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The largest burden of typhoid fever falls on the developing world. Because there is no simple diagnostic test for salmonella infections, the importance of typhoid is often underestimated. Complications include gastrointestinal bleeding, intestinal perforation, and encephalopathy. For decades, cheap, effective oral antibiotics have been available, but the situation is changing with the emergence of resistant organisms. With the new conjugate Vi vaccine, mass-vaccination programs may be an attractive option.

Supported by grants from the Wellcome Trust. Dr. White is a Wellcome Trust Principal Fellow, and Dr. Farrar is a Wellcome Trust Senior Clinical Fellow.

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