Report on the Global Burden of Typhoid and Paratyphoid Fevers: An Analysis in the Context of Sustainable Development Goals

Introduction: Aligning Disease Control with Global Development

This report analyzes the global, regional, and national burden of typhoid and paratyphoid fevers, focusing on incidence, mortality, and Disability-Adjusted Life Years (DALYs) from 1990 to 2021. The findings are framed within the United Nations Sustainable Development Goals (SDGs), particularly highlighting the interconnectedness of disease control with SDG 3 (Good Health and Well-being), SDG 5 (Gender Equality), SDG 6 (Clean Water and Sanitation), and SDG 10 (Reduced Inequalities).

Global Burden and Progress Towards SDG 3 (Good Health and Well-being)

The overall decreasing trend in enteric fevers from 1990 to 2021 signifies positive global progress towards SDG Target 3.3, which aims to end the epidemics of communicable diseases. However, the substantial number of cases and deaths in 2021 underscores the persistent challenge.

Typhoid Fever: A Continuing Public Health Challenge

• 2021 Global Statistics:
  • New Cases: 7,154,555
  • Deaths: 93,333
  • DALYs: 7,087,733 years
• Trends (1990-2021):
  • Incidence Decrease: 62.12%
  • Mortality Decrease: 50.65%
  • DALYs Decrease: 52.30%

Paratyphoid Fever: A Lighter but Significant Burden

• 2021 Global Statistics:
  • New Cases: 2,166,063
  • Deaths: 14,127
  • DALYs: 1,011,842 years
• Trends (1990-2021):
  • Incidence Decrease: 73.15%
  • Mortality Decrease: 65.44%
  • DALYs Decrease: 68.42%

Demographic Vulnerabilities: Focusing on SDG 3, SDG 5, and SDG 10

Analysis of demographic data reveals specific vulnerabilities that require targeted interventions to ensure no one is left behind, a core principle of the SDGs.

Age-Related Disparities and SDG Target 3.2

The disproportionate impact on the youngest populations is a critical concern for achieving SDG Target 3.2 (end preventable deaths of newborns and children under 5).

• Infants ( This group experiences the highest Age-Standardized Rates (ASRs) for both incidence of typhoid fever and for deaths and DALYs from both typhoid and paratyphoid fevers.
• Young Children (2-4 years): This group shows the highest incidence of new cases for paratyphoid fever.

Gender-Based Differences and SDG 5

While males show higher overall numbers, specific age-related variations highlight the importance of a gender-sensitive approach to health, in line with SDG 5 (Gender Equality).

• Males generally had higher numbers for incidence, mortality, and DALYs for both diseases.
• Females over 80 years old had higher absolute numbers of new typhoid cases and DALYs.
• Females aged 10-14 had a larger number of deaths and DALYs from paratyphoid fever.

Socio-demographic and Regional Disparities: The Link to SDG 1, SDG 6, and SDG 10

The burden of enteric fevers is not evenly distributed, strongly correlating with socio-economic development and geography. This underscores that progress on health is intrinsically linked to broader development goals.

Correlation with Socio-demographic Index (SDI)

The data reveals a significant negative correlation between the Socio-demographic Index (SDI) and the burden of both fevers. This demonstrates that achieving SDG 1 (No Poverty) and SDG 10 (Reduced Inequalities) is fundamental to disease eradication. The prevalence of these diseases in lower SDI regions points to systemic issues, including inadequate infrastructure for SDG 6 (Clean Water and Sanitation), which is a primary transmission route for typhoid and paratyphoid.

• Regions with lower SDI values consistently show a higher disease burden.
• Interestingly, low-middle SDI regions (SDI values ~0.3-0.4) exhibited the peak burden, potentially due to a combination of high exposure and other competing health crises in the lowest SDI regions.

Regional and National Hotspots

Identifying specific high-burden areas is crucial for directing resources to meet SDG targets effectively.

1. High-Burden Regions:
   • Typhoid Fever: The burden is heavily concentrated in South Asia, Southeast Asia, and Oceania.
   • Paratyphoid Fever: The burden is severely concentrated in South Asia.
2. National Level Analysis (Top Countries by ASRs):
   • Typhoid Incidence: Burkina Faso, Bangladesh, Papua New Guinea.
   • Typhoid Mortality & DALYs: Bhutan, Bangladesh, Burkina Faso.
   • Paratyphoid Incidence, Mortality & DALYs: The highest burdens are consistently found in India, Pakistan, and Nepal.

While some high-income regions (Australasia, Western Europe) show increasing trends in ASRs, their absolute case numbers remain low. Conversely, regions like South Asia show significant decreasing trends but still maintain the highest disease burden globally, emphasizing the scale of the inequality and the long road ahead to achieve SDG 10.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being

  This is the most central SDG addressed in the article. The text is entirely focused on the “global burden of typhoid and paratyphoid fevers,” which are communicable diseases. It analyzes key health metrics such as incidence (new cases), mortality (deaths), and Disability-Adjusted Life Years (DALYs), directly aligning with the goal of ensuring healthy lives and promoting well-being for all at all ages.

