Authors
Laura Hobbs, Katherine Shafer, Leah Sukri, Yakoubou Sanoussi, Saqib Qazi, Kathleen Neuzil, Matthew B. Laurens
Abstract
Typhoid fever remains a major public health problem in low- and middle-income countries, where access to clean water, reliable diagnostics, and effective antimicrobial therapy is limited. One of its most severe complications is typhoid intestinal perforation (TIP), a life-threatening condition that requires urgent surgical intervention and disproportionately affects children and adolescents. Despite advances in surgical management, TIP is associated with high morbidity, mortality, and catastrophic financial consequences for families. Increasing antimicrobial resistance, including the emergence of extensively drug-resistant Salmonella Typhi, further complicates disease management and contributes to delayed effective therapy. This review synthesizes current evidence on TIP in children and highlights preventive strategies, including typhoid conjugate vaccines and improved water and sanitation. We propose that systematic surgical surveillance of TIP represents a pragmatic and underutilized proxy for typhoid burden, with direct implications for vaccine policy and public health prioritization.
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