Burden of enteric fever in the India-Bangladesh-Myanmar border region

Background India is estimated to contribute greater than 50% of the global burden of enteric fever. Despite the huge burden, typhoid vaccination is currently not included in the national immunization schedule, mainly due to lack of reliable disease estimates, especially at the state and district levels. Methods Mizoram’s district-wise incidence rates of enteric fever cases (n = 30000) from January 2022 to September 2024 were calculated per 100 000-person-years. A chi-square test and multivariate logistic regression were carried out to identify sociodemographic and clinical variables associated with hospitalization. The spatial distribution, including the proportion of typhoid and paratyphoid cases, was mapped using the geographic information system. Results The incidence of typhoid and paratyphoid in Mizoram was 653 cases (95% CI: 645–661) and 190 cases (95% CI: 185–194) per 100 000 person-years, respectively. Age < 2 years and fever < 7 days were significant predictors of hospitalization; the hospitalization odds for S . Typhi and S . Paratyphi were not significant (p = 0.958). A high proportion of paratyphoid cases occurred along the Bangladesh border. Conclusion The huge burden of enteric fever across the rural and urban districts of Mizoram provides compelling evidence for the inclusion of typhoid vaccination in the national immunization schedule.