Burden of enteric fever in the India-Bangladesh-Myanmar border region

Burden of enteric fever in the India-Bangladesh-Myanmar border region | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Burden of enteric fever in the India-Bangladesh-Myanmar border region Lalfakzuala Pautu, Pooja T Prakash, Vanlalrengpuia Chinzah, Pachuau Lalmalsawma, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6879929/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background India is estimated to contribute greater than 50% of the global burden of enteric fever. Despite the huge burden, typhoid vaccination is currently not included in the national immunization schedule, mainly due to lack of reliable disease estimates, especially at the state and district levels. Methods Mizoram’s district-wise incidence rates of enteric fever cases (n = 30000) from January 2022 to September 2024 were calculated per 100 000-person-years. A chi-square test and multivariate logistic regression were carried out to identify sociodemographic and clinical variables associated with hospitalization. The spatial distribution, including the proportion of typhoid and paratyphoid cases, was mapped using the geographic information system. Results The incidence of typhoid and paratyphoid in Mizoram was 653 cases (95% CI: 645–661) and 190 cases (95% CI: 185–194) per 100 000 person-years, respectively. Age < 2 years and fever < 7 days were significant predictors of hospitalization; the hospitalization odds for S . Typhi and S . Paratyphi were not significant (p = 0.958). A high proportion of paratyphoid cases occurred along the Bangladesh border. Conclusion The huge burden of enteric fever across the rural and urban districts of Mizoram provides compelling evidence for the inclusion of typhoid vaccination in the national immunization schedule. Health sciences/Diseases/Infectious diseases Health sciences/Health care/Health policy Health sciences/Health care/Health services Health sciences/Health care/Public health Enteric fever typhoid paratyphoid Mizoram North-East India Figures Figure 1 Figure 2 Figure 3 Introduction Typhoid and paratyphoid, collectively known as enteric fever, are systemic infections caused by Salmonella enterica serovars Typhi ( S. Typhi) and Paratyphi ( S . Paratyphi) A, B or C, respectively. Transmitted via the fecal-oral route, enteric fever is characterized by the gradual onset of fever, accompanied by abdominal symptoms 1 . If treatment is delayed or not treated with appropriate antibiotics, it may lead to internal bleeding and perforation of the digestive system in some cases 2 . The case fatality rate (CFR) of enteric fever is estimated to be 2.49–4.45% among hospitalized patients 3 . In 2021, the global burden of enteric fever was estimated to be ~ 9·32 million cases and 107.5 thousand deaths 4 ; ~7·15 million (76.7%) of the enteric fever cases and 93.3 thousand deaths (86.7%) were attributed to S . Typhi 4 . India’s contribution to the global enteric fever cases and deaths was estimated to be 5.4 million cases (58%) and 51.5 thousand deaths (48%) 4 . Largely extrapolated from regional data, the 2021 Global Burden of Disease estimated enteric fever incidence in India to be 411.5 cases per 100 000 person-years 4 . In recent years, at several cities in India, S . Typhi and S . Paratyphi resistant to azithromycin and third-generation cephalosporins have been reported 5 – 8 . If strains resistant to the first line of antibiotics for enteric fever—ciprofloxacin, ceftriaxone, and azithromycin spread, then treatment of enteric fever would shift from oral to parenteral antibiotics, creating an enormous strain on the health systems 9 . In 2018, the typhoid vaccine based on the Vi polysaccharide has been recommended by the WHO for high-burden countries 10 . However, widespread public use of this vaccine is hindered by the lack of accurate incidence estimates at the district level across India. A National Surveillance System for Enteric Fever in India (NSSEFI) study from 2017-18 in children between 6 months to 14 years based on four cohorts has identified typhoid incidence estimates ranging from 35 to 1173 cases per 100 000 child-years 9 . The NSSEFI study in hospitalized patients, based on six hybrid surveillance sites from 2018-20, has reported incidence from 12 to 1622 9 , underscoring the data heterogeneity in different sites. Similar regional differences were reported in earlier studies carried out in Delhi (976 cases per 100 000 person-years) in 1995-96 11 and Kolkata (265 cases per 100 000 person-years) in 2006 12 . In addition to regional differences, understanding the heterogeneity of enteric fever at the district level in individual states is critical for developing focused intervention strategies and informing policy decisions on vaccine use. Mizoram is a North-East (NE) Indian state located in the Indo-Myanmar region and shares international boundaries with Bangladesh to its west and Myanmar to its east. For decades, malaria has been the major public health concern in the state 13 . In the last decade, dengue 14 , scrub typhus 15 , and typhoid have also emerged as a serious public health threat. Despite the limited resources, Mizoram has an efficient healthcare system that has integrated screening of malaria, scrub typhus, dengue, and typhoid across its health units. To guide policy on vaccination and implement micro-level strategies for the control of enteric fever, we report the incidence rates at the district level and spatial distribution of S . Typhi and S . Paratyphi at the village level across Mizoram. The data presented here could guide intervention efforts and health policies in NE India and the bordering districts of Bangladesh and Myanmar. Methods Data source: A retrospective deidentified line listing data for enteric fever cases from 2022 (n = 4499), 2023 (n = 15192), and 2024 (up to September) (n = 10309) were obtained from the Integrated Disease Surveillance Program of Mizoram’s Health and Family Welfare Department. The reported data is from government primary health centres, community health centres, subdistrict hospitals, district hospitals, medical college and hospital, and private hospitals. The diagnostic tests used were Widal test, immunochromatographic test (Typhidot), and culture. The line listing includes information on age, sex, village, district, provisional diagnosis, date of diagnosis, type of diagnosis, pathogen type, hospital type and inpatient hospitalization. Statistical analysis: District-wise incidence rates were calculated per 100 000 person-years for < 15 and ≥ 15 years using 2020 population estimates 16 – 18 . The projected population for Saitual district (separated from Aizawl in 2019) was estimated by applying Aizawl’s growth rate from 2011 to 2021 19 . Typhidot was used to diagnose enteric fever in 48% of the cases (n = 15447). As Typhidot cannot differentiate between S . Typhi and S . Paratyphi, incidence rates of typhoid and paratyphoid were extrapolated based on the age and district-wise S . Typhi and S . Paratyphi cases diagnosed by the Widal test and Culture. In 2023, enteric fever diagnosis in the Saiha district was made only with Typhidot; here, the extrapolation was carried out with data from the neighbouring Lawngtlai district that shares similar demographic characteristics. The chi-square test was performed to assess the association between socio-demographic and clinical variables with hospitalization, using IBM SPSS software (version 29.0). Age was categorized into five groups: below 2 years, 2–4 years, 5–14 years, 15–44 years, and 45 years and above; districts were classified as urban (Aizawl) and rural (other districts); hospitals were categorised into public and private; provisional diagnosis included fever < 7 days and fever ≥ 7 days, and typhoid consisted of patients with fever, headache, abdominal pain, nausea, constipation and sometimes rashes; pathogen types were classified as S . Typhi and S . Paratyphi. The variables significant at p-value < 0.05 were selected for multivariate logistic regression analysis using STATA version 13. Standard errors were adjusted for 11 clusters representing the 11 districts of the state to account for potential intra-cluster correlation in hospitalization outcomes, due to shared environmental factors and healthcare access within the districts. Adjusted odds ratios (aOR) and unadjusted odds ratios (uOR) with a confidence interval (CI) of 95% were calculated; p-value < 0.05 is considered significant. Only cases diagnosed by Widal test and Culture (n = 15447) were used for logistic regression. Variance inflation factor (VIF) was calculated as an indicator for multicollinearity in the logistic regression model. The Receiver Operator Characteristic (ROC) curve was developed, and the area under curve (AUC) for ROC curves was computed for the logistic regression model in order to assess model discrimination and validate identified risk factors. Spatial analysis: Based on the line listing data, 834 case locations across Mizoram’s 11 districts were extracted through Google Maps and assigned unique spatial identifiers for the preparation of a spatial database using ArcGIS 10.4 software ( https://desktop.arcgis.com ). The year-wise distribution of enteric fever cases from 2022 to 2024 (up to September) and the proportionate distribution of typhoid and paratyphoid cases were mapped using a dot-mapping technique, with dot sizes proportional to case numbers. Ethics statement: The IRB that waived informed consent for the research described was the Institutional Human Ethics Committee (IHEC), Central University of Kerala (CUK/IHEC/2024/D/07). We confirm that all methods performed in this study were in accordance with the protocol reviewed and approved by the IHEC. As it is a secondary data analysis with de-identified data, informed consent is not applicable. Results Incidence of enteric fever across the different districts of Mizoram The socio-demographic and clinical characteristics of enteric fever cases in Mizoram are shown in Table 01 . S . Typhi and S . Paratyphi account for 