Overview
India is facing a growing burden of infections caused by Salmonella. The disease spectrum ranges from mild gastroenteritis to life‑threatening bloodstream infection. A recent Lancet study estimated 4.9 million typhoid cases and 7,850 deaths in 2023, with 730,000 hospitalisations. Most of these hospitalisations involved strains resistant to fluoroquinolones.
Key Developments
- Fluoroquinolone resistance in S. Typhi rose to **85 %** in 2015‑19 and remains high.
- Outbreak in Thane (April‑July 2025) showed **26.35 %** ceftriaxone resistance, linked to tanker‑water supply.
- Carbapenem‑resistant S. Typhi carrying the blaNDM‑5 gene has been documented.
- WHO recommends the Typhoid conjugate vaccine for children, but it is not yet in India’s universal immunisation programme.
Important Facts
Transmission routes: Typhoid spreads via the faecal‑oral route from human carriers; non‑typhoidal strains have a broader ecology involving poultry, eggs, meat and the environment. Contamination can occur at farms, slaughterhouses, transport, restaurants and home kitchens – a classic One Health problem.
Vulnerable groups: Young children, older adults and immunocompromised persons are at higher risk of invasive disease.
Diagnosis: Blood culture is the gold standard for suspected typhoid and should be done before starting antibiotics. The Widal test is unreliable when used alone.
Treatment: Uncomplicated non‑typhoidal gastroenteritis requires only fluid and electrolyte replacement. Antibiotics are reserved for severe or invasive cases and for patients with risk factors. Over‑use of antibiotics fuels antimicrobial resistance.
Exam Relevance
Understanding the rise of fluoroquinolone resistance and emerging carbapenem resistance is essential for GS1 (Health) and GS3 (Public Health) topics on disease burden, drug resistance, and health‑system response. The One Health perspective links agriculture, food safety, and environmental policies – a recurring theme in GS4 and GS3. The exclusion of the Typhoid conjugate vaccine from the national programme raises questions of policy implementation and equity, relevant to GS2 (Polity) and GS3.
Way Forward
- Strengthen surveillance for both typhoid and non‑typhoidal Salmonella, especially in the informal food sector.
- Promote rational antibiotic use: reserve antibiotics for confirmed invasive cases and follow local susceptibility patterns.
- Integrate TCV into the universal immunisation schedule to reduce disease incidence.
- Enhance water, sanitation and hygiene (WASH) infrastructure to cut human‑to‑human transmission of typhoid.
- Adopt a One Health framework for food‑chain monitoring, including farm‑level biosecurity and cold‑chain maintenance.
Addressing antimicrobial resistance while improving preventive measures will be crucial for reducing the health and economic burden of Salmonella infections in India.