Typhoid fever epidemiology and demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Aysha Aslam, M.B.B.S[2]

## Overview

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An estimated 16-33 million cases of typhoid result in 500,000 to 600,000 deaths annually. In 2000, typhoid fever caused an estimated 21.7 million illnesses and 217,000 deaths.[1][2] Worldwide, typhoid fever is most prevalent in overcrowded areas with poor hygiene and sanitation. Typhoid fever is still common in the developing world, where it affects about 21.5 million people each year. 1-6% of the individuals who are infected will develop a chronic infection of the gall bladder.[3] The incidence of typhoid fever varies in different parts of world.[4][5][6] Age, race, gender and certain environmental factors affect the distribution of disease among these groups.[7][8][9]

## Epidemiology

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* An estimated 16-33 million cases of typhoid result in 500,000 to 600,000 deaths annually.
* In 2000, typhoid fever caused an estimated 21.7 million illnesses and 217,000 deaths.[1][2]
* In 2013, typhoid fever resulted in about 161,000 deaths as compared to 181,000 in 1990.[10][11]

### Prevalance

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* Worldwide, typhoid fever is most prevalent in overcrowded areas with poor hygiene and sanitation.
* In endemic areas, the World Health Organisation identifies typhoid as a serious public health problem.
* Typhoid fever is still common in the developing world, where it affects about 21.5 million people each year.
* Typhoid fever is common in the most parts of the world except in the industrialized regions such as the United States, Canada, Western Europe, Australia, and Japan.
* 1-6% of the individuals who are infected will develop a chronic infection of the gall bladder.[12][3]

### Incidence

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The incidence of typhoid fever varies in different parts of world.[4][5][6]

* Areas with the highest incidence of typhoid fever (>100/100,000 cases/year) include south-central Asia and south-east Asia.[13].
* Areas with the medium incidence (10-100/100,000 cases/year) include the rest of Asia, Africa, Latin America and the Caribbean, and Oceania, except for Australia and New Zealand[13]
* Areas with the low incidence (<10/100,000 cases/year) include Europe, North America, and the rest of the world.[13]
* The incidence of typhoid fever is estimated to be less than 400 cases per year in the United States and 75% of these are acquired while travelling internationally.[14]

### Case fatality rate

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* The case fatality rate for typhoid fever is 1%.[15]

Death rates for Typhoid Fever in the U.S. 1906-1960 - Source: https://www.cdc.gov/

## Demographics

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The following demographic factors may affect the incidence and prevalence of typhoid fever.

### Age

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The incidence of typhoid fever is highest in children between the ages of 5 and 19 years.[7][8][9]

### Race

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There is no racial predilection for typhoid fever.

### Gender

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Males are more commonly affected with the typhoid fever than females. The male to female ratio is approximately 1.36 to 1.[8]

### Environmental factors

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The incidence of typhoid fever increases with an increase in temperature and rainfall.[8]

### Developed countries

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Typhoid fever is sporadic in developed countries but may be seen in travellers returning from endemic areas. The incidence of typhoid fever in the United States has been stable at about 200-300 cases in 2013.[16]

### Developing countries

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The incidence and prevalence of typhoid fever is highest in developing countries.[8][2][17][9] The incidence of typhoid fever in the Mekong Delta region of Vietnam and Delhi in India is approximately 198 per 100,000 and 980 per 100,000 per year, respectively, based on recent reports.[18][19]