88.3% (n = 26474) and 11.7% (n = 3522) of the enteric fever cases in Mizoram, respectively. The age group highest affected was 15–44 (41.5%), followed by ≥ 45 (22.5%) and 5–14 (22.4%). A higher incidence of enteric fever among children < 15 years was observed compared to those ≥ 15 years across all months (Supplementary Fig. 01) . Even though enteric fever cases are reported throughout the year, the incidence peaks in August, and the cases steeply decline from September onwards; May to September is the monsoon season in Mizoram. Table 01 Socio-demographic and clinical profile of enteric fever in Mizoram (2022-September 2024) (n = 29996) Male n (%) Female n (%) Total n (%) Type of pathogen Salmonella Typhi 11133 (77.9%) 12104 (77%) 23237 (77.5%) Salmonella Paratyphi 3154 (22.1%) 3606 (23%) 6760 (22.5%) Age group Below 2 years 705 (5%) 589 (3.7%) 1294 (4.3%) 2–4 years 1400 (9.9%) 1385 (8.8%) 2785 (9.3%) 5–14 years 3507 (24.7%) 3221 (20.4%) 6728 (22.4%) 15–44 years 5536 (39%) 6902 (43.7%) 12438 (41.5%) 45 years and above 3058 (21.5%) 3693 (23.4%) 6751 (22.5%) Provisional diagnosis Only fever = 7 days 1929 (13.6%) 2167 (13.7%) 4096 (13.7%) Typhoid a 5575 (39.2%) 6471 (41%) 12046 (40.2%) Type of sample collected Blood 4284 (30.2%) 4655 (29.5%) 8939 (29.8%) Plasma 101 (0.7%) 162 (1%) 263 (0.9%) Serum 9821 (69.1%) 10973 (69.5%) 20794 (69.3%) Diagnostic test performed Widal test 6800 (47.9%) 7535 (47.7%) 14335 (47.8%) Typhidot RDT 6835 (48.1%) 7679 (48.6%) 14514 (48.4%) Culture 571 (4%) 576 (3.6%) 1147 (3.8%) Hospitalization IPD 921 (6.5%) 996 (6.3%) 1917 (6.4%) OPD 13285 (93.5%) 14794 (93.7%) 28079(93.6%) Type of hospital Public 11167 (78.61%) 12372 (78.35%) 23539 (78.47%) Private 3039 (21.39%) 3418 (21.65%) 6457 (21.53%) Place of residence b Urban 3833 (27%) 4361 (27.6%) 8194(27.3%) Rural 10373 (73%) 11429 (72.4%) 21802(72.7%) Total 14206 15790 29996 Note: The transgenders in the dataset were excluded due to their negligible count (n = 4); a Typhoid symptoms – Fever, headache, diarrhoea, and rashes in some cases; b Place of residence- Aizawl is considered urban, and the rest as rural The age-wise incidence of typhoid and paratyphoid fever are shown in Tables 02 and 03 , respectively . From January 2022 to September 2024, the average annual incidence of typhoid for children < 15 years was 745 cases per 100 000 child-years (95% CI:729–761), and in age group ≥ 15, it was 609 (95% CI:600–619). For paratyphoid, it was 204 (95% CI: 196–212) and 183 (95% CI:178–189) cases per 100 000 person-years for < 15 and ≥ 15 years, respectively. In the study period, with 1526 cases per 100 000 child-years (95% CI:1457–1595), Lunglei district bordering Bangladesh reported the highest incidence of typhoid in children < 15 years, while the lowest incidence in this age group was reported by Saitual district [220 cases per 100 000 child-years (95% CI:179–261). For the age group ≥ 15, Hnahthial district bordering Myanmar reported the highest typhoid incidence with 1495 cases per 100 000 person-years (95% CI: 1403–1588), while Saitual district reported the lowest incidence with 155 cases per 100 000 person-years (95% CI:132–179). In the case of paratyphoid, Saitual reported the highest incidence with 1009 cases per 100 000 child-years (95% CI:921–1097) for < 15, and Serchhip reported 1072 cases per 100 000 person-years (95% CI:1013–1131) for ≥ 15 years, whereas Khawzawl reported the lowest incidence in both the age groups (3 and 6 cases per 100 000 person-years, respectively). Table 02 Incidence of age-wise typhoid fever among the districts in Mizoram from 2022- September 2024 (n = 23240) Districts 2022 (Cases/ 100 000 person-years) 2023 (Cases/ 100 000 person-years) 2024 (until September) (Cases/ 100 000 person-years) Average incidence (2022- September 2024) (Cases/ 100 000 person-years) Below 15 15 and above Total Below 15 15 and above Total Below 15 15 and above Total Below 15 15 and above Total Aizawl Cases 429 890 1319 1311 2869 4180 622 1788 2410 2362 5547 7909 Incidence 293 [266–321] 286 [268–305] 289 [273–304] 896 [848–945] 923 [889–957] 914 [887–942] 567 [522–612] 767 [731–803] 703 [675–731] 587 [563–611] 649 [632–666] 629 [615–643] Champhai Cases 231 164 395 439 474 913 302 592 894 972 1230 2202 Incidence 697 [607–787] 233 [197–269] 381 [344–419] 1325 [1201–1449] 673 [613–734] 882 [824–939] 1215 [1078–1352] 1123 [1032–1213] 1152 [1077–1228] 1067 [1000–1134] 636 [600–671] 774 [741–806] Hnahthial Cases 134 306 440 178 397 575 100 297 397 412 1000 1412 Incidence 1171 [973–1369] 1258 [1117–1399] 1230 [1115–1345] 1556 [1327–1784] 1633 [1472–1793] 1608 [1477–1739] 1165 [937–1394] 1629 [1443–1814] 1480 [1335–1626] 1309 [1183–1436] 1495 [1403–1588] 1436 [1361–1511] Khawzawl Cases 23 42 65 195 191 386 63 127 190 281 360 641 Incidence 193 [114–272] 166 [116–216] 174 [132–217] 1635 [1406–1865] 754 [647–861] 1036 [933–1139] 704 [531–878] 668 [552–785] 680 [583–777] 857 [757–957] 517 [463–570] 626 [577–674] Kolasib Cases 77 93 170 224 278 502 72 132 204 373 503 876 Incidence 222 [172–271] 126 [100–151] 157 [133–180] 644 [560–729] 376 [332–421] 462 [422–503] 276 [212–340] 240 [199–281] 252 [217–286] 390 [351–430] 248 [226–270] 294 [274–313] Lawngtlai Cases 107 103 210 351 416 767 192 285 477 650 804 1454 Incidence 226 [183–269] 102 [83–122] 142 [123–161] 742 [664–819] 414 [374–453] 519 [482–555] 541 [464–617] 378 [334–422] 430 [391–469] 499 [461–538] 291 [271–311] 357 [339–376] Lunglei Cases 157 227 384 1056 1335 2391 644 1063 1707 1857 2625 4482 Incidence 355 [299–410] 241 [210–273] 278 [250–305] 2386 [2242–2530] 1420 [1343–1496] 1729 [1660–1798] 1940 [1790–2090] 1507 [1417–1598] 1646 [1568–1724] 1526 [1457–1595] 1015 [976–1054] 1179 [1144–1213] Mamit Cases 41 111 152 390 640 1030 169 314 483 600 1065 1665 Incidence 134 [93–174] 167 [136–198] 156 [131–181] 1244 [1121–1367] 961 [886–1035] 1051 [987–1116] 719 [610–827] 628 [559–698] 657 [599–716] 697 [641–753] 581 [546–616] 618 [589–648] Saiha Cases 43 87 130 202 250 452 116 184 300 361 521 882 Incidence 285 [200–370] 274 [217–332] 278 [230–325] 1338 [1153–1522] 779 [683–876] 958 [870–1046] 1024 [838–1211] 765 [654–875] 848 [752–944] 869 [780–959] 592 [541–642] 680 [636–725] Saitual Cases 13 26 39 77 83 160 21 57 78 111 166 277 Incidence 71 [32–110] 67 [41–93] 68 [47–90] 421 [327–514] 213 [167–259] 280 [236–323] 153 [88–218] 195 [145–246] 182 [141–222] 220 [179–261] 155 [132–179] 176 [155–197] Serchhip Cases 159 217 376 248 342 590 100 374 474 507 933 1440 Incidence 780 [659–901] 501 [434–568] 590 [531–650] 1217 [1065–1368] 790 [706–873] 926 [852–1001] 654 [526–782] 1151 [1035–1268] 992 [903–1082] 905 [826–983] 783 [733–894] 822 [780–865] Mizoram Cases 1414 2266 3680 4671 7275 11946 2401 5213 7614 8486 14754 23240 Incidence 341 [324–359] 258 [247–269] 285 [276–294] 1128 [1095–1160] 826 [807–845] 923 [906–939] 773 [742–804] 790 [768–811] 784 [767–802] 745 [729–761] 609 [600–619] 653 [644–661] Note: The population was taken from Harvard population estimates for 2022 except for Saitual. The population for Saitual was calculated from the percentage increase of Aizawl and the population of the 2011 census of Saitual. Incidence was calculated as cases per 100000 child-years for < 15 years age group and cases per 100000 person-years for ≥ 15 years age group. Cumulative incidence calculates the incidence during the study period (2 years, 9 months) Table 03 Incidence of age-wise paratyphoid fever among the districts in Mizoram from 2022- September 2024 (n = 6760) Districts 2022 (Cases/ 100 000 person-years) 2023 (Cases/ 100 000 person-years) 2024 (until September) (Cases/ 100 000 person-years) Average incidence (2022- September 2024) (Cases/ 100 000 person-years) Below 15 15 and above Total Below 15 15 and above Total Below 15 15 and above Total Below 15 15 and above Total Aizawl Cases 28 36 64 60 135 195 18 9 27 106 180 286 Incidence 19 [12–26] 12 [8–15] 14 [11–17] 41 [31–51] 43 [36–51] 43 [37–49] 16 [9–24] 4 [1–6] 8 [5–11] 26 [21–31] 21 [18–24] 23 [20–25] Champhai Cases 29 41 70 63 110 173 42 53 95 134 204 338 Incidence 88 [56–119] 58 [40–76] 68 [52–83] 190 [143–237] 156 [127–185] 167 [142–192] 169 [118–220] 98 [72–125] 121 [97–145] 147 [122–172] 105 [90–119] 118 [106–131] Hnahthial Cases 1 6 7 7 53 60 0 5 5 8 64 72 Incidence 9 [-8-26] 25 [5–44] 20 [5–34] 61 [16–106] 218 [159–277] 168 [125–210] 0 [0–0] 27 [3–51] 19 [2–35] 25 [8–43] 96 [72–119] 73 [56–90] Khawzawl Cases 0 0 0 1 2 3 0 2 2 1 4 5 Incidence 0 [0–0] 0 [0–0] 0 [0–0] 8 [-8-25] 8 [-3-19] 8 [-1-17] 0 [0–0] 11 [-4-25] 7 [-3-17] 3 [-3-9] 6 [0–11] 5 [1–9] Kolasib Cases 23 26 49 103 172 275 20 80 100 146 278 424 Incidence 66 [39–93] 35 [22–49] 45 [32–58] 296 [239–354] 234 [199–269] 254 [224–284] 77 [43–110] 144 [113–176] 123 [99–147] 153 [128–178] 137 [121–153] 142 [128–155] Lawngtlai Cases 5 10 15 143 229 372 74 156 230 222 395 617 Incidence 11 [1–20] 10 [4–16] 10 [5–15] 302 [253–352] 228 [198–257] 252 [226–277] 208 [161–256] 207 [174–239] 207 [181–234] 170 [147–192] 143 [129–157] 152 [140–164] Lunglei Cases 86 156 242 221 377 598 225 345 570 532 878 1410 Incidence 194 [153–235] 166 [140–192] 175 [153–197] 499 [434–565] 401 [360–441] 432 [398–467] 678 [589–767] 489 [438–541] 550 [504–595] 437 [400–474] 340 [317–362] 371 [351–390] Mamit Cases 42 79 121 28 66 94 16 58 74 86 203 289 Incidence 134 [93–174] 119 [92–145] 124 [101–146] 89 [56–122] 99 [75–123] 96 [77–115] 68 [35–101] 116 [86–146] 101 [78–124] 99 [78–120] 111 [96–126] 107 [95–119] Saiha Cases 2 9 11 82 138 220 44 101 145 128 248 376 Incidence 13 [-5-32] 25 [8–42] 21 [8–34] 543 [426–661] 430 [358–502] 466 [405–528] 389 [274–503] 420 [338–502] 410 [343–476] 308 [255–362] 280 [245–315] 289 [260–318] Saitual Cases 30 33 63 262 285 547 216 387 603 508 705 1213 Incidence 164 [105–222] 85 [56–114] 110 [83–137] 1431 [1258–1604] 732 [647–818] 956 [876–1036] 1573 [1363–1783] 1326 [1194–1458] 1405 [1293–1517] 1009 [921–1097] 659 [610–708] 771 [728–814] Serchhip Cases 53 124 177 165 545 710 235 608 843 453 1277 1730 Incidence 260 [190–330] 286 [236–337] 278 [237–319] 810 [686–933] 1258 [1153–1364] 1115 [1033–1197] 1537 [1341–1734] 1872 [1723–2021] 1765 [1646–1884] 808 [734–883] 1072 [1013–1131] 988 [941–1034] Mizoram Cases 299 520 819 1135 2112 3247 890 1804 2694 2324 4436 6760 Incidence 72 [64–80] 59 [54–64] 63 [59–68] 274 [258–290] 240 [230–250] 251 [242–259] 286 [268–305] 273 [261–286] 277 [267–288] 204 [196–212] 183 [178–189] 190 [185–194] Note: The population was taken from Harvard population estimates for 2022 except for Saitual. The population for Saitual was calculated from the percentage increase of Aizawl and the population of the 2011 census of Saitual. Incidence was calculated as cases per 100000 child-years for < 15 years age group and cases per 100000 person-years for ≥ 15 years age group. Average annual incidence calculated for the study period of 2 years, 9 months For children < 15 years, Mamit, Lunglei, and Lawngtlai, the districts bordering Bangladesh, reported typhoid incidence of 697 (95% CI:641–753), 1526 (95% CI:1457–1595) and 499 (95% CI:461–538) cases per 100 000 child-years, respectively, and for the age group ≥ 15, the incidence was 581 (95% CI:546–616), 1015 (95% CI:976–1054) and 291 (95% CI:271–311) cases per 100 000 person-years, respectively. The paratyphoid incidence for children < 15 years in Mamit, Lunglei, and Lawngtlai was 99 (95% CI:78–120), 437 (95% CI:400–474), and 170 cases per 100 000 child-years (95% CI:147–192) respectively, and for age group ≥ 15, the incidence was 111 (95% CI:96–126), 340 (95% CI:317–390) and 143 (95% CI:129–157), respectively. The typhoid incidence in Champhai district for the age group < 15 years was 1067 (95% CI:1000–1134) and 636 cases per 100 000 child-years (95% CI:600–671) in the age group ≥ 15. In the Champhai district, the paratyphoid incidence was 147 (95% CI:122–172) and 104 cases per 100 000 person-years (95% CI:90–119) for < 15 and ≥ 15 years, respectively. In the study years, the highest annual typhoid incidence in children < 15 years was reported in 2023 at the Lunglei district [2386 cases per 100 000 child-years (95% CI:2242–2530)], while for age group ≥ 15 years, it was 1633 cases per 100 000 person-years (95% CI:1472–1793) in 2023 from Hnahthial district. For paratyphoid, in 2023, Saitual and Serchhip reported the highest incidence of 1431 (95% CI:1258–1604) and 1258 (95% CI:1153–1364) cases per 100 000 person-years for age groups < 15 and ≥ 15, respectively. Enteric fever incidence stratified by diagnostic tests across districts ( Supplementary Table 01 ) highlights incidence estimates by diagnostic method. Sociodemographic and clinical factors affecting the hospitalization of enteric fever cases in Mizoram S . Typhi (87%), private hospitals (66%), urban residence (57%), provisional diagnosis of fever < 7 days (54.5%), Widal test (54.1%), and age group 15–44 years (40.5%) accounted for increased hospitalization rates of enteric fever ( Supplementary table 02) . Children < 2 years have higher odds of hospitalization compared to older children (2–4 years: AOR 0.52, 5–14 years: AOR 0.37) and adults (15–44 years: AOR 0.45). People in rural areas are less likely to be hospitalized (AOR 0.53) than those in urban areas. Hospital type is a significant determinant, with patients in private hospitals having higher odds of hospitalization (AOR 11.36) than in public hospitals (Table 04 ). The odds of hospitalization for S . Typhi and S . Paratyphi were not statistically significant (p = 0.958). The area under the ROC curve (0.83) ( Supplementary Fig. 02 ) and mean Variance Inflation Factor (2.45) indicates a strong discriminative ability to identify the hospitalized cases and a low correlation among variables, respectively. Table 04 Factors associated with hospitalization of enteric fever cases (n = 15447) Study variables AOR (95% CI) p-value Sex Female (ref) Male 0.96 (0.84–1.10) 0.525 Age < 2 years (ref) 2–4 years 0.52 (0.38–0.70) ≤ 0.001* 5–14 years 0.37 (0.28–0.49) ≤ 0.001* 15–44 years 0.45 (0.35–0.57) ≤ 0.001* 45 years and above 0.84 (0.65–1.09) 0.101 Place of residence Urban (ref) Rural 0.53 (0.45–0.62) ≤ 0.001* Provisional diagnosis Fever = 7 days 1.02 (0.82–1.28) 0.835 Typhoid 0.41 (0.3500.47) ≤ 0.001* Pathogen Typhi (ref) Paratyphi 0.99 (0.81–1.22) 0.958 Hospitalization type Public (ref) Private 11.36 (9.69–13.30) ≤ 0.001* Spatial analysis As seen in Fig. 01 , the enteric fever cases are clustered in and around the major urban centres of Mizoram—Aizawl has more case locations, followed by the towns Serchhip, Lunglei, and Saiha. The towns/villages with > 500 cases are in the western districts of Lunglei and Mamit, bordering Bangladesh. Even though locations with 101–500 cases are observed in all the districts, their proportions are very high in Aizawl, Serchhip, Hnahthial and Lunglei. Compared to 526 in 2022, the case locations increased to 741 in 2023. Similarly, 29 locations reported > 101 cases in 2023 compared to five in 2022 Fig. 02 . The year-wise proportions of typhoid and paratyphoid cases are shown in Fig. 03 . In 2022, typhoid dominated across all the districts. However, in 2023, the paratyphoid proportion increased with higher concentrations across the Bangladesh border. Even though Lawangtlai reported higher single-digit case locations, majority of its case locations, especially in the villages bordering Bangladesh, reported paratyphoid cases in 2023 and 2024, with a significant shift from typhoid (2022) to paratyphoid (2023). Another district with a higher number of paratyphoid case locations is Saitual. Discussion The study sheds key insight into the huge burden of typhoid and paratyphoid, their spatial distribution across the districts, hotspots, and hospitalization rates in Mizoram. The great strength of this data is that it is reported from health units distributed across the state, where enteric fever diagnostics is integrated into routine screening, and thus provides information on the true burden at village-level across the districts of an entire state in India. Cao et al., 2021, based on geospatial statistical modelling, have predicted India’s and Mizoram’s typhoid incidence rate to be 360 and 444 cases per 100 000 person-years, respectively 20 . At an average yearly incidence of 653 cases per 100 000 person-years ( Supplementary table 03 ), the incidence from Mizoram is ~ 1.5 times higher than predicted by Cao et al., 2021. In children < 15 years, with 1526 cases per 100 000 child-years, the typhoid incidence in the rural district of Lunglei, bordering Bangladesh, is on par with the estimates in the urban sites of Vellore (1955) and Chandigarh (1622), reported earlier 9 . Even though Mizoram is endemic for typhoid, the high incidence rates are observed only from 2022 onwards. When compared to 25,647 cases reported from 2011-21 (Supplementary Fig. 03) 21 , there were 4499, 15193, and 10308 cases reported in 2022, 2023, and 2024 (up to September), respectively. The recent increase in enteric fever cases might be due to multiple factors, including improved health-seeking behavior for febrile illness 22 , increased use of point-of-care testing combined with clinical diagnosis, and implementation of real-time reporting in the Integrated Health Information Platform 23 . Widal test and Typhidot test, despite their widespread use in peripheral healthcare units, have low diagnostic specificity 24 , 25 . Notably, Typhidot has been shown to yield false-positive results in patients with dengue fever due to serological cross-reactivity, which is concerning in dengue-endemic regions 26 . However, the poor infrastructure and lack of training allow the peripheral health centers to rely on these tests instead of the gold standard blood/bone marrow culture. In addition, there is growing concern about the emergence of antimicrobial-resistant strains in Mizoram. Antimicrobial resistance (AMR) poses a serious threat to enteric fever control efforts in South Asia. Pakistan has reported outbreaks of extensively drug-resistant S . Typhi 27 – 30 . Azithromycin-resistant S . Typhi has also been reported in Pakistan, Bangladesh and Nepal. Mizoram shares its international borders with typhoid-endemic countries of Bangladesh 31 and Myanmar 32 , 33 . Azithromycin resistance to S . Typhi and S . Paratyphi has been reported in Bangladesh, with the first case identified as early in 2013 34 . While no data on enteric fever AMR is available from Myanmar, AMR to first-line antibiotics for other bacterial infections is prevalent 35 . In recent years, Mizoram has seen an influx of refugees from Bangladesh and Myanmar 36 – 38 ; genomic analysis could give important insights into the population structure of the circulating enteric fever strains and drug resistance. Mizoram also has a huge burden of scrub typhus and other rickettsial infections 15 ; the incidence rates are the highest in India. Across Mizoram, there is a continuous and heavy use of antibiotics, including azithromycin, to treat scrub typhus and enteric fever; sustained antibiotic use could lead or have led to the emergence of drug-resistant S . Typhi and S . Paratyphi strains. Even though extensively drug-resistant S . Typhi has not been reported in India, the recent reports of resistance to azithromycin 39 and third-generation cephalosporins 5 – 7 , 40 are worrying. With several districts in Mizoram reporting very high incidence rates, the status of drug resistance in the circulating strains of S . Typhi and S . Paratyphi in this region must be assessed urgently. Mizoram’s enteric fever incidence estimates reported here and status of drug resistance will be highly relevant for policy and intervention measures in the bordering districts of Bangladesh and Myanmar. In 2018, the WHO recommended the use of typhoid conjugate vaccines (TCV) to be prioritized in high-burden countries 10 . As of 2024, WHO has prequalified the use of three typhoid conjugate vaccines due to their effectiveness, safety, single-use, protection > 4 years and suitability to children > 6 months of age 41 . The regions with > 100 typhoid cases per 100 000 person-years are categorized as high burden 42 . Mizoram, with typhoid incidence of 653 cases per 100 000 person-years and high