Forecasting the Future Burden of Typhoid Fever: Global Projections and Afghanistan Estimates to Inform Public Health Planning Through 2040
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Abstract
Background: Typhoid fever remains a significant public health challenge in many low- and middle-income countries, particularly in regions with inadequate water, sanitation, and hygiene (WASH) infrastructure. The Global Burden of Disease (GBD) study estimates that typhoid caused more than 6 million infections and more than 71,000 deaths globally in 2023. Understanding future trajectories of disease burden is essential for guiding public health policy and resource allocation.
Methods: We extracted age-standardized prevalence rates (ASPR) for typhoid fever from the GBD 2023 for both global and Afghanistan-specific estimates, disaggregated by sex, from 1990 to 2023. A cubic spline regression model was fitted to historical data using a least squares technique and used to project ASPR through 2040. Confidence intervals (95% UI) are reported for all estimates.
Results: In 2023, the global ASPR for typhoid fever stood at 5.34 per 100,000 for both sexes combined, with males experiencing a greater burden (5.68 per 100,000) compared to females (4.98 per 100,000). Afghanistan recorded an ASPR of 1.29 per 100,000 for both sexes. On a global scale, the ASPR is forecasted to fall to 1.68 per 100,000 by 2040, representing a 68.5% decrease from the 2023 level, whereas Afghanistan's ASPR is projected to drop to 0.43 per 100,000, a 67.0% reduction.
Conclusion: Typhoid fever prevalence is projected to continue its long-term decline through 2040 in both global and Afghanistan settings. However, the pace of decline may decelerate compared to historical trends, and sex-based differences may persist in some settings. Continued investments in WASH infrastructure and accelerated typhoid conjugate vaccine introduction are essential to sustain progress.
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