Geographic Pattern of Typhoid Fever in India: A Model-Based Estimate of Cohort and Surveillance Data

Yanjia Cao, Arun S. Karthikeyan, Karthikeyan Ramanujam, Reshma Raju, Swathi Krishna, Dilesh Kumar, Theresa Ryckman, Venkata Raghava Mohan, Gagandeep Kang, Jacob John, Jason R. Andrews, Nathan C. Lo

Research output: Contribution to journalArticle*Academicpeer-review


BACKGROUND: Typhoid fever remains a major public health problem in India. Recently, the Surveillance for Enteric Fever in India program completed a multisite surveillance study. However, data on subnational variation in typhoid fever are needed to guide the introduction of the new typhoid conjugate vaccine in India. METHODS: We applied a geospatial statistical model to estimate typhoid fever incidence across India, using data from 4 cohort studies and 6 hybrid surveillance sites from October 2017 to March 2020. We collected geocoded data from the Demographic and Health Survey in India as predictors of typhoid fever incidence. We used a log linear regression model to predict a primary outcome of typhoid incidence. RESULTS: We estimated a national incidence of typhoid fever in India of 360 cases (95% confidence interval [CI], 297-494) per 100 000 person-years, with an annual estimate of 4.5 million cases (95% CI, 3.7-6.1 million) and 8930 deaths (95% CI, 7360-12 260), assuming a 0.2% case-fatality rate. We found substantial geographic variation of typhoid incidence across the country, with higher incidence in southwestern states and urban centers in the north. CONCLUSIONS: There is a large burden of typhoid fever in India with substantial heterogeneity across the country, with higher burden in urban centers.
Original languageEnglish
Pages (from-to)S475-S483
JournalJournal of Infectious Diseases
Issue number5
Publication statusPublished - 23 Nov 2021

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