Lok Sabha Question No. 1350 (UNSTARRED), answered on 2026-02-06
Subject: Scrutiny of Typhoid Fever and Drug Resistance Failures
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Shri Suresh Kumar Shetkar, Shri Vijayakumar Alias Vijay Vasanth

## GOVERNMENTOFINDIA MINISTRYOF HEALTH AND FAMILY WELFARE DEPARTMENTOFHEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 1350 TO BE ANSWERED ON 06.02.2026

## SCRUTINYOFTYPHOID FEVER AND DRUG RESISTANCE FAILURES

## 1350. SHRI VIJAYAKUMAR ALIAS VIJAY VASANTH: SHRI SURESH KUMAR SHETKAR:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:-

- (a) whether the Government has taken cognisance of the findings of a study published in the Lancet Regional Health estimating approximately 49 lakh cases of typhoid fever and over 7,800 deaths in the country during the year 2023;
- (b) if so, the details thereof and the reasons identified by the Government for the continued high burden of typhoid fever in the country;
- (c) whether the Government has noted that Delhi, Maharashtra and Karnataka together account for nearly 30 per cent of the reported typhoid burden in the country and if so, the details thereof;
- (d) the details of the specific failures in public health planning, sanitation and diseases surveillance in the country along with the measures taken by the Government in this regard;
- (e) the manner in which nearly six lakh out of approximately 7.3 lakh hospitalisations were directly attributable to fluoroquinolone resistance, despite repeated warnings on antimicrobial misuse over decades; and
- (f) whether the Government has conducted any independent national-level assessment to evaluate the extent of antimicrobial resistance in typhoid fever, particularly in highburden States and if so, the details thereof and if not, the reasons therefor, State/UTswise?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH & FAMILY WELFARE (SHRI PRATAPRAO JADHAV)

(a): The said study is a modelling study on the burden of typhoid fever and antimicrobial resistance (AMR) in India in 2023, integrating typhoid fever incidence data from the Surveillance for Enteric Fever in India (SEFI) study (from 2017-2020 among children aged 6 months to 14 years in India), Global Burden of Disease Study 2021, and state-specific AMR prevalence data from systematic reviews (including the 2024 systematic review preprint on typhoid anti-microbial resistance conducted by the same authors). This modelling study aims to estimate the typhoid burden in India in 2023, categorised by age, state, and AMR profile; it is funded by the Nagasaki University World-leading Innovative & Smart Education (WISE) Programme, Vaccine Impact Modelling Consortium, and Japan Agency for Medical Research and Development. This study has not been conducted or funded by the Government of India.

The detail of typhoid cases reported by the States/UTs on Integrated Disease Surveillance

Platform-Integrated Health Information Platform (IDSP-IHIP) in the year 2023 is at Annexure.

(b) & (f): Health is a State subject and the responsibility for providing healthcare facilities to patients primarily lies with the respective State Government. However, Ministry of Health and Family Welfare provides financial and technical assistance to State/UT Government under National Health Mission (NHM) for strengthening of primary and secondary health care facilities to effectively respond to health care needs including health problems arising from consumption of contaminated drinking water.

(c): The Government has noted that Delhi, Maharashtra and Karnataka is higher than most of the States/UTs as per data provided by States/UTs on IDSP-IHIP. However, as per the data of IDSP-IHIP the total cases in these States/UTs did not exceed 20% of the total cases in India in 2023.

(d): The Integrated Disease Surveillance Programme (IDSP) at National Centre for Diseases Control (NCDC) under MoHFW is mandated with surveillance of several epidemic prone diseases, including typhoid. IDSP is implemented in all 36 States/UTs. The surveillance tool consists of S (Syndromic) form filled by Auxiliary Nurse and Midwife (ANMs) at the Sub-centre level, P (Presumptive) form filled by medical officers at health facility level and L(Laboratory confirmed) form filled by laboratories as per standard case definitions.

Ministry of Health & Family Welfare has issued a comprehensive 'Public Health Guidelines for Flood Events' which provides details on common public health effects due to floods, disease surveillance during and after flood with particular focus on water and food borne diseases; vectorborne diseases, and water, sanitation issues etc and the link for the guideline is as below https://www.ncdc.mohfw.gov.in/wpcontent/uploads/2024/08/PUBLIC-HEALTH-GUIDELINES-FOR-FLOOD-EVENT.pdf

Further, awareness on prevention of water-borne diseases and safe water practices is promoted through community engagement via Village Water and Sanitation Committees/Pani Samitis, regular water quality testing, sensitization workshops, public awareness campaigns on hygiene and sanitation, targeted interventions for vulnerable groups, and training programmes on safe water purification and handwashing practices, particularly in rural areas.

