India’s typhoid crisis: How drug resistance is driving costs higher

New Delhi: Antibiotic-resistant typhoid infections accounted for at least 87 per cent of India’s typhoid-related economic burden in 2023, according to a study published in The Lancet Regional Health – Southeast Asia.

The study estimated the total economic burden of typhoid fever in India at approximately ₹123 billion, highlighting the growing impact of antibiotic resistance in India on public health and household finances.

Researchers from institutions including the London School of Hygiene & Tropical Medicine and Christian Medical College found that children under the age of 10 bore the highest burden, contributing to more than 50 per cent of total costs.

Households bear the majority of typhoid costs in India

The analysis revealed that households accounted for 91 per cent of typhoid-related expenses, with nearly 70,000 families experiencing catastrophic health expenditure due to the disease.

States including Maharashtra, Uttar Pradesh, Andhra Pradesh (including Telangana), Tamil Nadu, and West Bengal together contributed to 51 per cent of the national economic burden, underlining regional disparities in typhoid cases in India.

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Fluoroquinolone resistance fuelling costs

The study identified fluoroquinolone-resistant typhoid infections as the primary driver of costs. Fluoroquinolones—widely used antibiotics for treating severe infections—are typically effective in reducing typhoid fever within four days. However, rising resistance has increased treatment complexity and costs.

“Typhoid fever imposes a significant economic burden in India, driven by fluoroquinolone resistance, high incidence among young children, and concentration in high-burden states,” the authors noted.

Call for typhoid vaccine and policy intervention

The findings strengthen the case for introducing the typhoid conjugate vaccine in India’s national immunisation programme, which is currently under consideration. Experts say such measures could significantly reduce both disease incidence and economic impact.

The study also recommends strengthening antibiotic resistance control strategies and improving national health financing policies to ease the financial strain on families.

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Comprehensive national analysis of the typhoid burden

Researchers conducted a nationally representative analysis using empirical data on typhoid epidemiology, healthcare access, clinical outcomes, and both direct and indirect costs for hospitalised and non-hospitalised patients.

They noted that previous estimates of typhoid burden in India were fragmented and region-specific, while this study provides a comprehensive national picture.

Public health implications

Typhoid fever, a water- and food-borne infectious disease, continues to pose a major public health challenge in India, with symptoms including high fever, fatigue, headache, and abdominal pain.

The study concludes that antibiotic-resistant typhoid in India disproportionately affects children and low-income households, making urgent policy intervention critical to reduce both health risks and financial hardship.

PTI