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Typhoid fever must be given a higher priority in the international health community if it is to be controlled, say Denise DeRoeck and colleagues in this New England Journal of Medicine article.

The WHO estimates there are 16–33 million cases of typhoid every year, killing up to 600,000 people. But vaccination has largely fallen from the international radar.

The authors say complacency following the introduction of inexpensive antibiotics has led to increased resistance, and that the disease is underestimated in most developing countries.

In 2000 the WHO recommended that school-age children should be immunised where typhoid is a substantial public health problem. So far only China and Vietnam have responded, though Indonesia and Pakistan have pilot vaccination programmes planned.

And new developments — such as studies revealing high typhoid rates among children in urban slums India, Indonesia and Pakistan — have strengthened the case for refocusing on typhoid vaccination, say the authors.

The Vi vaccine — first introduced two decades ago — is safe and has become both inexpensive and increasingly available, as developing countries have acquired the technology to produce it.

But further research must be done into vaccine strategies for different — and more resistant — strains of the typhoid-causing Salmonella bacteria, the authors conclude.

Link to full article in New England Journal of Medicine