(e): Fluoroquinolones ceased to be relied upon as routine empiric first-line therapy for enteric fever following the widespread emergence of nalidixic-acid-resistant and fluoroquinolone-non-susceptible Salmonella Typhi and Paratyphi strains from the late 1990s and early 2000s.

As per the Annual AMR Surveillance Report 2024 of the National AMR Surveillance Network established under the National Programme for AMR Containment, fluoroquinolone resistance in India is approximately 33.5%. In view of this resistance pattern, the National Treatment Guidelines for Antimicrobial use in Infections Disease Syndromes 2016, and subsequently in 2025, recommends ceftriaxone and azithromycin as empiric first-line therapy for enteric fever.

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| Cases of Typhoid reported on L- form by States/UTs under IDSP in 2023   | Cases of Typhoid reported on L- form by States/UTs under IDSP in 2023   | Cases of Typhoid reported on L- form by States/UTs under IDSP in 2023   |
|-------------------------------------------------------------------------|-------------------------------------------------------------------------|-------------------------------------------------------------------------|
| S.no                                                                    | States/UTs                                                              | Number of Typhoid cases                                                 |
| 1                                                                       | Andaman &Nicobar Islands                                                | 176                                                                     |
| 2                                                                       | Andhra Pradesh                                                          | 38747                                                                   |
| 3                                                                       | Arunachal Pradesh                                                       | 4262                                                                    |
| 4                                                                       | Assam                                                                   | 11497                                                                   |
| 5                                                                       | Bihar                                                                   | 33269                                                                   |
| 6                                                                       | Chandigarh                                                              | 734                                                                     |
| 7                                                                       | Chhattisgarh                                                            | 39536                                                                   |
| 8                                                                       | Delhi                                                                   | 22969                                                                   |
| 9                                                                       | Goa                                                                     | 46                                                                      |
| 10                                                                      | Gujarat                                                                 | 17851                                                                   |
| 11                                                                      | Haryana                                                                 | 26434                                                                   |
| 12                                                                      | Himachal Pradesh                                                        | 9194                                                                    |
| 13                                                                      | Jammu And Kashmir                                                       | 19244                                                                   |
| 14                                                                      | Jharkhand                                                               | 11104                                                                   |
| 15                                                                      | Karnataka                                                               | 42096                                                                   |
| 16                                                                      | Kerala                                                                  | 1740                                                                    |
| 17                                                                      | Ladakh                                                                  | 25                                                                      |
| 18                                                                      | Lakshadweep                                                             | 41                                                                      |
| 19                                                                      | Madhya Pradesh                                                          | 20862                                                                   |
| 20                                                                      | Maharashtra                                                             | 46673                                                                   |
| 21                                                                      | Manipur                                                                 | 816                                                                     |
| 22                                                                      | Meghalaya                                                               | 11651                                                                   |
| 23                                                                      | Mizoram                                                                 | 15203                                                                   |
| 24                                                                      | Nagaland                                                                | 5234                                                                    |
| 25                                                                      | Odisha                                                                  | 23628                                                                   |
| 26                                                                      | Puducherry                                                              | 1351                                                                    |
| 27                                                                      | Punjab                                                                  | 13268                                                                   |
| 28                                                                      | Rajasthan                                                               | 41269                                                                   |
| 29                                                                      | Sikkim                                                                  | 2201                                                                    |
| 30                                                                      | Tamil Nadu                                                              | 29920                                                                   |
| 31                                                                      | Telangana                                                               | 20730                                                                   |
| 32                                                                      | The Dadra And Nagar Haveli And Daman And Diu                            | 739                                                                     |
| 33                                                                      | Tripura                                                                 | 6694                                                                    |
| 34                                                                      | Uttarakhand                                                             | 11638                                                                   |
| 35                                                                      | Uttar Pradesh                                                           | 40375                                                                   |
| 36                                                                      | West Bengal                                                             | 2919                                                                    |
| Total                                                                   |                                                                         | 574136                                                                  |

Source: Data extracted from IDSP-IHIP portal as on date 22 nd Jan 2026.