hospitalization rates of children < 2 years (OR = 2.03) and adults ≥ 45 years (OR = 2.71), would greatly benefit from vaccination with TCV. In India, the cost of enteric fever treatment is high and varies in different settings; the mean direct cost of severe enteric fever ranges from US $ 119.1 (95% CI, US $ 85.8–152.4) in smaller hospitals in urban slums/rural/tribal settings and US $ 405.7 (95% CI, US $ 366.9–444.4) in urban referral hospitals 43 . Introducing TCV can prevent typhoid cases and deaths up to 17–36% in urban areas and 19–36% in rural areas 44 . Vaccination with TCV is suggested to be cost-effective in countries with 300 or more typhoid cases per 100 000 person-years 45 . Within the first 10 years of implementing a nationwide community-based catchup campaign targeting children aged 1–15 years alongside routine vaccination in India, TCV could avert 21–39 million cases and save $ 1.6– $ 2.2 billion 46 . However, it is important to note that TCV does not confer protection against S . Paratyphi. Currently, there are no vaccines licensed to use against S . Paratyphi; a bivalent vaccine against S . Typhi and S . Paratyphi was shown to be safe and immunogenic in a phase I trial 47 , and in late 2024, the results on the efficacy of a paratyphoid vaccine in a controlled human infection model will be known 48 – 50 . According to GBD 2021, S . Paratyphi is estimated to contribute 30% of the global enteric fever burden and 14 000 deaths per year 51 . Mizoram’s S . Paratyphi burden was ~ 23% and showed an average annual incidence of 189 cases per 100 000 person-years. Saitual and Serchhip had high paratyphoid burden (770 and 987 cases per 100 000 person-years). Except for three districts (Aizawl, Hnahthial, and Khawzawl), the remaining eight districts reported > 100 cases per 100 000 person-years. Interestingly, Hnahthial reported the highest incidence of typhoid (1434 cases per 100 000 person-years) in Mizoram, and typhoid incidence of other five districts (Champhai, Khawzawl, Lunglei, Mamit, Serchhip) is also higher than the state’s average, suggesting the dominant distribution of S . Typhi over S . Paratyphi in some regions in Mizoram. The paratyphoid incidence of Mizoram is higher than the previous studies reported in India 9 , 52 . Even though S . Paratyphi incidence is less in Mizoram, the odds of hospitalization are statistically not significant for S . Typhi, indicating the need for vaccination for both S . Typhi and S . Paratyphi to effectively control the burden of enteric fever. It remains to be seen if the implementation of TCV will increase the incidence of S . Paratyphi in Mizoram and India. In 2021, paratyphoid was estimated to contribute almost one-fourth of the enteric fever burden 53 , 54 , the observations of rise in paratyphoid cases may be due to increased vaccination against typhoid 55 . The study has some notable limitations. Firstly, 97.2% of clinically suspected typhoid cases were diagnosed using the Widal test or the Typhidot RDT test, which has low diagnostic accuracy when compared to the gold standard blood/bone marrow culture. We could not calculate the CFR attributable to typhoid and paratyphoid due to the absence of mortality data. The duration of hospitalization is considered a proxy indicator of the severity; the duration of hospitalization in paratyphoid is shorter 56 . As we lacked data on the duration of hospitalization, we could not compare the recovery time in typhoid and paratyphoid. As enteric fever cases are reported from health units across Mizoram, the decision of the handling physician to perform enteric fever diagnosis could affect the final data from individual health units. Furthermore, segregation of Typhidot-positive cases to S . Typhi and S . Paratyphi based on the data from the Widal test and culture may not be entirely accurate. For decades, malaria has been the major public health concern in Mizoram. In recent years, the state is also witnessing a huge burden of scrub typhus and typhoid. The high incidence of infectious diseases in Mizoram is due to the integration of specific diagnostics in its healthcare units, which results in early diagnosis and prompt treatment. With efficient diagnostics and accurate reporting, a similar burden of enteric fever might also be seen in several parts of India, thus underlining a strong case for including typhoid vaccination in the immunization schedule. Conclusions The high incidence rates of enteric fever across Mizoram and increased hospitalization of children < 2 years of age in the study present compelling evidence for the urgent implementation of TCV in Mizoram. The steep increase in enteric fever incidence in 2022 and 2023 warrants immediate assessment of the status of antibiotic resistance to the circulating strains of S . Typhi and S . Paratyphi. The findings of this study could also have important public health implications on enteric fever control in the districts of Bangladesh and Myanmar that border Mizoram. Declarations Authors' contributions LP, PTP, and PBN conceptualized, designed, and wrote the first draft of the manuscript. CV, and PTW contributed to the literature search. VC, VL, EZ, PKB, SKB, and KB contributed to the review and editing of the manuscript. PKB and PTP analysed the data, and KB made the figure. All authors have read and agreed to the final version of the manuscript. Ethics approval The IRB that waived informed consent for the research described was the Institutional Human Ethics Committee (IHEC), Central University of Kerala (CUK/IHEC/2024/D/07). We confirm that all methods performed in this study were in accordance with the protocol reviewed and approved by the IHEC. As it is a secondary data analysis with de-identified data, informed consent is not applicable. Availability of data and materials The data that support the findings of this study are available from the Integrated Disease Surveillance Program of Mizoram’s Health and Family Welfare Department and are not publicly available. The request for de-identified datasets should be made to Dr. Lalfakzuala Pautu, State Vector Borne Disease Control Programme, Health & Family Welfare Department, Mizoram, Email ID: [email protected] . Competing interests The authors declare that they have no competing interests Funding No funding received to the current study References Basnyat, B., Qamar, F. 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10:20:44","extension":"html","order_by":24,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":285077,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-6879929/v1/834d7a049b1eec9b73ed81f4.html"},{"id":91847847,"identity":"2cfd5ac4-bd02-430e-b5b2-b8890c63c5e9","added_by":"auto","created_at":"2025-09-22 10:28:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":3954888,"visible":true,"origin":"","legend":"\u003cp\u003eSpatial distribution of enteric fever case locations in the districts of Mizoram reported during 2022- September 2024.\u003c/p\u003e\n\u003cp\u003eThe size of the dots proportionately represents the number of cases. The case distributions are comparatively higher in the urban centres, especially in Aizawl—the state capital of Mizoram. The location of Mizoram in North East India is depicted in the insert map. The neighbouring countries and states are labelled with a background map sourced from ESRI online map services.\u003c/p\u003e","description":"","filename":"Figure01.png","url":"https://assets-eu.researchsquare.com/files/rs-6879929/v1/7d072c5b762df5edba499212.png"},{"id":91846863,"identity":"e97d028c-743a-4916-a5b1-09cde16b73a6","added_by":"auto","created_at":"2025-09-22 10:20:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":2953466,"visible":true,"origin":"","legend":"\u003cp\u003eSpatial distribution of enteric fever case locations in Mizoram in 2022, 2023 and 2024.\u003c/p\u003e\n\u003cp\u003eThe size of the dots proportionately represent the number of cases. The case distributions are increased from 2022 to 2023 with more concentrations in the major habitations of Mizoram. The background map represents the topography of the region.\u003c/p\u003e","description":"","filename":"Figure02.png","url":"https://assets-eu.researchsquare.com/files/rs-6879929/v1/139569f043dc41e28560a0b1.png"},{"id":91846865,"identity":"6da62baf-0b6a-4b57-8733-b7d56f22fd1d","added_by":"auto","created_at":"2025-09-22 10:20:44","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1431664,"visible":true,"origin":"","legend":"\u003cp\u003eProportionate distribution of typhoid and paratyphoid cases in Mizoram reported in 2022, 2023, and 2024.\u003c/p\u003e\n\u003cp\u003eThe proportions of paratyphoid cases increased from 2022 to 2023, with more concentrations along the Bangladesh border, especially in Lawangtlai. The background map is sourced from ESRI online map services.\u003c/p\u003e","description":"","filename":"Figure03.png","url":"https://assets-eu.researchsquare.com/files/rs-6879929/v1/d71be5af85a3220aa9a0f4ef.png"},{"id":98433142,"identity":"e9a1e8af-a620-42b0-bd82-5da989765808","added_by":"auto","created_at":"2025-12-17 16:50:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":11576563,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6879929/v1/39c45ef2-937e-466e-8fca-5850adb44abd.pdf"},{"id":91847845,"identity":"d2d0f3e3-13b0-4e26-821b-882c3dae9b4a","added_by":"auto","created_at":"2025-09-22 10:28:44","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":255118,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfilewithfootnote.docx","url":"https://assets-eu.researchsquare.com/files/rs-6879929/v1/0eaa2475938e223e3b6b8c00.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Burden of enteric fever in the India-Bangladesh-Myanmar border region","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTyphoid and paratyphoid, collectively known as enteric fever, are systemic infections caused by \u003cem\u003eSalmonella enterica\u003c/em\u003e serovars Typhi (\u003cem\u003eS.