TCV vaccines | NITAG RESOURCE CENTER

Burden & epidemiology

Number of new cases per year (last 3-5 years)

Global modelled estimates indicate approximately 6.2 million typhoid illnesses in 2023,^{Go to footnote 11} compared with 7.2 million illnesses in 2021.^{Go to footnote 22} A systematic review of blood culture–confirmed incidence (studies 1954–2023) found pooled incidence of 119 per 100,000 person-years (95% CI: 81.9–174.4) in population-based studies and 123 per 100 000 (95% CI: 77.2–196.2) in hybrid-surveillance studies overall, highest in Asia (206.8 and 259.1 per 100 000 respectively) and lower in Africa (68.9 and 72.5 per 100 000) and Europe (55.6 per 100 000, population-based only).^{Go to footnote 33} Data were insufficient to generate incidence estimates for the Americas; no Oceania estimates were identified.

Proportion of the population affected by the disease or infected with the antigen

Global pooled age-occurrence estimates indicate that 1.3% of illnesses occur before six months of age, 3.6% before 15 months, 18.7% before five years and 55.5% before 15 years; approximately 36.8% occur between five and 15 years of age.^{Go to footnote 44} The age distribution varies geographically and between surveillance sites, and population-based estimates remain limited in many endemic countries.^{Go to footnote 55, Go to footnote 66}

Serogroup or serotype distribution (for serogroup- or serotype-specific vaccines)

Typhoid fever is caused by Salmonella enterica serovar Typhi, which expresses somatic O, flagellar H and capsular Vi antigens.^{Go to footnote 55} The Vi polysaccharide is the antigen used in all currently available typhoid conjugate vaccines (TCVs). Vi is also expressed by Salmonella Paratyphi C and, rarely, by other organisms, but is absent from Salmonella Paratyphi A and B. TCVs are directed against Vi-expressing S. Typhi and are not expected to protect against S. Paratyphi A or B infections. A whole-genome-sequencing-based SNP genotyping framework for S. Typhi (GenoTyphi) provides a phylogenetically informative nomenclature for circulating lineages and their antimicrobial resistance (AMR) determinants.^{Go to footnote 77, Go to footnote 88}

Number of deaths from the disease per year

The Global Burden of Disease Study estimated approximately 72 000 typhoid deaths globally in 2023 (95% UI: 38 000–120 000).^{Go to footnote 99} The WHO Foodborne Disease Epidemiology Reference Group estimated 94 700 deaths in 2021 (95% UI: 46 900–161 000).^{Go to footnote 22} Mortality burden is concentrated in South Asia and sub-Saharan Africa, with substantial variation in the countries within these regions. These are modelled estimates rather than vital-registration counts, reflecting incomplete diagnosis, limited blood-culture access and under-ascertainment in many endemic settings.

Case Fatality ratio (number of deaths / number of new cases, in %)

A global systematic review and meta-analysis (reports 1980–2025) estimated an overall pooled case fatality ratio (CFR) of 2.1% (95% CI: 1.7–2.7) among non-surgical typhoid reports; 2.7% (95% CI: 1.8–4.0) among children aged ≤15 years and 1.8% (95% CI: 1.3–2.4) in mixed-age populations.^{Go to footnote 1010}

CFR was higher in facility-based than community-based studies and higher in sub-Saharan Africa than in Asia. Typhoid intestinal perforation occurs in approximately 1–2% of illnesses and carries substantially higher mortality risk than uncomplicated typhoid fever.^{Go to footnote 1111} Case fatality is strongly influenced by timely diagnosis and access to effective antimicrobial and surgical care.

Outbreak, epidemic or pandemic risk

Salmonella Typhi is transmitted through food or water contaminated with faeces from infected people, and outbreaks are facilitated by inadequate water, sanitation, hygiene and food-safety systems.^{Go to footnote 1212} Large and prolonged outbreaks have occurred in endemic settings, including outbreaks involving multidrug-resistant and extensively drug-resistant organisms, notably in Pakistan.^{Go to footnote 1313} TCV has been used in outbreak-response campaigns in Pakistan and Zimbabwe alongside case management and water, sanitation and hygiene interventions.^{Go to footnote 1414, Go to footnote 1515, Go to footnote 1616} The emergence of resistance to the major antimicrobial classes used to treat typhoid increases the clinical and public-health consequences of outbreaks and may limit treatment options.^{Go to footnote 1717, Go to footnote 1818, Go to footnote 1919}

Contribution of the vaccine to achievement of the national, regional or global disease goals

There is currently no regional or global disease control or elimination goal for typhoid fever.

