Why typhoid remains endemic in India: Key challenges and solutions
Typhoid fever is a disease that has been eliminated in most high-income countries. In India, however, it is a public health issue, as it keeps returning in the same communities, affecting the same age groups. This is what makes typhoid endemic here. This article looks at why typhoid has persisted despite being a preventable disease, and what a credible, evidence-based response to it looks like.
What does "endemic" mean in the context of typhoid?
A disease is endemic when it is consistently present in a specific region, with relatively stable and predictable case numbers. It is not the same as an epidemic, which refers to an unexpected spike in cases, or a pandemic, which crosses international borders. An endemic disease remains geographically concentrated.[1]
Typhoid fits this definition in India. It does not appear suddenly or disappear between seasons. It is a year-round, persistent public health problem that returns because the underlying conditions that allow it to spread have not been adequately addressed.
The burden of typhoid in India
Poor sanitation and unsafe water (WASH)
The primary reasons why typhoid spreads are contaminated food and water. Once Salmonella typhi, the typhoid-causing bacterium, is consumed, it multiplies and spreads into the bloodstream. Communities that lack access to safe drinking water and adequate sanitation face a significantly higher risk.[4]
Evidence from high-income countries shows that, by developing clean water access and improving water treatment infrastructure, it is possible to eradicate typhoid.[3] However, in India, access to safe, treated water remains limited, even in some urban areas, since water contamination can happen even at the infrastructure level.
Rising antibiotic resistance
Antibiotics are the primary treatment for typhoid fever, but growing resistance to these drugs is making treatment more complicated.[4] Salmonella typhi is developing resistance to the drugs that are commonly used to treat typhoid. In 2023, 82% of all typhoid hospitalisations in India were linked to fluoroquinolone-resistant strains.[2] A more severe form, extensively drug-resistant (XDR) typhoid, has already emerged in Pakistan and poses a risk of spread into India. Misuse of antibiotics continues to contribute to the emergence of resistant strains.[3]
Weak surveillance and diagnostics
India does not yet have a reliable, nationwide system to accurately track typhoid infections. Without consistent data, it is difficult to know where the disease is most active, which age groups are most at risk, and where interventions are most urgently needed.[2] Blood culture tests, considered the standard, are not widely available in India, particularly in rural areas and smaller health facilities. Low-cost, accessible surveillance methods are needed to generate reliable data at the state and district level, which can then guide targeted public health responses.[3]
Online and home vaccination services
Home vaccination services have grown significantly in Indian cities. A qualified healthcare provider visits your home to administer the vaccine. This option is convenient for families, the elderly, or those with mobility constraints. This option is also practical for vaccinating all family members in a single visit. Before booking, verify that they have qualified healthcare providers, certified medical facilities, and follow proper cold chain protocols during transport and administration.
Find a typhoid vaccination centre near you.
Use our vaccination centre finder. Simply enter your pincode to find the nearest authorised typhoid vaccination centre near you.
Types of typhoid vaccines available
Typhoid Conjugate Vaccine (TCV)
TCV is the newer generation of typhoid vaccines and is currently the preferred choice recommended by leading medical bodies in India. It can be given to children as young as 6 months and to adults up to 45 years of age, as a single-dose injection. This typhoid vaccine is available in India and has been shown to offer superior protection compared to older vaccines. It stimulates the body’s immune memory and is safe for immunocompromised individuals.[1,2]
Vi Capsular Polysaccharide Vaccine (ViCPS)
The Vi capsular polysaccharide vaccine is an older injectable typhoid vaccine that has been in use for several decades and has a well-established record. It can be given to children aged 2 years and above, as well as adults, as a single injection. Unlike TCV, this vaccine does not create immune memory, and a booster dose may be required.[1]
Oral typhoid vaccine
There is an oral typhoid vaccine called Ty21a, which is used in several countries. However, this vaccine is currently not available in India and will therefore not be discussed further in this guide.[1, 2]
To learn more about the differences, which vaccine is more suitable for you, or the cost of typhoid vaccines in India, talk to your doctor.
