The global burden of typhoid and paratyphoid fever from 1990 to 2021 and the impact on prevention and control.

Background: Typhoid and paratyphoid fever are common infectious diseases and remain a heavy burden, especially in some low-income countries. Although the global burden has decreased over the past three decades, an analysis of the burden of typhoid and paratyphoid fever will help inform public health strategies.

Methods: This study is aimed to comprehensively evaluate the global, regional, and national burden of typhoid and paratyphoid, and the temporal trends while exploring potential associations with socio-demographic development over three decades (1990-2021). Data on typhoid and paratyphoid fever were analyzed using the Global Burden of Disease (GBD) study in 2021. For this analysis, we calculated to demonstrate temporal trends in the incidence, mortality, and disability adjusted life years (DALYs) of typhoid and paratyphoid fever from 1990 to 2021.

Results: From 1990 to 2021, both typhoid and paratyphoid fever showed declining trends globally and in different socio-demographic index (SDI) regions, including incidence, mortality, and DALYs. For typhoid fever worldwide, new cases decreased by 62.12%, with an EAPC of -3.92 (-4.14, -3.71); deaths decreased by 50.65%, EAPC - 2.83 (-2.99, -2.66), and DALYs decreased by 52.30%, EAPC - 2.82 (-3.00, -2.64). For paratyphoid fever, new cases decreased by 73.15%, with an EAPC of -4.77 (-5.29, -4.26); deaths decreased by 65.44%, EAPC - 3.74 (-4.24, -3.24), and DALYs decreased by 68.42%, EAPC - 3.87 (-4.42, -3.31). For both typhoid and paratyphoid fever, children had the highest morbidity and mortality rates; males had higher rates of incidence, mortality, and DALYs than females. However, among older patients, the absolute number of new cases and DALYs was higher in women. The burden is concentrated in South Asia, Southeast Asia, and Oceania, with only South Asia suffering severely from paratyphoid fever. Regarding typhoid fever, the top three countries with the highest ASRs of incidence are Burkina Faso (328.48) (SDI: 0.285), Bangladesh (303.14) (SDI: 0.492), and Papua New Guinea (299.45) (SDI: 418) which are in Western Sub-Saharan, South Asia, and Oceania. The top three countries in terms of mortality and DALYs are Bhutan (5.61; 434.23) (SDI: 0.473), Bangladesh (5.06; 382.38), and Burkina Faso (4.64; 352.57). Regarding paratyphoid fever, the top three countries with the highest ASRs of mortality and DALYs are the same, including Pakistan (1.05; 72.66), India (0.75; 53.42), and Nepal (0.72; 50.65) (SDI: 0.433), all of which are located in South Asia.