What is typhoid fever?

Typhoid fever is a systemic infection caused by Salmonella enterica serovar Typhi — transmitted through contaminated water, food or close contact with an infected person via the faecal-oral route. It begins with a sustained, gradually rising fever, headache, malaise and abdominal discomfort. Without treatment, it can progress to intestinal perforation, haemorrhage and death. It is estimated to infect 9-11 million people per year and kill approximately 110,000.

How is typhoid different from Salmonella food poisoning?

Non-typhoidal Salmonella (NTS) causes the common food poisoning with acute diarrhoea, vomiting and cramps, usually self-limiting in healthy adults. Typhoid (Salmonella Typhi) causes a systemic febrile illness — not primarily gastrointestinal — that requires antibiotic treatment and can be fatal without it. Both spread faecal-orally through contaminated food and water, but typhoid is strictly human-adapted and requires a larger infecting dose.

Extensively drug-resistant (XDR) typhoid — first identified in Pakistan in 2016 — is resistant to all first-, second- and third-line oral antibiotics: ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, fluoroquinolones and third-generation cephalosporins (like ceftriaxone). This leaves only azithromycin (with emerging resistance) for oral treatment, and IV carbapenems for severe cases. XDR typhoid has spread to over 20 countries through international travel. TCV vaccination is the most effective counter-strategy.

What is the typhoid conjugate vaccine (TCV)?

TCV (Typbar-TCV and Typhi-VACC) conjugates the Vi polysaccharide antigen to a carrier protein — generating T-cell dependent immunity that is stronger, longer-lasting and effective from 6 months of age. This improves on older Vi polysaccharide vaccines (effective only from age 2, shorter duration, no immunological memory). WHO's SAGE recommended TCV for routine immunisation in children from 6 months in typhoid-endemic settings in December 2017, and Gavi financing has enabled rollout in several high-burden countries.

How is typhoid diagnosed?

The gold standard is blood culture — detecting S. Typhi in blood, typically positive in the first 2 weeks of illness (sensitivity approximately 60-80%). Bone marrow culture is more sensitive but invasive. Urine and stool cultures are less sensitive. The Widal test (serological) is unreliable in endemic settings and should be abandoned. Rapid diagnostic tests (RDTs) detecting S. Typhi antigens or antibodies are increasingly used in endemic LMICs for faster results at point-of-care.

How is typhoid treated?

Uncomplicated typhoid in non-XDR cases: fluoroquinolones (ciprofloxacin) are first-line, though resistance is widespread in South Asia. Third-generation cephalosporins (ceftriaxone — IV) or azithromycin (oral) are alternatives. For XDR typhoid: azithromycin (oral, if sensitive) or IV carbapenems. Treatment typically lasts 7-14 days. Carriers — people who shed S. Typhi for over a year without symptoms (gallbladder colonisation) — are treated with prolonged fluoroquinolone courses or cholecystectomy.

Where is typhoid most prevalent?

South Asia carries the majority of the global typhoid burden — India, Pakistan, Bangladesh and Nepal together account for approximately 70% of cases. Sub-Saharan Africa, Southeast Asia and the Middle East are also affected. Pakistan has the dual burden of highest overall typhoid prevalence and the epicentre of XDR typhoid emergence. The disease closely tracks WASH deprivation — countries with universal safe water access have eliminated typhoid.

How does TCV vaccination prevent XDR typhoid spread?

Because XDR typhoid is spread the same way as drug-sensitive typhoid (faecal-oral through contaminated water and food), TCV vaccination prevents infection by XDR strains just as effectively as drug-sensitive strains. Pakistan's national TCV campaign — launched in 2019 after the XDR outbreak — demonstrates how rapid mass vaccination can contain XDR spread. TCV is the most impactful immediate response to XDR typhoid, while the long-term solution remains WASH improvement.

What are typhoid carriers?

Chronic typhoid carriers continue to shed S. Typhi in faeces (or occasionally urine) for over a year after acute infection, often without symptoms. The gallbladder serves as the reservoir — S. Typhi persists in gallstones. Carriers are a major source of ongoing transmission in endemic communities. Treatment with prolonged high-dose fluoroquinolones achieves clearance in approximately 80% of cases; cholecystectomy is more definitive but rarely necessary.

How can typhoid be prevented without a vaccine?

The primary prevention of typhoid is improving access to safe drinking water and adequate sanitation — since contaminated water is the main transmission route. Boiling water; treating water with chlorine; using safe food handling practices; washing hands after defecation and before eating; and avoiding raw vegetables washed with potentially contaminated water are individual protective measures. At a population level, only universal WASH access eliminates typhoid sustainably.

What is the Gavi TCV programme?

Gavi (the Vaccine Alliance) approved TCV for funding in 2018 — enabling introduction in Gavi-eligible high-burden countries at deeply subsidised prices. Programmes have launched in Zimbabwe, Pakistan, Nepal, Liberia and others. Zimbabwe's 2019 typhoid outbreak — the worst in decades — prompted an emergency TCV campaign; Pakistan's XDR outbreak prompted a national preventive campaign. Gavi's TCV support has dramatically accelerated introduction in countries that previously lacked any typhoid vaccination programme.

