Health and Me

Rachel V Thomas

Drug Resistance Driving Severe Typhoid Disease, Death Among Children Under-5s in India: Lancet Study

Children under 5 in India remain at high risk of <a href="https://www.healthandme.com/health/typhoid">typhoid</a> infections, hospitalization, and death due to growing antimicrobial resistance (AMR), according to an alarming study, which highlighted the urgent need to control drug resistance in the country.

<a href="https://www.healthandme.com/health/typhoid">Typhoid</a> fever is a systemic illness caused by Salmonella enterica serovar Typhi (S. Typhi), and presents a significant health challenge in India.

The modelling study, published in The Lancet Regional Health – Southeast Asia, showed that typhoid fever caused an estimated 4.9 million cases and nearly 8,000 deaths in India in 2023.

However, more concerning was that a large proportion of infections were found resistant to fluoroquinolones — one of the main classes of antibiotics used to treat typhoid. They found that:

<ul><li>Children aged 5–9 years had the highest number of typhoid fever cases and AMR cases</li><li>Children aged 6 months to 4 years experienced the highest number of hospitalizations and deaths. </li></ul>

"Drug-resistant typhoid fever remains a serious public-health threat in India, with implications beyond national borders," said Dr Vijayalaxmi Mogasale, Joint PhD Candidate at the London School of Hygiene &amp; Tropical Medicine and Nagasaki University. 

"Tackling this problem does not lie solely in moving to newer antibiotics, but calls for timely preventive action, including responsible antibiotic use and the introduction of the typhoid vaccine into the national immunization program, prioritizing high-burden age groups and regions," she added.

Also read: <a href="https://www.healthandme.com/health-news/study-links-widespread-use-of-antibiotics-during-covid-to-surge-in-amr-cases-article-153872161" data-type="tilCustomLink">Study Links Widespread Use of Antibiotics During COVID To Surge In AMR Cases</a>

<h2>Typhoid: AMR A Major Concern In India </h2>

In Global Burden of Diseases (GBD) 2021, India contributed to 58 percent of global typhoid fever cases and 48 percent of global deaths.

The new study, including researchers from Christian Medical College in Vellore, estimated that more than two-thirds of typhoid cases in India are resistant to fluoroquinolones. This not only limits treatment options but also increases the risk of complications. 

The major drivers of typhoid fever deaths were identified among those with no treatment and hospitalized cases with AMR-related complications. The highest burden of typhoid cases were reported from Delhi, Maharashtra, and Karnataka.

Further, the study found that drug-resistant typhoid infections accounted for at least 87 per cent of India's disease-related economic burden in 2023, the PTI reported.

The total economic burden due to typhoid fever was estimated at Rs 123 billion.

Children under the age of 10 incurred the highest economic burden, contributing to over half of the costs, researchers found. 

In addition, they estimated that households bore 91 per cent of expenses, and 70,000 families faced "catastrophic" health expenditure.

A <a href="https://www.healthandme.com/health-news/indians-are-developing-antibiotic-resistance-against-typhoid-pneumonia-and-urinary-infections-article-151041008" data-type="tilCustomLink">2024 ICMR report</a> also flagged that more Indians are developing antibiotic resistance against typhoid, pneumonia, and urinary infections. Over 95 percent of Salmonella typhi strains are now resistant to fluoroquinolones, making it difficult to treat infections caused by this bacterium.

Also read:<a href="https://www.healthandme.com/health-news/antimicrobial-resistance-explained-why-is-who-calling-it-a-serious-health-threat-article-151040547" data-type="tilCustomLink"> Antimicrobial Resistance Explained: Why Is WHO Calling It A Serious Health Threat?</a>

 Typhoid fever is a water- and food-borne infectious disease. Major symptoms include 

<ul><li>high fever, </li><li>fatigue, </li><li>headache, </li><li>abdominal pain.</li></ul>The effective typhoid conjugate vaccine (TCV) is available in India through private healthcare. In 2022, it was recommended to be added into the Universal Immunization Program.

