Study Estimates 49 Lakh Cases of Typhoid Fever in India in 2023
New Delhi: A study estimates 49 lakh typhoid cases and 7,850 deaths in India in 2023; Delhi, Maharashtra and Karnataka together account for nearly 30 per cent of the national burden.
The findings, published in Lancet Regional Health Southeast Asia, show that six lakh out of 7.3 lakh hospitalizations across the country can be attributed to fluoroquinolone resistance, a type of antibiotic or antimicrobial resistance.
Typhoid fever is a bacterial infection spread through contaminated food and water. Symptoms may begin one to three weeks after exposure and may include high fever, headache, abdominal pain, and fatigue. Treatment includes antibiotics and supportive care.
Researchers, including those from the London School of Hygiene and Tropical Medicine and the Christian Medical College in Vellore, India, found that the states of Delhi, Maharashtra and Karnataka also had the highest rates of fluoroquinolone-resistant cases and deaths among the ten highest-burden states.
The authors “estimate 4.9 million typhoid cases and 7,850 deaths in India in 2023”. “Delhi, Maharashtra and Karnataka together accounted for 29 per cent of the national burden and had the highest rates of fluoroquinolone-resistant cases and deaths among the ten highest burden states,” they said.
“Fluoroquinolone resistance drives a large proportion of typhoid-related hospitalizations and deaths, especially in children under five and in high-burden states in India,” the team said.
Researchers examined studies published through July 2025 that carried data on typhoid incidence, mortality and antibiotic resistance. A consistently high level of fluoroquinolone resistance was found (more than 60 percent), increasing steadily from 1989 to 2024 and reaching 94 percent in 2017.
Resistance to third-generation cephalosporins and azithromycin, common and effective first-line antibiotics used to treat typhoid, has remained consistently low, and multidrug resistance has declined steadily over the past three decades, the team said.
The authors also found that children ages 5 to 9 had the highest number of cases of typhoid and antibiotic resistance, while the highest number of hospitalizations and deaths occurred in children ages 6 months to 4 years.
Delhi, Maharashtra and Karnataka have been identified as priority states for the administration of the single-dose typhoid conjugate vaccine, which provides long-term protection.
The team added that relying solely on routine vaccination program targeting typhoid conjugate vaccine at around nine months would be insufficient for immediate control of typhoid fever in India as it could take decades to reach elderly people, who also carry a significant disease burden.
Measures to control antimicrobial resistance (AMR), including antimicrobial stewardship programs, infection prevention and control strategies, and enhanced monitoring of both AMR and antimicrobial use, are also important, the authors noted.
Enteric Fever Surveillance study in India (2017-2020) and Global Burden of Disease (GBD) study 2021 were among the analyzed data sources.
