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Typhoid Outbreaks, 1989-2018: Implications for Prevention and Control.

Grace D Appiah1, Alexandria Chung2, Adwoa D Bentsi-Enchill3

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Typhoid fever outbreaks are a significant global health issue, particularly in Asia and Africa. This review highlights the need for more data on outbreak characteristics to guide the effective use of typhoid vaccines in control strategies.

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Area of Science:

  • Epidemiology
  • Infectious Diseases
  • Public Health

Background:

  • Typhoid fever is a major public health concern in low- and middle-income countries, frequently causing large outbreaks.
  • Existing World Health Organization (WHO) recommendations for typhoid vaccination in outbreaks are limited by scarce data on outbreak epidemiology.
  • Understanding outbreak characteristics is crucial for optimizing vaccine deployment and control measures.

Purpose of the Study:

  • To review and analyze the epidemiologic characteristics of typhoid fever outbreaks reported globally since 1990.
  • To identify trends in outbreak size, duration, transmission modes, and antimicrobial resistance patterns.
  • To evaluate the current use of vaccination in typhoid outbreak control and inform future strategies.

Main Methods:

  • A comprehensive literature review was conducted, searching for studies on typhoid outbreaks published from 1990 to 2018.
  • Data on outbreak epidemiology, including case numbers, duration, transmission routes, and antimicrobial resistance, were extracted and analyzed.
  • Geographic distribution and control strategies employed were also documented.

Main Results:

  • The review identified 47 publications detailing 45,215 typhoid fever cases across 25 countries between 1989 and 2018.
  • Outbreak characteristics varied significantly by WHO region; Southeast Asia and Africa reported the highest number of outbreaks.
  • Waterborne transmission was most common (56%), followed by foodborne (40%). Antimicrobial resistance, including multidrug-resistant (MDR) strains, was prevalent in a substantial proportion of outbreaks.
  • Vaccine use was reported in only 13% of reviewed outbreaks, with control measures primarily focusing on water, sanitation, and food safety.

Conclusions:

  • Typhoid fever outbreaks exhibit diverse epidemiologic features globally, influenced by region and transmission dynamics.
  • The increasing prevalence of antimicrobial resistance, particularly MDR strains, complicates treatment and control efforts.
  • Further research is needed to assess the role and impact of typhoid conjugate vaccines in controlling outbreaks, complementing traditional public health interventions.