International travel and the risk of extensively drug-resistant (XDR) typhoid: issues and potential solutions


Zulfiqar A Bhutta, FRS


Despite significant progress in our understanding of the disease, its pathogenesis and risk factors, typhoid fever is still responsible for a significant global burden of disease. Globally, 14·3 million (95% uncertainty interval [UI] 12·5-16·3) cases of typhoid and paratyphoid fevers occurred in 2017 (1) with an estimated 135·9 thousand (76·9-218·9) deaths. Marchello et al (2) undertook a systematic review of studies providing incident data and estimated a pooled incidence of 267.6 (95% CI, 182.8–368.2) typhoid cases per 100 000 per year in Asia with rates from the six sites in India of 497.2 (95% CI, 291.9–754.8) cases per 100,000 population. Their review found no incident data from the United States (USA) as much of the disease in North America is imported.

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