\u003c/em\u003e Typhi) and Paratyphi (\u003cem\u003eS\u003c/em\u003e. Paratyphi) A, B or C, respectively. Transmitted via the fecal-oral route, enteric fever is characterized by the gradual onset of fever, accompanied by abdominal symptoms \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. If treatment is delayed or not treated with appropriate antibiotics, it may lead to internal bleeding and perforation of the digestive system in some cases \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. The case fatality rate (CFR) of enteric fever is estimated to be 2.49\u0026ndash;4.45% among hospitalized patients \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. In 2021, the global burden of enteric fever was estimated to be ~\u0026thinsp;9\u0026middot;32\u0026nbsp;million cases and 107.5 thousand deaths \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e; ~7\u0026middot;15\u0026nbsp;million (76.7%) of the enteric fever cases and 93.3 thousand deaths (86.7%) were attributed to \u003cem\u003eS\u003c/em\u003e. Typhi \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. India\u0026rsquo;s contribution to the global enteric fever cases and deaths was estimated to be 5.4\u0026nbsp;million cases (58%) and 51.5 thousand deaths (48%) \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Largely extrapolated from regional data, the 2021 Global Burden of Disease estimated enteric fever incidence in India to be 411.5 cases per 100 000 person-years \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. In recent years, at several cities in India, \u003cem\u003eS\u003c/em\u003e. Typhi and \u003cem\u003eS\u003c/em\u003e. Paratyphi resistant to azithromycin and third-generation cephalosporins have been reported \u003csup\u003e\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. If strains resistant to the first line of antibiotics for enteric fever\u0026mdash;ciprofloxacin, ceftriaxone, and azithromycin spread, then treatment of enteric fever would shift from oral to parenteral antibiotics, creating an enormous strain on the health systems \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn 2018, the typhoid vaccine based on the Vi polysaccharide has been recommended by the WHO for high-burden countries \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. However, widespread public use of this vaccine is hindered by the lack of accurate incidence estimates at the district level across India. A National Surveillance System for Enteric Fever in India (NSSEFI) study from 2017-18 in children between 6 months to 14 years based on four cohorts has identified typhoid incidence estimates ranging from 35 to 1173 cases per 100 000 child-years \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. The NSSEFI study in hospitalized patients, based on six hybrid surveillance sites from 2018-20, has reported incidence from 12 to 1622 \u003csup\u003e9\u003c/sup\u003e, underscoring the data heterogeneity in different sites. Similar regional differences were reported in earlier studies carried out in Delhi (976 cases per 100 000 person-years) in 1995-96 \u003csup\u003e11\u003c/sup\u003e and Kolkata (265 cases per 100 000 person-years) in 2006 \u003csup\u003e12\u003c/sup\u003e. In addition to regional differences, understanding the heterogeneity of enteric fever at the district level in individual states is critical for developing focused intervention strategies and informing policy decisions on vaccine use.\u003c/p\u003e\u003cp\u003eMizoram is a North-East (NE) Indian state located in the Indo-Myanmar region and shares international boundaries with Bangladesh to its west and Myanmar to its east. For decades, malaria has been the major public health concern in the state \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. In the last decade, dengue \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e, scrub typhus \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e, and typhoid have also emerged as a serious public health threat. Despite the limited resources, Mizoram has an efficient healthcare system that has integrated screening of malaria, scrub typhus, dengue, and typhoid across its health units. To guide policy on vaccination and implement micro-level strategies for the control of enteric fever, we report the incidence rates at the district level and spatial distribution of \u003cem\u003eS\u003c/em\u003e. Typhi and \u003cem\u003eS\u003c/em\u003e. Paratyphi at the village level across Mizoram. The data presented here could guide intervention efforts and health policies in NE India and the bordering districts of Bangladesh and Myanmar.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData source:\u003c/h2\u003e\u003cp\u003eA retrospective deidentified line listing data for enteric fever cases from 2022 (n\u0026thinsp;=\u0026thinsp;4499), 2023 (n\u0026thinsp;=\u0026thinsp;15192), and 2024 (up to September) (n\u0026thinsp;=\u0026thinsp;10309) were obtained from the Integrated Disease Surveillance Program of Mizoram\u0026rsquo;s Health and Family Welfare Department. The reported data is from government primary health centres, community health centres, subdistrict hospitals, district hospitals, medical college and hospital, and private hospitals. The diagnostic tests used were Widal test, immunochromatographic test (Typhidot), and culture. The line listing includes information on age, sex, village, district, provisional diagnosis, date of diagnosis, type of diagnosis, pathogen type, hospital type and inpatient hospitalization.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis:\u003c/h2\u003e\u003cp\u003eDistrict-wise incidence rates were calculated per 100 000 person-years for \u0026lt;\u0026thinsp;15 and \u0026ge;\u0026thinsp;15 years using 2020 population estimates \u003csup\u003e\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. The projected population for Saitual district (separated from Aizawl in 2019) was estimated by applying Aizawl\u0026rsquo;s growth rate from 2011 to 2021 \u003csup\u003e19\u003c/sup\u003e. Typhidot was used to diagnose enteric fever in 48% of the cases (n\u0026thinsp;=\u0026thinsp;15447). As Typhidot cannot differentiate between \u003cem\u003eS\u003c/em\u003e. Typhi and \u003cem\u003eS\u003c/em\u003e. Paratyphi, incidence rates of typhoid and paratyphoid were extrapolated based on the age and district-wise \u003cem\u003eS\u003c/em\u003e. Typhi and \u003cem\u003eS\u003c/em\u003e. Paratyphi cases diagnosed by the Widal test and Culture. In 2023, enteric fever diagnosis in the Saiha district was made only with Typhidot; here, the extrapolation was carried out with data from the neighbouring Lawngtlai district that shares similar demographic characteristics.\u003c/p\u003e\u003cp\u003eThe chi-square test was performed to assess the association between socio-demographic and clinical variables with hospitalization, using IBM SPSS software (version 29.0). Age was categorized into five groups: below 2 years, 2\u0026ndash;4 years, 5\u0026ndash;14 years, 15\u0026ndash;44 years, and 45 years and above; districts were classified as urban (Aizawl) and rural (other districts); hospitals were categorised into public and private; provisional diagnosis included fever\u0026thinsp;\u0026lt;\u0026thinsp;7 days and fever\u0026thinsp;\u0026ge;\u0026thinsp;7 days, and typhoid consisted of patients with fever, headache, abdominal pain, nausea, constipation and sometimes rashes; pathogen types were classified as \u003cem\u003eS\u003c/em\u003e. Typhi and \u003cem\u003eS\u003c/em\u003e. Paratyphi. The variables significant at p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were selected for multivariate logistic regression analysis using STATA version 13. Standard errors were adjusted for 11 clusters representing the 11 districts of the state to account for potential intra-cluster correlation in hospitalization outcomes, due to shared environmental factors and healthcare access within the districts. Adjusted odds ratios (aOR) and unadjusted odds ratios (uOR) with a confidence interval (CI) of 95% were calculated; p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 is considered significant. Only cases diagnosed by Widal test and Culture (n\u0026thinsp;=\u0026thinsp;15447) were used for logistic regression. Variance inflation factor (VIF) was calculated as an indicator for multicollinearity in the logistic regression model. The Receiver Operator Characteristic (ROC) curve was developed, and the area under curve (AUC) for ROC curves was computed for the logistic regression model in order to assess model discrimination and validate identified risk factors.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSpatial analysis:\u003c/h3\u003e\n\u003cp\u003eBased on the line listing data, 834 case locations across Mizoram\u0026rsquo;s 11 districts were extracted through Google Maps and assigned unique spatial identifiers for the preparation of a spatial database using ArcGIS 10.4 software (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://desktop.arcgis.com\u003c/span\u003e\u003cspan address=\"https://desktop.arcgis.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). The year-wise distribution of enteric fever cases from 2022 to 2024 (up to September) and the proportionate distribution of typhoid and paratyphoid cases were mapped using a dot-mapping technique, with dot sizes proportional to case numbers.\u003c/p\u003e\n\u003ch3\u003eEthics statement:\u003c/h3\u003e\n\u003cp\u003e The IRB that waived informed consent for the research described was the Institutional Human Ethics Committee (IHEC), Central University of Kerala (CUK/IHEC/2024/D/07). We confirm that all methods performed in this study were in accordance with the protocol reviewed and approved by the IHEC. As it is a secondary data analysis with de-identified data, informed consent is not applicable.