{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:00:02Z","timestamp":1790805602186,"version":"4.1.0"},"reference-count":20,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82300650"],"award-info":[{"award-number":["82300650"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although global typhoid fever burden has declined, African destination-level risk remains incompletely characterized for travel medicine. We assessed trends, demographic drivers and traveller-relevant typhoid risk across African destinations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed Global Burden of Diseases 2023 modelled estimates for typhoid fever in 54 African Union destinations, 2010\u20132023. Outcomes were incidence, prevalence, deaths and disability-adjusted life-years (DALYs). We estimated age-standardized rates, all-age numbers and trends, developed a burden\u2013trend typology, attributed DALY-count changes to population growth, age-structure change and age-specific DALY-rate change, and estimated destination-specific expected cases per 100\u2009000 travellers. This model-derived metric was used for relative destination ranking, not as an observed individual-level traveller risk estimate. We also performed exploratory interrupted time-series, ecological deaths-to-incidence ratio and 2030 scenario extrapolation analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 2010 to 2023, estimated incident cases declined from ~1.36 million to 902\u2009000, and age-standardized incidence from 103.8 to 52.3 per 100\u2009000. Age-standardized prevalence, death and DALY rates declined from 6.6 to 3.3, 1.3 to 0.7, and 96.9 to 53.9 per 100\u2009000, respectively. The highest 2023 incidence rates occurred in the Central African Republic, the Republic of the Congo, the Democratic Republic of the Congo, Gabon and Angola; the Democratic Republic of the Congo had the largest absolute burden. Malawi was the only high-burden, non-declining destination across incidence, deaths and DALYs. DALY counts decreased by ~403\u2009000, mainly due to lower age-specific DALY rates. Traveller risk ranged from 0.03 to 9.0 expected cases per 100\u2009000 travellers, with the five highest-risk destinations in Central Sub-Saharan Africa. Scenario extrapolation suggested incidence may decline to 36.1 per 100\u2009000 by 2030.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Typhoid fever incidence is declining overall, but substantial heterogeneity persists across African destinations. These findings support destination-specific risk assessment, typhoid vaccination where appropriate, food and water precautions, and clinical vigilance for febrile returning travellers from higher-risk destinations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jtm\/taag073","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:24:00Z","timestamp":1788521040000},"source":"Crossref","is-referenced-by-count":0,"title":["Typhoid fever in Africa: trends, demographic determinants and relevance to travel medicine"],"prefix":"10.1093","author":[{"given":"Kui","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Qilu Hospital of Shandong University , 107 Wenhua Xilu, Jinan, Shandong 250012,","place":["China"]},{"name":"Shandong Provincial Clinical Research Center for Digestive Disease, Qilu Hospital of Shandong University , 107 Wenhua Xilu, Jinan, Shandong 250012,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0211-6026","authenticated-orcid":false,"given":"Shanshan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Qilu Hospital of Shandong University , 107 Wenhua Xilu, Jinan, Shandong 250012,","place":["China"]},{"name":"Shandong Provincial Clinical Research Center for Digestive Disease, Qilu Hospital of Shandong University , 107 Wenhua Xilu, Jinan, Shandong 250012,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,6]]},"reference":[{"key":"2026093017270109300_ref1","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1016\/S1473-3099(25)00551-1","article-title":"Complications and mortality of typhoid fever: an updated global systematic review and meta-analysis","volume":"26","author":"Murthy","year":"2026","journal-title":"Lancet Infect Dis"},{"key":"2026093017270109300_ref2","doi-asserted-by":"publisher","first-page":"1283","DOI":"10.1016\/S0140-6736(25)01335-2","article-title":"Enteric (typhoid and paratyphoid) fever","volume":"406","author":"Kuehn","year":"2025","journal-title":"Lancet"},{"key":"2026093017270109300_ref3","doi-asserted-by":"publisher","first-page":"1347","DOI":"10.1016\/S1473-3099(25)00359-7","article-title":"Global typhoid fever incidence: an updated systematic review with meta-analysis","volume":"25","author":"Murthy","year":"2025","journal-title":"Lancet Infect Dis"},{"key":"2026093017270109300_ref4","doi-asserted-by":"publisher","DOI":"10.1093\/jtm\/taab150","article-title":"Typhoid fever in travellers: estimating the risk of acquisition by country","volume":"28","author":"Forster","year":"2021","journal-title":"J Travel Med"},{"key":"2026093017270109300_ref5","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01084-20","article-title":"Epidemiological and clinical characteristics of international travelers with enteric fever and antibiotic resistance profiles of their isolates: a GeoSentinel analysis","volume":"64","author":"Hagmann","year":"2020","journal-title":"Antimicrob Agents Chemother"},{"key":"2026093017270109300_ref6","doi-asserted-by":"publisher","first-page":"e0012960","DOI":"10.1371\/journal.pntd.0012960","article-title":"The global, regional, and national burden of invasive non-typhoidal salmonella (iNTS): an analysis from the global burden of disease study 1990-2021","volume":"19","author":"He","year":"2025","journal-title":"PLoS Negl Trop Dis"},{"key":"2026093017270109300_ref7","doi-asserted-by":"publisher","first-page":"e599","DOI":"10.1016\/S2214-109X(24)00007-X","article-title":"Incidence of typhoid fever in Burkina Faso, Democratic Republic of the Congo, Ethiopia, Ghana, Madagascar, and Nigeria (the severe typhoid in Africa programme): a population-based study","volume":"12","author":"Marks","year":"2024","journal-title":"Lancet Glob Health"},{"key":"2026093017270109300_ref8","doi-asserted-by":"publisher","first-page":"e537","DOI":"10.1016\/S2214-109X(24)00079-2","article-title":"High burden of typhoid disease in sub-Saharan Africa calls for urgent roll-out of typhoid conjugate vaccines","volume":"12","author":"Kariuki","year":"2024","journal-title":"Lancet Glob Health"},{"key":"2026093017270109300_ref9","doi-asserted-by":"publisher","first-page":"171","DOI":"10.15585\/mmwr.mm7207a2","article-title":"Typhoid fever surveillance, incidence estimates, and progress toward typhoid conjugate vaccine introduction - 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