The burden of enteric fever.

Enteric fever is a disease of developing countries associated with poor public health and low socio-economic indices. Cases of enteric fever occurring in travelers returning to the United States and the UK suggest that it is present across the developing world but that the Indian subcontinent represents a hotspot of disease activity. The best figures available for the global burden of enteric fever support this and suggest that Africa (50/ 100,000) has a far lower burden of disease than Asia (274/100,000). However these figures are based mainly on data for typhoid fever in Asia and the data for returning travelers is biased by preferred travel destinations. Given that most socio-economic indices, including known risk factors for enteric fever, such as provision of safe drinking water and sanitation, are much lower in most parts of Africa than in South-East and South-Central Asia it seems remarkable that Africa has such a low burden of disease. In such a scenario, rather than comparing whole continents, it may be more relevant to estimate region-specific burden of disease. It is clear is that there is an urgent need for more population-based studies of typhoid fever incidence in different parts of Africa to clarify the typhoid fever situation for the continent and so guide public health intervention.