Study estimates 49 lakh cases of typhoid fever in India in 2023

A study has estimated 49 lakh cases of typhoid fever and 7,850 deaths in India in 2023, with Delhi, Maharashtra and Karnataka together accounting for nearly 30 per cent of the national burden.

Findings published in The Lancet Regional Health Southeast Asia also show that six lakh of the 7.3 lakh hospitalisations across the country were attributable to fluoroquinolone-resistance — a type of antibiotic, or antimicrobial, resistance.

Typhoid fever is a bacterial infection that spreads through contaminated food and water. Symptoms can start one to three weeks following exposure and include high fever, headaches, abdominal pain and fatigue. Treatment involves antibiotics and supportive care.

Researchers, including those from the London School of Hygiene and Tropical Medicine and Christian Medical College in Vellore, India, found that the states of Delhi, Maharashtra and Karnataka also had the highest rates of fluoroquinolone-resistant cases and deaths among the ten highest-burden states.

The authors “estimated 4.9 million typhoid cases and 7,850 deaths in India in 2023”.

“Delhi, Maharashtra, and Karnataka together accounted for 29 per cent of the national burden and had the highest rates of fluoroquinolone-resistant cases and deaths among the ten highest-burden states,” they said.

“Fluoroquinolone-resistance drives a large share of typhoid-related hospitalisations and deaths, especially in children under five and in high-burden states of India,” the team said.

The researchers reviewed studies published up to July 2025 that carried data on typhoid fever incidence, mortality and antibiotic resistance.

A persistently high fluoroquinolone-resistance was found (more than 60 per cent), steadily increasing from 1989 to 2024 and peaking at 94 % in 2017.

Resistance to third-generation cephalosporin and azithromycin — both common and effective first-line antibiotics used for treating typhoid fever — remained consistently low and multidrug resistance steadily declined over the last three decades, the team said.

The authors also found that children aged 5-9 exhibit the highest number of typhoid fever and antibiotic resistance cases, while children aged 6 months to four years experience the highest number of hospitalisations and deaths.

Delhi, Maharashtra, and Karnataka were identified as priority states for introducing the typhoid conjugate vaccine — a single-dose providing long-lasting protection.

The team added that relying solely on routine immunisation programme, which targets the typhoid conjugate vaccine around nine months, would be insufficient for an immediate control of typhoid fever in India, as it could take decades to reach older people, who also bear a significant disease burden.

Measures to control antimicrobial resistance (AMR) are also essential, including antimicrobial stewardship programmes, infection prevention and control strategies, and an enhanced monitoring of both AMR and antimicrobial usage, the authors said.

The Surveillance for Enteric Fever in India study (2017–2020) and Global Burden of Disease (GBD) study 2021 were among the data sources analysed.