## References

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1. ↑ 1.0 1.1 Crump, J. A., & Mintz, E. D (2010). "Global trends in typhoid and paratyphoid fever". Clinical Infectious Diseases. 50 (2): 241–246. doi:10.1086/649541. PMID 20014951.CS1 maint: Multiple names: authors list (link)
2. ↑ 2.0 2.1 2.2 Daul CB, deShazo RD, Andes WA, Pankey GA (1986). "Immunologic studies in homosexual and hemophiliac subjects with persistent generalized lymphadenopathy: a comparative analysis". J Allergy Clin Immunol. 77 (2): 295–301. PMID 3484760.CS1 maint: Multiple names: authors list (link)
3. ↑ 3.0 3.1 Lanata CF, Levine MM, Ristori C, Black RE, Jimenez L, Salcedo M; et al. (1983). "Vi serology in detection of chronic Salmonella typhi carriers in an endemic area". Lancet. 2 (8347): 441–3. PMID 6192305.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
4. ↑ 4.0 4.1 Crump JA, Luby SP, Mintz ED (2004). "The global burden of typhoid fever". Bull World Health Organ. 82 (5): 346–53. PMC 2622843. PMID 15298225.CS1 maint: Multiple names: authors list (link)
5. ↑ 5.0 5.1 Lynch MF, Blanton EM, Bulens S, Polyak C, Vojdani J, Stevenson J; et al. (2009). "Typhoid fever in the United States, 1999-2006". JAMA. 302 (8): 859–65. doi:10.1001/jama.2009.1229. PMID 19706859.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
6. ↑ 6.0 6.1 Jensenius M, Han PV, Schlagenhauf P, Schwartz E, Parola P, Castelli F; et al. (2013). "Acute and potentially life-threatening tropical diseases in western travelers--a GeoSentinel multicenter study, 1996-2011". Am J Trop Med Hyg. 88 (2): 397–404. doi:10.4269/ajtmh.12-0551. PMC 3583336. PMID 23324216.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
7. ↑ 7.0 7.1 "Typhoid Fever". World Health Organisation. Retrieved 2007-08-28. Check date values in: `|accessdate=` (help)
8. ↑ 8.0 8.1 8.2 8.3 8.4 Dewan AM, Corner R, Hashizume M, Ongee ET (2013). "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 (1): e1998. doi:10.1371/journal.pntd.0001998. PMC 3554574. PMID 23359825.CS1 maint: Multiple names: authors list (link)
9. ↑ 9.0 9.1 9.2 Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID http://dx.doi.org/10.1016/S0140-6736(98)09 Check `|pmid=` value (help).CS1 maint: Multiple names: authors list (link)
10. ↑ Infants, children, and adolescents in south-central and Southeast Asia experience the greatest burden of illness.
11. ↑ Crump JA, Luby SP, Mintz ED (2004). "The global burden of typhoid fever". Bull World Health Organ. 82: 346–353.
12. ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID doi:10.1093/infdis/146.6.724 Check `|pmid=` value (help).CS1 maint: Multiple names: authors list (link)
13. ↑ 13.0 13.1 13.2 Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID doi:10.1128/jb.00581-12 . doi:10.1128/jb.00581-12 Check `|pmid=` value (help).CS1 maint: Multiple names: authors list (link)
14. ↑ Imanishi M, Newton AE, Vieira AR, Gonzalez-Aviles G, Kendall Scott ME, Manikonda K; et al. (2015). "Typhoid fever acquired in the United States, 1999-2010: epidemiology, microbiology, and use of a space-time scan statistic for outbreak detection". Epidemiol Infect. 143 (11): 2343–54. doi:10.1017/S0950268814003021. PMID 25427666.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
15. ↑ Heymann, David L., ed. (2008), Control of Communicable Diseases Manual, Washington, D.C.: American Public Health Association, pg 665. ISBN 978-0-87553-189-2.
16. ↑ Center for Disease Control United States http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/typhoid-paratyphoid-fever. Accessed on September 12, 2016.
17. ↑ Baddam R, Kumar N, Thong KL, Ngoi ST, Teh CS, Yap KP; et al. (2012). "Genetic fine structure of a Salmonella enterica serovar Typhi strain associated with the 2005 outbreak of typhoid fever in Kelantan, Malaysia". J Bacteriol. 194 (13): 3565–6. doi:10.1128/JB.00581-12. PMC 3434757. PMID 22689247.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
18. ↑ Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ (2002). "Typhoid fever". N Engl J Med. 347 (22): 1770–82. doi:10.1056/NEJMra020201. PMID 12456854.CS1 maint: Multiple names: authors list (link)
19. ↑ Chau TT, Campbell JI, Galindo CM, Van Minh Hoang N, Diep TS, Nga TT; et al. (2007). "Antimicrobial drug resistance of Salmonella enterica serovar typhi in asia and molecular mechanism of reduced susceptibility to the fluoroquinolones". Antimicrob Agents Chemother. 51 (12): 4315–23. doi:10.1128/AAC.00294-07. PMC 2167998. PMID 17908946.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)

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