Antibiotic resistance fuels 87% of India’s typhoid economic burden: Study

Antibiotic-resistant typhoid infections accounted for at least 87% of India’s disease-related economic burden in 2023, according to a study in The Lancet Regional Health Southeast Asia.

The total economic burden due to typhoid fever was estimated at ₹123 billion.

Children under the age of 10 incurred the highest economic burden, contributing to over half of the costs, researchers, including those from London School of Hygiene and Tropical Medicine and Christian Medical College in Vellore, found.

They also estimated that households bore 91% of expenses, and 70,000 families faced “catastrophic” health expenditure.

Maharashtra, Uttar Pradesh, Andhra Pradesh (including Telangana), Tamil Nadu, and West Bengal were estimated to account for 51% of the national costs.

Typhoid fever is an infectious disease commonly transmitted through contaminated food or water. Symptoms can include high fever, fatigue, headache and stomach pain.

The authors said the findings provide key evidence to support the introduction of the typhoid conjugate vaccine in the national immunisation schedule, which is under consideration.

Evidence from the study a lso supports enhancing antibiotic resistance control and guiding national health financing policies, they said.

The researchers analysed empirical data from India on typhoid epidemiology, care-seeking, clinical outcomes, and estimated direct and indirect costs for hospitalised and non-hospitalised typhoid fever patients.

“Typhoid fever imposes a significant economic burden in India, shaped by fluoroquinolone resistance, children less than ten years of age, and high-burden provincial states of the country, resulting in considerable household financial strain,” the authors wrote.

“Fluoroquinolone-resistant infections accounted for 87% of total costs,” they said.

The antibiotic fluoroquinolone helps treat severe infections and is said to be highly effective in reducing fever in typhoid within four days.

The authors said available evidence on the economic burden of typhoid fever is fragmented and geographically limited.

The study presents a comprehensive, nationally representative estimate, they said.

The analysis also indicated that fluoroquinolone-resistant infections drive the economic burden of typhoid fever in India, disproportionately affecting young children and placing a significant financial burden on families, the team said.