active population-based surveillance in 5,000 urban households among children < 5 years old to determine invasive pneumococcal disease (IPD) incidence, serotype distribution, clinical presentation, and antimicrobial resistance, which have not been previously described in population-based studies from the region. IPD was documented by blood culture isolation. From 01 April 2004 to 31 March 2006, 5,903 blood cultures were collected from 6,167 eligible children. Streptococcus pneumoniae was isolated from 34 pneumococcal patients; IPD was clinically associated with pneumonia (24%), upper respiratory infection (62%), and febrile syndromes (14%). Overall, IPD and 13-valent serotype-related IPD incidences were 447 and 276 episodes/100,000 child-years, respectively. Peak IPD incidence occurred during the cool dry seasons. Penicillin, cotrimoxazole, chloramphenicol, and ciprofloxacin resistances were 2.9%, 82.4%, 14.7%, and 24.1%, respectively. Current conjugate vaccines should substantially reduce IPD, childhood pneumonia, and antimicrobial resistance in Bangladesh.

Noor Ahmed

Papers

Bacteremic typhoid fever in children in an urban slum, Bangladesh.

Invasive pneumococcal disease burden and implications for vaccine policy in urban Bangladesh.