Integrated Approaches to Controlling Typhoid Fever in Uganda: Synergizing Vaccination, Sanitation, and antibiotic stewardship

Typhoid fever remains a significant public health challenge in Uganda, exacerbated by inadequate water sanitation, antimicrobial resistance (AMR), and limited vaccine coverage. The disease, caused by Salmonella enterica serovar Typhi, is primarily transmitted through contaminated food and water, disproportionately affecting urban slums and rural communities. This review explores an integrated approach to controlling typhoid fever by synergizing vaccination, sanitation, and antibiotic stewardship. While typhoid conjugate vaccines (TCVs) offer a promising prevention strategy, their accessibility and implementation face financial and logistical barriers. Water, Sanitation, and Hygiene (WASH) interventions play a crucial role in reducing transmission, yet infrastructural deficiencies hinder their effectiveness. Additionally, the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) S. Typhi strains necessitates stronger antibiotic stewardship programs to regulate antibiotic use and mitigate resistance. This review underscores the need for a comprehensive, multi-sectoral strategy to combat typhoid fever in Uganda, integrating vaccination programs, improved sanitation infrastructure, and responsible antibiotic use to reduce disease burden and enhance public health outcomes. Keywords: Typhoid fever, Salmonella Typhi, Uganda, typhoid conjugate vaccines (TCVs), antimicrobial resistance (AMR)