• SDG 10: Reduced Inequalities

  The article strongly connects to SDG 10 by analyzing the disease burden through various lenses of inequality. It explicitly breaks down the data by:

  • Socio-economic status: The analysis by Socio-demographic Index (SDI) reveals that “more developed regions tend to have lighter burden” and that “low-middle SDI regions seem to have higher ASR values and heavier burden.”
  • Geographic location: The article highlights significant disparities between regions, noting that the “burden of typhoid fever concentrates on South Asia, Southeast Asia, and Oceania.”
  • Age: It points out that the youngest are most vulnerable, with “peaks for deaths and DALYs” for both diseases occurring in the “less-than-1-year age group.”
  • Sex: The analysis shows disparities between sexes, stating that “males had higher overall numbers of incidence, mortality, and DALYs compared to females” for typhoid fever.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. SDG 3: Good Health and Well-being

   • Target 3.2: By 2030, end preventable deaths of newborns and children under 5 years of age. The article directly addresses this target by highlighting the severe impact of typhoid and paratyphoid on the youngest populations. It states that for typhoid, the “highest incidence of new cases was in the less-than-1-year age group” and that the “peaks for deaths and DALYs were also in the less-than-1-year age group.” This demonstrates that these diseases are a significant contributor to child mortality and morbidity, which this target aims to eliminate.
   • Target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases. Typhoid and paratyphoid are communicable, often water-borne, diseases. The article’s entire purpose is to quantify the “global burden” of these diseases by tracking their incidence and mortality trends over time (1990-2021), which is essential for monitoring progress toward ending their epidemics.

2. SDG 10: Reduced Inequalities

   • Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status. While this target often refers to social and economic inclusion, health is a fundamental component of well-being and inclusion. The article’s detailed analysis of how the burden of typhoid and paratyphoid disproportionately affects certain groups—based on age (infants), sex (males overall), and economic status (low-middle SDI regions)—directly highlights the health inequalities that this target seeks to address.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article is rich with quantitative indicators used to measure the burden of disease, which directly serve as measures of progress for the identified SDG targets.

1. Indicators for SDG Target 3.2 (End child mortality)

   • Mortality Rate in Children Under 1: The article provides specific Age-Standardized Rate (ASR) values for deaths in the “less-than-1-year age group,” such as “6.11” for typhoid and “0.71” for paratyphoid. This is a direct indicator of the diseases’ contribution to infant mortality.
   • Incidence Rate in Children: The article specifies the ASR of incidence for the “less-than-1-year age group” (319.43 for typhoid) and notes the “most common age group for new cases of paratyphoid fever was 2–4 years.” These metrics track the risk of infection in early childhood.
   • Disability-Adjusted Life Years (DALYs) in Children: The article reports DALYs for the “less-than-1-year age group” (e.g., ASR of 549.55 for typhoid), measuring the total years of healthy life lost to disease and death in infants.

2. Indicators for SDG Target 3.3 (End epidemics of communicable diseases)

   • Incidence / New Cases: The article provides the total number of “new cases” for both diseases in 2021 (7,154,555 for typhoid) and tracks the trend since 1990.
   • Mortality / Deaths: It reports the total number of “deaths” (93,333 for typhoid in 2021) and the mortality trend.
   • Disability-Adjusted Life Years (DALYs): This composite measure of disease burden is used extensively throughout the article (e.g., “a total DALYs of 7,087,733 years” for typhoid).
   • Estimated Annual Percentage Change (EAPC): The article uses EAPC to measure progress over time, stating that for typhoid, “new cases decreased by 62.12%, with an EAPC of -3.92.” A negative EAPC indicates progress in combating the disease.

3. Indicators for SDG Target 10.2 (Reduce inequalities)

   The indicators are the health metrics mentioned above, but specifically disaggregated to show disparities between groups:

   • Incidence, Mortality, and DALYs by Sex: The article compares these metrics for males and females, noting that “males had higher overall numbers.”
   • Incidence, Mortality, and DALYs by Age Group: The data is broken down by age to show the vulnerability of different age groups, especially infants.
   • Incidence, Mortality, and DALYs by Socio-demographic Index (SDI): The analysis by SDI quintiles demonstrates the strong negative correlation between development and disease burden.
   • Incidence, Mortality, and DALYs by Country and Region: The article provides country-specific data (e.g., “The top three countries with the highest ASRs of incidence are Burkina Faso… Bangladesh… and Papua New Guinea”) to highlight geographic inequality.

4. Table of SDGs, Targets, and Indicators

Source: bmcinfectdis.biomedcentral.com