When should you get vaccinated?
If you aren’t vaccinated against typhoid, consider getting the vaccine as soon as possible. Children and adults living in urban India are at meaningful risk and should consider vaccination even if they have never had typhoid before. Certain groups, including healthcare workers, food service workers, and frequent travellers, should prioritise getting vaccinated. If you are currently unwell with a fever, wait until you have fully recovered before getting vaccinated.
Who should get the typhoid vaccine?
- Children are among the most vulnerable, as the peak incidence of typhoid is seen in those aged 5–15 years.
- Adults, particularly those living in urban areas, where exposure through contaminated food and water is higher.
- Healthcare workers who may come into contact with infected patients or laboratory specimens.
- Food service workers and those involved in the F&B industry who prepare or handle food for larger groups.
- Travellers heading to regions with high typhoid risk.
- Immunocompromised individuals, including those living with HIV (TCV and ViCPS are safe vaccination options for this group).
- Pregnant women may receive typhoid vaccination, though it may be advisable to delay vaccination until the second or third trimester, where possible. Get a medical consultation before considering the vaccine.
Things to know before getting vaccinated
Always consult your doctor before getting vaccinated, especially if you have an existing health condition, are pregnant, or are currently on any medication. Let your doctor know if you have had a previous allergic reaction to any vaccine, and inform them of any typhoid vaccines you may have received in the past. If you are currently running a fever or feeling unwell, postpone your appointment until you have recovered.[2]
Common and mild side effects include pain, redness, or swelling at the injection site, and occasionally a mild fever or headache. These usually resolve on their own within a day or two. Severe allergic reactions are rare but possible. Watch out for swelling of the face or throat, difficulty breathing, a rapid heartbeat, dizziness, or sudden weakness. If any of these occur, seek medical attention immediately.[1,2]
Conclusion
Typhoid remains a significant public health concern in India, affecting people across all age groups, not just children. Effective vaccines are readily available across the country, from hospitals and private clinics to pharmacies and home vaccination services. TCV is currently the recommended vaccine for most people, including infants as young as 6 months. Vaccination programmes have also demonstrated meaningful herd protection in communities where uptake is high.
Speak to your doctor to find out which vaccine is right for you, confirm whether you are due for a booster, and use our typhoid vaccination centre finder to locate the nearest authorised centre in your area.
FAQs
Where can I get a typhoid vaccine near me?
You can find typhoid vaccines in hospitals and clinics, authorised pharmacies, and through home vaccination services across India. You can also use our vaccination centre finder to find the closest authorised centre.
Do I need a prescription for typhoid vaccination?
It is always advisable to consult a doctor before getting vaccinated, as they can recommend the right vaccine based on your age, health history, and previous vaccinations.
Which typhoid vaccine is best?
Medical guidelines in India currently recommend the Typhoid Conjugate Vaccine (TCV) as the preferred option for most people. However, it is best to consult your doctor before getting the vaccination.
How long before travel should I get vaccinated?
It is advisable to get travel vaccines for typhoid well in advance to allow adequate time for the vaccine to take effect. Consult your doctor as soon as your travel plans are confirmed.
Is typhoid vaccination safe?
Yes. Both TCV and Vi capsular polysaccharide vaccines have well-established safety records. Speak to your doctor if you have any specific concerns before getting vaccinated.
Resources
- Goel, K., Verma, M., Sharma, N., Parida, S. P., Bhardwaj, A., Nadda, A., Sharma, S., Sen, A., John, J., Bansal, A., & Gupta, M. (2024). IAPSM’s position paper on typhoid vaccines for adult immunization in India. Indian Journal of Community Medicine
- Shastri, D. D., & Dhir, S. K. (2025). Purple Book: IAP Guidebook on Immunization 2025. JP Medical Ltd.
Disclaimer: A public awareness initiative by Bharat Biotech International Limited. This information is for general awareness only and does not constitute medical advice. The doctors, medical facilities and graphics shown are for illustrative purposes only. For any medical advice or any question or concern you may have regarding your condition, consult your doctor.