Typhoid Fever in Africa: Trends, Demographic Determinants, and Relevance to Travel Medicine.

BACKGROUND: Although global typhoid fever burden has declined, African destination-level risk remains incompletely characterised for travel medicine. We assessed trends, demographic drivers and traveller-relevant typhoid risk across African destinations. METHODS: We analysed GBD 2023 modelled estimates for typhoid fever in 54 African Union destinations, 2010-2023. Outcomes were incidence, prevalence, deaths and DALYs. We estimated age-standardised rates, all-age numbers and trends, developed a burden-trend typology, attributed DALY-count changes to population growth, age-structure change and age-specific DALY-rate change, and estimated destination-specific expected cases per 100 000 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. RESULTS: From 2010 to 2023, estimated incident cases declined from approximately 1.36 million to 902 000, and age-standardised incidence from 103.8 to 52.3 per 100 000. Age-standardised prevalence, death and DALY rates declined from 6.6 to 3.3, 1.3 to 0.7, and 96.9 to 53.9 per 100 000, 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 approximately 403 000, mainly due to lower age-specific DALY rates. Traveller risk ranged from 0.03 to 9.0 expected cases per 100 000 travellers, with the five highest-risk destinations in Central Sub-Saharan Africa. Scenario extrapolation suggested incidence may decline to 36.1 per 100 000 by 2030. CONCLUSIONS: 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.