Sources

Go back to footnote reference 1
GBD 2023 Causes of Death Collaborators (2025). Global burden of 292 causes of death in 204 countries and territories and 660 subnational locations, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet. 406:1811–72. doi:/10.1016/S0140-6736(25)01917-8.
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Majowicz SE, Scallan WE, Pires SM, Minato Y, Founou L et al. (2026). WHO estimates of the global, regional, and national burden of eight foodborne non-diarrhoeal enteric disease hazards, 2000–21: an updated data synthesis. Lancet Glob Health. Published online 16 June 2026. doi:/10.1016/j.langlo.2026.103981.
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Murthy S, Hagedoorn NN, Faigan S, Rathan MD, Sharples KJ et al (2025). Global typhoid fever incidence: an updated systematic review with meta-analysis. Lancet Infect Dis. 25(12):1347–62. doi:/10.1016/S1473-3099(25)00359-7.
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Batool R, Gamble C, Murthy S, Aung T, Akinlabi OS et al. (2026). Age distribution of typhoid fever, paratyphoid fever, and non-typhoidal Salmonella invasive disease: a secondary analysis of global epidemiologic data [version 1]. VeriXiv.3:213. doi:/10.12688/verixiv.3426.1.
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World Health Organization. WHO position paper on typhoid vaccines, August 2026. Wkly Epidemiol Rec. 2026;101:166–180 (https://www.who.int/publications/i/item/who-wer10132-166-180, accessed 22 September 2026).
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World Health Organization (2026). SAGE Background Document – Typhoid vaccines. SAGE meeting, 9–11 March 2026. (https://terrance.who.int/mediacentre/data/sage/SAGE_eYB_March26.pdf, accessed 22 July 2026).
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Wong VK, Baker S, Pickard DJ, Parkhill J, Farrar JJ et al. (2016). An extended genotyping framework for Salmonella enterica serovar Typhi, the cause of human typhoid. Nat Commun. 7:12827.
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Dyson ZA, Holt KE (2021). Five years of GenoTyphi: updates to the global Salmonella Typhi genotyping framework. J Infect Dis. 224(Suppl 7):S775–S780.
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GBD 2023 Causes of Death Collaborators (2025). Global burden of 292 causes of death in 204 countries and territories and 660 subnational locations, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet. 406:1811–72. doi:/10.1016/S0140-6736(25)01917-8.
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Murthy S, Hagedoorn NN, Faigan S, Rathan MD, Marchello CS et al (2026). Complications and mortality of typhoid fever: an updated global systematic review and meta-analysis. Lancet Infect Dis. 26:270–83. doi:/10.1016/S1473-3099(25)00551-1.
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Hagedoorn NN, Birkhold M, Murthy S, Rathan MD, Faigan S et al. (2024). Mortality, morbidity, and post-operative complications of typhoid intestinal perforations: global systematic review and meta-analysis. medRxiv [preprint]. 2024.06.28.24309663. doi:/10.1101/2024.06.28.24309663.
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Crump JA, Sjolund-Karlsson M, Gordon MA, Parry CM (2015). Epidemiology, Clinical Presentation, Laboratory Diagnosis, Antimicrobial Resistance, and Antimicrobial Management of Invasive Salmonella Infections. Clin Microbiol Rev. 28(4):901–937.
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Andrews JR, Qamar FN, Charles RC, Ryan ET (2018). Extensively Drug-Resistant Typhoid - Are Conjugate Vaccines Arriving Just in Time? N Engl J Med. 379(16):1493–1495.
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Batool R, Yousafzai MT, Qureshi S, Ali M, Sadaf T et al. (2021). Effectiveness of typhoid conjugate vaccine against culture-confirmed typhoid in a peri-urban setting in Karachi: a case-control study. Vaccine. 39(40):5858–5865.
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Yousafzai MT, Karim S, Qureshi S, Kazi M, Memon H et al. (2021). Effectiveness of typhoid conjugate vaccine against culture-confirmed Salmonella enterica serotype Typhi in an extensively drug-resistant outbreak setting of Hyderabad, Pakistan: a cohort study. Lancet Glob Health. 9(8):e1154–e1162.
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Lightowler MS, Manangazira P, Nackers F, Van Herp M, Phiri I et al. (2022). Effectiveness of typhoid conjugate vaccine in Zimbabwe used in response to an outbreak among children and young adults: a matched case control study. Vaccine. 40:4199–4210.
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Hooda Y, Tanmoy AM, Nath SD, Jul AB, Amin A et al. (2025). Outbreak of Ceftriaxone-resistant Salmonella enterica serovar Typhi, Bangladesh, 2024. Emerg Infect Dis. 31(7):1460–1465.
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Nizamuddin S, Khan EA, Chattaway MA, Godbole G (2023). Case of Carbapenem-resistant Salmonella Typhi Infection, Pakistan, 2022. Emerg Infect Dis. 29(11).
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Carey ME, Dyson ZA, Ingle DJ, Amir A, Aworh MK et al. (2023). Global diversity and antimicrobial resistance of typhoid fever pathogens: insights from a meta-analysis of 13 000 Salmonella Typhi genomes. eLife. 12:e85867. doi:/10.7554/eLife.85867.