**Executive Summary**
This document contains the Minister of Health and Family Welfare's response to questions regarding typhoid fever and drug resistance in India, to be answered on February 6, 2026. It addresses the government's awareness of typhoid burden studies, details on surveillance, public health measures, and antimicrobial resistance. The response references data from various sources, including the Integrated Disease Surveillance Programme (IDSP) and modeling studies.
**Key Points / Main Content**
* **Typhoid Burden Study:** Acknowledges a modelling study on typhoid fever and antimicrobial resistance (AMR) in India in 2023. The study integrates data from the Surveillance for Enteric Fever in India (SEFI), Global Burden of Disease Study 2021, and state-specific AMR prevalence data. The study was not conducted or funded by the Government of India.
* **State Government Responsibility:** Healthcare is primarily a state subject, with the Ministry of Health and Family Welfare providing financial and technical assistance under the National Health Mission (NHM).
* **Regional Burden:** Notes that Delhi, Maharashtra, and Karnataka report a higher number of cases but did not exceed 20% of total cases in India in 2023, according to IDSP-IHIP data.
* **Disease Surveillance:** The Integrated Disease Surveillance Programme (IDSP) is mandated for surveillance of epidemic-prone diseases, including typhoid, across all States/UTs using Syndromic (S), Presumptive (P), and Laboratory confirmed (L) forms.
* **Public Health Guidelines:** Comprehensive 'Public Health Guidelines for Flood Events' detail public health effects due to floods, disease surveillance, water-borne diseases, sanitation etc.
* **Preventative measures:** Awareness of water-borne diseases and safe water practices promoted through community engagement and regular water quality testing, particularly in rural areas.
* **Antimicrobial Resistance:** Fluoroquinolones are no longer the first-line therapy for enteric fever due to resistance. The National Treatment Guidelines for Antimicrobial use recommends ceftriaxone and azithromycin as empiric first-line therapy.
**Impact Analysis**
**Stakeholder: State Governments**
* **Impact:** Primary responsibility for providing healthcare facilities to patients with typhoid fever.
* **Action Required:** To utilize financial and technical assistance from the Ministry of Health and Family Welfare to strengthen healthcare facilities and effectively respond to health problems.
**Stakeholder: Ministry of Health and Family Welfare**
* **Impact:** Provides financial and technical assistance to States/UTs under NHM. Oversees IDSP through the National Centre for Diseases Control (NCDC).
* **Action Required:** To continue providing support to states and monitoring disease surveillance programs.
**Stakeholder: Healthcare Professionals**
* **Impact:** Implementing IDSP, filling out surveillance forms, and providing treatment for typhoid fever.
* **Action Required:** To adhere to updated treatment guidelines, promote water-borne diseases and safe water practices, and participate in surveillance efforts.
**Stakeholder: General Public**
* **Impact:** Risk of contracting typhoid fever, particularly in areas with poor sanitation and water quality.
* **Action Required:** To adopt safe water practices, maintain good hygiene, and participate in community awareness programs.
Key Entities Referenced
Ministry of Health and Family Welfare: Primary government entity responsible for public health, including addressing typhoid fever and drug resistance.
Integrated Disease Surveillance Programme (IDSP): A surveillance program under the National Centre for Diseases Control (NCDC) mandated with surveillance of several epidemic prone diseases, including typhoid.
National Health Mission (NHM): Provides financial and technical assistance to State/UT Government for strengthening of primary and secondary health care facilities to effectively respond to health care needs
India: The geographical location where the typhoid fever and drug resistance scrutiny is focused.
Lancet Regional Health: Source of study on typhoid fever cases and deaths in India during 2023, prompting the parliamentary inquiry.
GOVERNMENTOFINDIA
MINISTRYOFHEALTH AND FAMILYWELFARE
DEPARTMENTOFHEALTH AND FAMILYWELFARE
LOK SABHA
UNSTARREDQUESTION NO. 1350
TO BE ANSWERED ON06.02.2026
SCRUTINYOFTYPHOID FEVER AND DRUG RESISTANCEFAILURES
1350.SHRIVIJAYAKUMARALIASVIJAYVASANTH:
SHRISURESHKUMAR SHETKAR:
Will the Ministerof HEALTH AND FAMILYWELFAREbe pleasedtostate:-
(a) whether the Government hastaken cognisance of the findingsof a study published in the
Lancet Regional Health estimating approximately 49 lakh cases of typhoid fever and
over7,800deathsinthe countryduring the year2023;
(b) if so, the details thereof and the reasons identified by the Government for the continued
highburdenof typhoidfeverinthe country;
(c) whether the Government has noted that Delhi, Maharashtra and Karnataka together
accountfor nearly 30percentof the reportedtyphoidburden inthe countryandif so, the
detailsthereof;
(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
antimicrobialmisuse 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 high-
burden States and if so, the details thereof and if not, the reasons therefor, State/UTs-
wise?
ANSWER
THE MINISTER OFSTATEIN THE MINISTRYOFHEALTH& FAMILY
WELFARE
(SHRIPRATAPRAOJADHAV)
(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,andAMR profile; itisfundedbytheNagasaki University World-leadingInnovative &
Smart Education (WISE) Programme, Vaccine Impact Modelling Consortium, and Japan
Agency for Medical Research and Development. This study has not been conducted or
fundedbythe Governmentof India.
The detail of typhoid cases reported by the States/UTs on Integrated Disease SurveillancePlatform-Integrated Health Information Platform (IDSP-IHIP) in the year 2023 is at
Annexure.
(b) & (f): Healthisa State subject andthe responsibility for providinghealthcare 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
problemsarising fromconsumption ofcontaminateddrinkingwater.
(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
inIndiain2023.
(d):TheIntegrated Disease SurveillanceProgramme (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(Laboratoryconfirmed) form filledbylaboratoriesasperstandard case definitions.
Ministry of Health& FamilyWelfare hasissued a comprehensive 'Public HealthGuidelines
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; vector- borne diseases, and water, sanitation issues etc and the link for the
guideline is as below https://www.ncdc.mohfw.gov.in/wp-
content/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 inrural 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
1990sand early2000s.
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 therapyfor enteric fever.
*****Annexure
Cases of Typhoid reportedon L-form byStates/UTs underIDSPin2023
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 HimachalPradesh 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
The Dadra And Nagar Haveli And Daman And 739
32
Diu
33 Tripura 6694
34 Uttarakhand 11638
35 Uttar Pradesh 40375
36 West Bengal 2919
Total 574136
Source:Data extractedfrom IDSP-IHIPportal asondate 22nd Jan2026.