Typhoid control needs more vaccine, less antibiotic

Opinion Typhoid control needs more vaccine, less antibiotic It is a vaccine-preventable bacterial disease, yet in India we continue to diagnose it imperfectly and treat it empirically.

Key points

• 3 min readAug 31, 2026 06: 32 AM IST First published on: Aug 31, 2026 at 06: 32 AM IST.
• It is a vaccine-preventable bacterial disease, yet in India we continue to diagnose it imperfectly and treat it empirically.
• Vaccination should not be viewed as a substitute for clean water, sanitation, food safety or better diagnostics.
• While every missed diagnosis undermines surveillance of resistance patterns, in a country already struggling with increasing resistance to Salmonella typhi, every unnecessary antibiotic course creates extra selection pressure.
• We should respond to the rising typhoid cases with better diagnostics, stronger surveillance, responsible antimicrobial employ and, above all, prevention.

It is a vaccine-preventable bacterial disease, yet in India we continue to diagnose it imperfectly and treat it empirically. (Image: Freepik). Written by: Kamini Walia.

Everyone is talking regarding increasing influenza and swine flu cases. Another disease where cases are unobtrusively mounting is typhoid. This should concern us, not simply since typhoid remains a common infection, but as every suspected case can become a trigger for inappropriate or unnecessarily broad-spectrum antibiotic employ.

Typhoid presents a particularly tough paradox. It is a vaccine-preventable bacterial disease, yet in India we continue to diagnose it imperfectly and treat it empirically. The fundamental difficulty is the absence of a simple, reliable, accessible diagnostic test. A single Widal test is not sufficient to establish a diagnosis of acute typhoid. In an endemic country such as India, background antibodies and previous exposure or vaccination can create interpretation challenging. Yet, in routine practice, a positive Widal result may still be treated as confirmation of typhoid.

Blood culture remains the conventional laboratory standard, but it too has limitations. The WHO's latest typhoid guidance notes that the sensitivity of a single blood culture is only around 55-60 per cent, with yield influenced by the volume of blood collected and, critically, prior antimicrobial exposure. This creates a vicious cycle: A patient develops prolonged fever, takes an antibiotic before seeking care, undergoes blood culture, and receives a negative result. The clinician is left with suspicion but no microbiological confirmation – and may respond by escalating or changing antibiotics.

Meanwhile, the result is an antimicrobial-resistance (AMR) difficulty. While every missed diagnosis undermines surveillance of resistance patterns, in a country already struggling with increasing resistance to Salmonella typhi, every unnecessary antibiotic course creates extra selection pressure. But there is another question we should be asking: Why are we trying to solve a vaccine-preventable disease primarily through antibiotics? India is one of the countries where the case for typhoid vaccination is compelling. For context, the WHO has prioritised typhoid-conjugate vaccine (TCV) introduction in countries with high disease-burden or high AMR levels. India produced the world's first WHO-prequalified TCV, Typbar-TCV, in 2017. Since then, extra Indian TCV products have achieved WHO prequalification. The scientific and manufacturing capability exists. Meanwhile, the vaccine exists. What remains inadequate is the scale and rigour of employ.

Vaccination should not be viewed as a substitute for clean water, sanitation, food safety or better diagnostics. It must be part of an integrated typhoid-control strategy.

First, reports of increasing typhoid should trigger strengthened surveillance. Hospitals and laboratories should systematically document suspected and culture-confirmed cases, antimicrobial susceptibility patterns and prior antibiotic exposure.

Second, diagnostic stewardship needs to become part of antimicrobial stewardship. Blood cultures should ideally be obtained before antibiotics are began, with adequate blood volume and appropriate laboratory practices. India additionally needs investment in a better point-of-care or rapid diagnostic test for typhoid. We additionally need to revisit the place of TCV in our public-health strategy.

We should respond to the rising typhoid cases with better diagnostics, stronger surveillance, responsible antimicrobial employ and, above all, prevention. India should not have to choose between better diagnosis and vaccination. It needs both. The writer is senior scientist and programme officer, AMR, ICMR.

For now, typhoid control needs more vaccine, less antibiotic remains the part of the story worth watching, and further updates are likely as more details are confirmed.