The global burden of typhoid and paratyphoid fevers: a systematic analysis for the Global Burden of Disease Study 2017

Jeffrey D Stanaway(University of Washington), Robert C. Reiner(University of Washington), Brigette F. Blacker(University of Washington), Ellen M Goldberg(University of Washington), Ibrahim A. Khalil(University of Washington), Christopher Troeger(University of Washington), Jason R. Andrews(University of Washington), Zulfiqar A Bhutta(University of Washington), John A. Crump(University of Washington), Justin Im(University of Washington), Florian Marks(University of Washington), Eric Mintz(University of Washington), Se Eun Park(University of Washington), Anita K. M. Zaidi(University of Washington), Abebe Zegeye(University of Washington), Ayenew Negesse Abejie(University of Washington), Isaac Akinkunmi Adedeji(University of Washington), Beriwan Abdulqadir Ali(University of Washington), Azmeraw T. Amare(University of Washington), Hagos Tasew Atalay(University of Washington), Euripide Avokpaho(University of Washington), Umar Bacha(University of Washington), Aleksandra Barać(University of Washington), Neeraj Bedi(University of Washington), Adugnaw Berhane(University of Washington), Annie J. Browne(University of Washington), Jesús L. Chirinos(University of Washington), Abdulaal Chitheer(University of Washington), Christiane Dolecek(University of Washington), Maysaa El Sayed Zaki(University of Washington), Babak Eshrati(University of Washington), Kyle J Foreman(University of Washington), Abdella Gemechu(University of Washington), Rahul Gupta(University of Washington), Gessessew Bugssa Hailu(University of Washington), Andualem Henok(University of Washington), Desalegn Tsegaw Hibstu(University of Washington), Chi Linh Hoang(University of Washington), Olayinka Stephen Ilesanmi(University of Washington), Veena Iyer(University of Washington), Amaha Kahsay(University of Washington), Amir Kasaeian(University of Washington), Tesfaye Kassa(University of Washington), Ejaz Ahmad Khan(University of Washington), Young‐Ho Khang(University of Washington), Hassan Magdy Abd El Razek(University of Washington), Mulugeta Melku(University of Washington), Desalegn Tadese Mengistu, Karzan Abdulmuhsin Mohammad(University of Washington), Shafiu Mohammed(University of Washington), Ali H. Mokdad(University of Washington), Jean B. Nachega(University of Washington), Aliya Naheed(University of Washington), Cuong Tat Nguyen(University of Washington), Huong Lan Thi Nguyen(University of Washington), Long Hoang Nguyen(University of Washington), Nam Ba Nguyen(University of Washington), Trang Huyen Nguyen(University of Washington), Yirga Legesse Nirayo(University of Washington), Tikki Pangestu(University of Washington), George Patton(University of Washington), Mostafa Qorbani(University of Washington), Rajesh Kumar(University of Washington), Saleem M Rana, Chhabi Lal Ranabhat, Kedir Teji Roba(University of Washington), Nicholas L S Roberts(University of Washington), Salvatore Rubino(University of Washington), Saeid Safiri(University of Washington), Benn Sartorius(University of Washington), Monika Sawhney(University of Washington), Mekonnen Sisay Shiferaw(University of Washington), David L. Smith(University of Washington), Bryan L. Sykes(University of Washington), Bach Xuan Tran(University of Washington), Tung Thanh Tran(University of Washington), Kingsley Nnanna Ukwaja, Giang Thu Vu(University of Washington), Linh Gia Vu(University of Washington), Fitsum Weldegebreal(University of Washington), Melaku Kindie Yenit(University of Washington), Christopher J L Murray(University of Washington), Simon I Hay
The Lancet Infectious Diseases
February 18, 2019
10.1016/s1473-3099(18)30685-6
Cited by 848Open Access
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Abstract

BACKGROUND: Efforts to quantify the global burden of enteric fever are valuable for understanding the health lost and the large-scale spatial distribution of the disease. We present the estimates of typhoid and paratyphoid fever burden from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, and the approach taken to produce them. METHODS: For this systematic analysis we broke down the relative contributions of typhoid and paratyphoid fevers by country, year, and age, and analysed trends in incidence and mortality. We modelled the combined incidence of typhoid and paratyphoid fevers and split these total cases proportionally between typhoid and paratyphoid fevers using aetiological proportion models. We estimated deaths using vital registration data for countries with sufficiently high data completeness and using a natural history approach for other locations. We also estimated disability-adjusted life-years (DALYs) for typhoid and paratyphoid fevers. FINDINGS: Globally, 14·3 million (95% uncertainty interval [UI] 12·5-16·3) cases of typhoid and paratyphoid fevers occurred in 2017, a 44·6% (42·2-47·0) decline from 25·9 million (22·0-29·9) in 1990. Age-standardised incidence rates declined by 54·9% (53·4-56·5), from 439·2 (376·7-507·7) per 100 000 person-years in 1990, to 197·8 (172·0-226·2) per 100 000 person-years in 2017. In 2017, Salmonella enterica serotype Typhi caused 76·3% (71·8-80·5) of cases of enteric fever. We estimated a global case fatality of 0·95% (0·54-1·53) in 2017, with higher case fatality estimates among children and older adults, and among those living in lower-income countries. We therefore estimated 135·9 thousand (76·9-218·9) deaths from typhoid and paratyphoid fever globally in 2017, a 41·0% (33·6-48·3) decline from 230·5 thousand (131·2-372·6) in 1990. Overall, typhoid and paratyphoid fevers were responsible for 9·8 million (5·6-15·8) DALYs in 2017, down 43·0% (35·5-50·6) from 17·2 million (9·9-27·8) DALYs in 1990. INTERPRETATION: Despite notable progress, typhoid and paratyphoid fevers remain major causes of disability and death, with billions of people likely to be exposed to the pathogens. Although improvements in water and sanitation remain essential, increased vaccine use (including with typhoid conjugate vaccines that are effective in infants and young children and protective for longer periods) and improved data and surveillance to inform vaccine rollout are likely to drive the greatest improvements in the global burden of the disease. FUNDING: Bill & Melinda Gates Foundation.

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