SAGE meeting of October 2017 on Typhoid Vaccine Policy Recommendations

Typhoid fever remains an important cause of enteric disease in children in low and middle income countries with global estimates of disease burden ranging between 11 and 21 million typhoid fever cases and approximately 145 000 to 161 000 deaths annually.

Transmission of Salmonella Typhi is by the feco-oral route through a short-cycle (contamination of food and water in the immediate environment through inadequate hygiene and sanitation measures, either by shedding from temporary or chronic carriers) or long-cycle transmission (defined as contamination of the
broader environment, such as pollution of water supplies by sewage, inadequate treatment of piped water or use of raw human feces as a crop fertiliser).

The often non-specific symptoms of typhoid fever makes clinical diagnosis difficult as it may be confused with a wide range of other febrile illnesses common in typhoid fever endemic regions. Laboratory confirmation of cases by blood culture (the most commonly used diagnostic test) has a limited sensitivity of approximately 50% and is further complicated by the common practice of pre-treatment with antibiotics or is often not performed for the majority of cases in LMICs.