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eIncidence of enteric fever across the different districts of Mizoram\u003c/h2\u003e\u003cp\u003eThe socio-demographic and clinical characteristics of enteric fever cases in Mizoram are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e01\u003c/span\u003e. \u003cem\u003eS\u003c/em\u003e. Typhi and \u003cem\u003eS\u003c/em\u003e. Paratyphi account for 88.3% (n\u0026thinsp;=\u0026thinsp;26474) and 11.7% (n\u0026thinsp;=\u0026thinsp;3522) of the enteric fever cases in Mizoram, respectively. The age group highest affected was 15\u0026ndash;44 (41.5%), followed by \u0026ge;\u0026thinsp;45 (22.5%) and 5\u0026ndash;14 (22.4%). A higher incidence of enteric fever among children\u0026thinsp;\u0026lt;\u0026thinsp;15 years was observed compared to those\u0026thinsp;\u0026ge;\u0026thinsp;15 years across all months \u003cb\u003e(Supplementary Fig.\u0026nbsp;01)\u003c/b\u003e. Even though enteric fever cases are reported throughout the year, the incidence peaks in August, and the cases steeply decline from September onwards; May to September is the monsoon season in Mizoram.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 01\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSocio-demographic and clinical profile of enteric fever in Mizoram (2022-September 2024) (n\u0026thinsp;=\u0026thinsp;29996)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eType of pathogen\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eSalmonella\u003c/em\u003e Typhi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11133 (77.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12104 (77%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23237 (77.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eSalmonella\u003c/em\u003e Paratyphi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3154 (22.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3606 (23%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6760 (22.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eAge group\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBelow 2 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e705 (5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e589 (3.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1294 (4.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u0026ndash;4 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1400 (9.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1385 (8.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2785 (9.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u0026ndash;14 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3507 (24.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3221 (20.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6728 (22.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u0026ndash;44 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5536 (39%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6902 (43.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12438 (41.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e45 years and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3058 (21.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3693 (23.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6751 (22.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eProvisional diagnosis\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnly fever\u0026thinsp;\u0026lt;\u0026thinsp;7 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6702 (47.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7152 (45.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13854 (46.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnly fever\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;7 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1929 (13.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2167 (13.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4096 (13.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTyphoid\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5575 (39.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6471 (41%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12046 (40.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eType of sample collected\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4284 (30.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4655 (29.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8939 (29.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePlasma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e101 (0.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e162 (1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e263 (0.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSerum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9821 (69.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10973 (69.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20794 (69.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eDiagnostic test performed\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWidal test\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6800 (47.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7535 (47.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14335 (47.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTyphidot RDT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6835 (48.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7679 (48.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14514 (48.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCulture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e571 (4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e576 (3.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1147 (3.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eHospitalization\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIPD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e921 (6.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e996 (6.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1917 (6.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOPD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13285 (93.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14794 (93.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28079(93.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003eType of hospital\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePublic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11167 (78.61%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12372 (78.35%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23539 (78.47%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrivate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3039 (21.39%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3418 (21.65%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6457 (21.53%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003ePlace of residence\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3833 (27%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4361 (27.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8194(27.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10373 (73%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11429 (72.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21802(72.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e14206\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e15790\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e29996\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eNote: The transgenders in the dataset were excluded due to their negligible count (n\u0026thinsp;=\u0026thinsp;4); \u003csup\u003ea\u003c/sup\u003e Typhoid symptoms \u0026ndash; Fever, headache, diarrhoea, and rashes in some cases; \u003csup\u003eb\u003c/sup\u003ePlace of residence- Aizawl is considered urban, and the rest as rural\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe age-wise incidence of typhoid and paratyphoid fever are shown in Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e02\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e03\u003c/span\u003e, \u003cb\u003erespectively\u003c/b\u003e. From January 2022 to September 2024, the average annual incidence of typhoid for children\u0026thinsp;\u0026lt;\u0026thinsp;15 years was 745 cases per 100 000 child-years (95% CI:729\u0026ndash;761), and in age group\u0026thinsp;\u0026ge;\u0026thinsp;15, it was 609 (95% CI:600\u0026ndash;619). For paratyphoid, it was 204 (95% CI: 196\u0026ndash;212) and 183 (95% CI:178\u0026ndash;189) cases per 100 000 person-years for \u0026lt;\u0026thinsp;15 and \u0026ge;\u0026thinsp;15 years, respectively. In the study period, with 1526 cases per 100 000 child-years (95% CI:1457\u0026ndash;1595), Lunglei district bordering Bangladesh reported the highest incidence of typhoid in children\u0026thinsp;\u0026lt;\u0026thinsp;15 years, while the lowest incidence in this age group was reported by Saitual district [220 cases per 100 000 child-years (95% CI:179\u0026ndash;261). For the age group\u0026thinsp;\u0026ge;\u0026thinsp;15, Hnahthial district bordering Myanmar reported the highest typhoid incidence with 1495 cases per 100 000 person-years (95% CI: 1403\u0026ndash;1588), while Saitual district reported the lowest incidence with 155 cases per 100 000 person-years (95% CI:132\u0026ndash;179). In the case of paratyphoid, Saitual reported the highest incidence with 1009 cases per 100 000 child-years (95% CI:921\u0026ndash;1097) for \u0026lt;\u0026thinsp;15, and Serchhip reported 1072 cases per 100 000 person-years (95% CI:1013\u0026ndash;1131) for \u0026ge;\u0026thinsp;15 years, whereas Khawzawl reported the lowest incidence in both the age groups (3 and 6 cases per 100 000 person-years, respectively).