The World Health Organization (WHO) recommends TCV for children from six months of age and for adults up to 45–65 years, depending on the vaccine.

To achieve greater impact, the Lancet researchers suggested implementing:<ul><li>A broader catch-up or school-based vaccination campaigns </li><li>controlling the broader strategy of antimicrobial stewardship </li><li>Making improvements in water, sanitation, and hygiene.</li></ul>

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Global Burden of Diseases

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Children under 5 in India remain at high risk of typhoid infections, hospitalization, and death due to growing antimicrobial resistance (AMR), according to an alarming study, which highlighted the urgent need to control drug resistance in the country.  Typhoid fever is a systemic illness caused by Salmonella enterica serovar Typhi (S. Typhi), and presents a significant health challenge in India.  The modelling study, published in The Lancet Regional Health – Southeast Asia, showed that typhoid fever caused an estimated 4.9 million cases and nearly 8,000 deaths in India in 2023.However, more concerning was that a large proportion of infections were found resistant to fluoroquinolones — one of the main classes of antibiotics used to treat typhoid. They found that: Children aged 5–9 years had the highest number of typhoid fever cases and AMR casesChildren aged 6 months to 4 years experienced the highest number of hospitalizations and deaths.  "Drug-resistant typhoid fever remains a serious public-health threat in India, with implications beyond national borders," said Dr Vijayalaxmi Mogasale, Joint PhD Candidate at the London School of Hygiene & Tropical Medicine and Nagasaki University.  "Tackling this problem does not lie solely in moving to newer antibiotics, but calls for timely preventive action, including responsible antibiotic use and the introduction of the typhoid vaccine into the national immunization program, prioritizing high-burden age groups and regions," she added.Also read: Study Links Widespread Use of Antibiotics During COVID To Surge In AMR Cases  Typhoid: AMR A Major Concern In India  In Global Burden of Diseases (GBD) 2021, India contributed to 58 percent of global typhoid fever cases and 48 percent of global deaths.The new study, including researchers from Christian Medical College in Vellore, estimated that more than two-thirds of typhoid cases in India are resistant to fluoroquinolones. This not only limits treatment options but also increases the risk of complications.  The major drivers of typhoid fever deaths were identified among those with no treatment and hospitalized cases with AMR-related complications. The highest burden of typhoid cases were reported from Delhi, Maharashtra, and Karnataka.Further, the study found that drug-resistant typhoid infections accounted for at least 87 per cent of India's disease-related economic burden in 2023, the PTI reported.The total economic burden due to typhoid fever was estimated at Rs 123 billion.Children under the age of 10 incurred the highest economic burden, contributing to over half of the costs, researchers found. In addition, they estimated that households bore 91 per cent of expenses, and 70,000 families faced "catastrophic" health expenditure.A 2024 ICMR report also flagged that more Indians are developing antibiotic resistance against typhoid, pneumonia, and urinary infections. Over 95 percent of Salmonella typhi strains are now resistant to fluoroquinolones, making it difficult to treat infections caused by this bacterium.Also read: Antimicrobial Resistance Explained: Why Is WHO Calling It A Serious Health Threat?Typhoid: How Vaccines Can Help  Typhoid fever is a water- and food-borne infectious disease. Major symptoms include high fever, fatigue, headache, abdominal pain.The effective typhoid conjugate vaccine (TCV) is available in India through private healthcare. In 2022, it was recommended to be added into the Universal Immunization Program. The World Health Organization (WHO) recommends TCV for children from six months of age and for adults up to 45–65 years, depending on the vaccine. To achieve greater impact, the Lancet researchers suggested implementing:A broader catch-up or school-based vaccination campaigns controlling the broader strategy of antimicrobial stewardship Making improvements in water, sanitation, and hygiene.