Typhoid fever is no longer just a story from history books. It’s a disease we urgently need to worry about — again.
Caused by the bacterium Salmonella enterica serovar Typhi (or S. Typhi), typhoid fever was once a deadly scourge. Thanks to antibiotics and vaccines, it has become rare in high-income countries. But today, it’s quietly staging a dangerous return — and it’s doing so in a more powerful, drug-resistant form.
Researchers have confirmed that S. Typhi is evolving. And it’s happening fast.
In a major study, scientists sequenced over 3,000 strains of the bacteria collected between 2014 and 2019 from South Asia. They found a dramatic rise in extensively drug-resistant (XDR) typhoid strains that don’t respond to the most commonly used antibiotics.
Worryingly, this isn’t a local issue anymore. Since 1990, nearly 200 cases of drug-resistant typhoid have spread from South Asia to other parts of the world, including East and Southern Africa, Southeast Asia, the UK, the US, and Canada.
Until recently, doctors treated typhoid with oral antibiotics like ampicillin, chloramphenicol, and fluoroquinolones. But these drugs are losing effectiveness fast. Even third-generation antibiotics like cephalosporins are starting to fail.
The only oral antibiotic left that still works against many typhoid strains is azithromycin. But cracks are starting to show. Some strains are now showing signs of resistance to this last-line treatment too.
That means we’re now staring down the barrel of a major global health threat: a common bacterial infection that we can no longer treat with pills.
If left untreated, typhoid can be fatal in up to 1 in 5 cases. Symptoms include high fever, weakness, stomach pain, and in severe cases, internal bleeding or death. Globally, the World Health Organisation estimates 11 million people contract typhoid each year.
While better sanitation has reduced cases in wealthy countries, in many low- and middle-income nations, especially in South Asia, typhoid remains a major public health issue.
Yes, and they might be our best shot.
One of the most promising tools against typhoid is the typhoid conjugate vaccine (TCV). These vaccines are safe, effective, and recommended by the WHO, especially for children in high-risk countries.
Pakistan was the first country in the world to roll out typhoid vaccines in its routine immunisation program. Early data shows this move could reduce typhoid deaths and cases significantly, especially in urban areas.
India, Bangladesh, and Nepal have also made strides, but experts warn it’s not enough. Without wider global access, we risk facing outbreaks of typhoid that no longer respond to standard treatments.
Scientists and doctors are calling for urgent action:
Most of all, we need governments and global health agencies to take the threat seriously before drug-resistant typhoid becomes a widespread catastrophe.
If you’re travelling to high-risk areas like South Asia or parts of Africa, make sure you get vaccinated. Practice safe food and water habits. And if you develop symptoms during or after travel, seek medical advice immediately.
Typhoid may be an ancient disease, but it’s evolving with terrifying speed. If the world doesn’t act soon, we could find ourselves without a reliable treatment — for a disease that still kills thousands every year.
Vaccines work. Clean water helps. And research saves lives. Let’s not wait until it’s too late.
