Global burden, trends and inequalities for typhoid and paratyphoid fever among children younger than 15 years over the past 30 years.

BACKGROUND

Typhoid and paratyphoid fever, collectively known as enteric fever, are systemic infections caused by Salmonella enterica and are highly prevalent in children. We aimed to describe the global burden, trends and inequalities of enteric fever among children under 15 years from 1990 to 2019 based on data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019).

METHODS

In this secondary analysis of GBD 2019, we extracted data for incident cases, deaths and disability-adjusted life-years (DALYs) as measures of enteric fever burden. We estimated the average annual percentage changes (AAPCs) in enteric fever incidence, mortality and DALYs rate to quantify trends over time. Cross-country inequalities in enteric fever incidence were measured using the slope index of inequality and concentration index.

RESULTS

In 2019, the global cases of typhoid and paratyphoid were 4 833 282 and 1 793 172, respectively, both lower than those in 1990. On secondary analysis, paratyphoid incidence decreased at a faster rate than typhoid from 1990 to 2009, whereas the incidence of paratyphoid (AAPC = -3.78, 95% CI: -4.07, -3.49) declined slower than that of typhoid (AAPC = -4.32, 95% CI: -4.50, -4.13) from 2010 to 2019 (P < 0.05) at the global level. The incidence burden of enteric fever increased in Australasia (AAPC = 1.28, 95% CI: 0.77, 1.78) and Western Europe (AAPC = 0.77, 95% CI: 0.44, 1.11). Death and DALYs burden in low socio-demographic index (SDI) region showed a stable trend. A significant reduction in SDI-related inequality occurred, with the concentration index falling from -0.31 in 1990 to -0.22 in 2019.

CONCLUSIONS

The global disease burden of enteric fever and the magnitude of inequalities across countries have declined since 1990, but low SDI countries remain a region of concern. Travellers from Oceania and Western Europe to endemic regions should be particularly aware of the risk of enteric fever.