How does GMJ News cover typhoid?

GMJ News tracks WHO typhoid data, XDR typhoid spread, TCV rollout through Gavi and WASH-typhoid links. Typhoid is relevant to Georgian travellers and healthcare workers managing imported cases. The principles of drug-resistant enteric fever, diagnostic stewardship and WASH investment are directly relevant to PHIG's public health work.

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Typhoid Fever

GMJ News knowledge hub · last reviewed September 2026 · Georgian Medical Journal

Summary Statistics Glossary GMJ news FAQ Documents Organizations Research

Typhoid fever — caused by Salmonella enterica serovar Typhi — infects an estimated 9-11 million people per year and kills approximately 110,000, predominantly in South and Southeast Asia and sub-Saharan Africa where access to safe water and sanitation is inadequate (WHO). The emergence of extensively drug-resistant (XDR) typhoid in Pakistan — resistant to all oral antibiotics — has created a near-untreatable public health emergency. The WHO-recommended typhoid conjugate vaccine (TCV) provides stronger and more durable protection than older vaccines and is now recommended for routine immunisation in endemic countries.

Key messages

9-11 million cases per year

Typhoid fever infects an estimated 9-11 million people per year and kills approximately 110,000 — predominantly in South and Southeast Asia and Sub-Saharan Africa where access to safe water and sanitation is inadequate (WHO).

XDR typhoid — an urgent crisis

Extensively drug-resistant (XDR) typhoid — resistant to all first-, second- and third-line oral antibiotics — emerged in Pakistan in 2016 and has spread to over 20 countries. It is treatable only with azithromycin (with emerging resistance) or IV carbapenems.

TCV vaccine — a breakthrough

The typhoid conjugate vaccine (TCV) — Typbar-TCV and Typhi-VACC — provides stronger, more durable protection than older Vi polysaccharide vaccines and is suitable for children from 6 months. WHO recommended TCV for routine use in high-burden settings in 2018.

WASH is the permanent solution

Typhoid is entirely prevented by access to safe drinking water and adequate sanitation. TCV vaccination is a bridge intervention — the durable solution is universal WASH coverage in endemic settings.

Gavi financing

Gavi has funded TCV rollout in endemic LMICs since 2018 — with programmes in Zimbabwe, Pakistan, Nepal, Ghana and others. Mass vaccination campaigns in typhoid hotspots reduce burden rapidly.

Paratyphoid

Paratyphoid fever — caused by Salmonella Paratyphi A, B and C — is clinically similar to typhoid, less common, and not prevented by typhoid vaccines. Rapid diagnostic tests distinguishing typhoid from paratyphoid are important for treatment.

Key statistics

9-11M

typhoid cases/year

WHO

110K

typhoid deaths/year

WHO

20+

countries with XDR typhoid

WHO/GTFCC

2016

year XDR typhoid first identified (Pakistan)

WHO

2018

WHO recommended TCV for routine use

WHO/SAGE 2018

6mths

minimum age for TCV (vs 2yr for older vaccine)

WHO

Estimated typhoid fever cases by region per 100,000 population — WHO/GBD

Source: Global Burden of Disease / WHO. South Asia carries the majority of global typhoid burden.

Glossary of key terms

Salmonella Typhi
WHOThe bacterial pathogen causing typhoid fever — a Gram-negative rod transmitted through contaminated water and food via the faecal-oral route. Infects the gastrointestinal tract and can cause bacteraemia, hepatosplenomegaly, rose spots and intestinal perforation.

XDR typhoid
WHO/GTFCCExtensively drug-resistant typhoid — resistant to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole (all first-line); fluoroquinolones (second-line); and third-generation cephalosporins (third-line). Oral treatment options are limited to azithromycin (with emerging resistance) and IV carbapenems.

Typhoid conjugate vaccine (TCV)
WHO/SAGEA Vi polysaccharide vaccine conjugated to a carrier protein (tetanus toxoid) — providing T-cell dependent immunity, suitable from 6 months of age, and offering stronger and more durable protection than older Vi polysaccharide vaccines. WHO recommended TCV for all children in endemic settings in 2018.

Rose spots
WHO/ClinicalA pathognomonic rash of typhoid fever — faint salmon-coloured macules on the trunk, appearing in the first week of illness in approximately 20% of patients with light skin. Rarely seen in dark-skinned patients.

Widal test
WHOA historical serological test for typhoid fever — detecting agglutinating antibodies against S. Typhi O and H antigens. Now considered unreliable due to poor specificity and poor sensitivity in endemic areas. Replaced by blood culture (gold standard) and rapid diagnostic tests.

Enteric fever
WHOThe collective term for typhoid and paratyphoid fever — systemic infections caused by S. Typhi, S. Paratyphi A, B or C, presenting as undifferentiated febrile illness in the first week with gradual onset of sustained fever, headache, malaise and often gastrointestinal symptoms.

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