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 02\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eIncidence of age-wise typhoid fever among the districts in Mizoram from 2022- September 2024 (n\u0026thinsp;=\u0026thinsp;23240)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"14\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003eDistricts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003cp\u003e(Cases/ 100 000 person-years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003cp\u003e(Cases/ 100 000 person-years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003e2024 (until September)\u003c/p\u003e\u003cp\u003e(Cases/ 100 000 person-years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u003cp\u003eAverage incidence (2022- September 2024)\u003c/p\u003e\u003cp\u003e(Cases/ 100 000 person-years)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBelow 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBelow 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eBelow 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e15 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eBelow 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e15 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eAizawl\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e429\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e890\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1319\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1311\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2869\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4180\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e622\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1788\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2410\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e2362\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e5547\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e7909\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e293 [266\u0026ndash;321]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e286 [268\u0026ndash;305]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e289 [273\u0026ndash;304]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e896 [848\u0026ndash;945]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e923 [889\u0026ndash;957]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e914 [887\u0026ndash;942]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e567 [522\u0026ndash;612]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e767 [731\u0026ndash;803]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e703 [675\u0026ndash;731]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e587 [563\u0026ndash;611]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e649 [632\u0026ndash;666]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e629 [615\u0026ndash;643]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eChamphai\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e231\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e164\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e395\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e439\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e474\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e913\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e302\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e592\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e894\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e972\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e1230\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e2202\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e697 [607\u0026ndash;787]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e233 [197\u0026ndash;269]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e381 [344\u0026ndash;419]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1325 [1201\u0026ndash;1449]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e673 [613\u0026ndash;734]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e882 [824\u0026ndash;939]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1215 [1078\u0026ndash;1352]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1123 [1032\u0026ndash;1213]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1152 [1077\u0026ndash;1228]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1067 [1000\u0026ndash;1134]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e636 [600\u0026ndash;671]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e774 [741\u0026ndash;806]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eHnahthial\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e306\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e440\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e178\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e397\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e575\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e397\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e412\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e1000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1412\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1171 [973\u0026ndash;1369]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1258 [1117\u0026ndash;1399]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1230 [1115\u0026ndash;1345]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1556 [1327\u0026ndash;1784]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1633 [1472\u0026ndash;1793]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1608 [1477\u0026ndash;1739]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1165 [937\u0026ndash;1394]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1629 [1443\u0026ndash;1814]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1480 [1335\u0026ndash;1626]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1309 [1183\u0026ndash;1436]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e1495 [1403\u0026ndash;1588]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1436 [1361\u0026ndash;1511]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eKhawzawl\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e195\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e191\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e386\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e190\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e281\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e360\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e641\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e193 [114\u0026ndash;272]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e166 [116\u0026ndash;216]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e174 [132\u0026ndash;217]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1635 [1406\u0026ndash;1865]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e754 [647\u0026ndash;861]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1036 [933\u0026ndash;1139]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e704 [531\u0026ndash;878]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e668 [552\u0026ndash;785]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e680 [583\u0026ndash;777]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e857 [757\u0026ndash;957]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e517 [463\u0026ndash;570]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e626 [577\u0026ndash;674]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eKolasib\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e170\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e224\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e278\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e502\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e132\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e204\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e373\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e503\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e876\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e222 [172\u0026ndash;271]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e126 [100\u0026ndash;151]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e157 [133\u0026ndash;180]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e644 [560\u0026ndash;729]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e376 [332\u0026ndash;421]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e462 [422\u0026ndash;503]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e276 [212\u0026ndash;340]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e240 [199\u0026ndash;281]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e252 [217\u0026ndash;286]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e390 [351\u0026ndash;430]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e248 [226\u0026ndash;270]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e294 [274\u0026ndash;313]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eLawngtlai\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e351\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e416\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e767\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e285\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e477\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e650\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e804\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1454\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e226 [183\u0026ndash;269]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e102 [83\u0026ndash;122]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e142 [123\u0026ndash;161]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e742 [664\u0026ndash;819]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e414 [374\u0026ndash;453]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e519 [482\u0026ndash;555]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e541 [464\u0026ndash;617]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e378 [334\u0026ndash;422]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e430 [391\u0026ndash;469]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e499 [461\u0026ndash;538]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e291 [271\u0026ndash;311]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e357 [339\u0026ndash;376]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eLunglei\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e227\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e384\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1056\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1335\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2391\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e644\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1063\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1707\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1857\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e2625\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e4482\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e355 [299\u0026ndash;410]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e241 [210\u0026ndash;273]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e278 [250\u0026ndash;305]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2386 [2242\u0026ndash;2530]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1420 [1343\u0026ndash;1496]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1729 [1660\u0026ndash;1798]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1940 [1790\u0026ndash;2090]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1507 [1417\u0026ndash;1598]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1646 [1568\u0026ndash;1724]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1526 [1457\u0026ndash;1595]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e1015 [976\u0026ndash;1054]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1179 [1144\u0026ndash;1213]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eMamit\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e152\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e390\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e640\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e169\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e314\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e483\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e600\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e1065\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1665\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e134 [93\u0026ndash;174]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e167 [136\u0026ndash;198]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e156 [131\u0026ndash;181]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1244 [1121\u0026ndash;1367]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e961 [886\u0026ndash;1035]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1051 [987\u0026ndash;1116]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e719 [610\u0026ndash;827]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e628 [559\u0026ndash;698]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e657 [599\u0026ndash;716]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e697 [641\u0026ndash;753]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e581 [546\u0026ndash;616]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e618 [589\u0026ndash;648]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eSaiha\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e202\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e250\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e452\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e184\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e300\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e361\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e521\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e882\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e285 [200\u0026ndash;370]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e274 [217\u0026ndash;332]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e278 [230\u0026ndash;325]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1338 [1153\u0026ndash;1522]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e779 [683\u0026ndash;876]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e958 [870\u0026ndash;1046]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1024 [838\u0026ndash;1211]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e765 [654\u0026ndash;875]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e848 [752\u0026ndash;944]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e869 [780\u0026ndash;959]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e592 [541\u0026ndash;642]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e680 [636\u0026ndash;725]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eSaitual\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e160\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e166\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e277\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71 [32\u0026ndash;110]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67 [41\u0026ndash;93]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e68 [47\u0026ndash;90]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e421 [327\u0026ndash;514]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e213 [167\u0026ndash;259]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e280 [236\u0026ndash;323]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e153 [88\u0026ndash;218]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e195 [145\u0026ndash;246]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e182 [141\u0026ndash;222]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e220 [179\u0026ndash;261]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e155 [132\u0026ndash;179]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e176 [155\u0026ndash;197]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eSerchhip\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e159\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e217\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e376\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e248\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e342\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e590\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e374\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e474\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e507\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e933\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1440\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e780 [659\u0026ndash;901]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e501 [434\u0026ndash;568]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e590 [531\u0026ndash;650]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1217 [1065\u0026ndash;1368]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e790 [706\u0026ndash;873]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e926 [852\u0026ndash;1001]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e654 [526\u0026ndash;782]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1151 [1035\u0026ndash;1268]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e992 [903\u0026ndash;1082]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e905 [826\u0026ndash;983]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e783 [733\u0026ndash;894]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e822 [780\u0026ndash;865]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eMizoram\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1414\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2266\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3680\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4671\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7275\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e11946\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2401\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e5213\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e7614\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e8486\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e14754\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e23240\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e341 [324\u0026ndash;359]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e258 [247\u0026ndash;269]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e285 [276\u0026ndash;294]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1128 [1095\u0026ndash;1160]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e826 [807\u0026ndash;845]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e923 [906\u0026ndash;939]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e773 [742\u0026ndash;804]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e790 [768\u0026ndash;811]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e784 [767\u0026ndash;802]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e745 [729\u0026ndash;761]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e609 [600\u0026ndash;619]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e\u003cb\u003e653 [644\u0026ndash;661]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"14\"\u003eNote: The population was taken from Harvard population estimates for 2022 except for Saitual.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"14\"\u003eThe population for Saitual was calculated from the percentage increase of Aizawl and the population of the 2011 census of Saitual.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"14\"\u003eIncidence was calculated as cases per 100000 child-years for \u0026lt;\u0026thinsp;15 years age group and cases per 100000 person-years for \u0026ge;\u0026thinsp;15 years age group.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"14\"\u003eCumulative incidence calculates the incidence during the study period (2 years, 9 months)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 03\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eIncidence of age-wise paratyphoid fever among the districts in Mizoram from 2022- September 2024 (n\u0026thinsp;=\u0026thinsp;6760)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"14\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003eDistricts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003cp\u003e(Cases/ 100 000 person-years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003cp\u003e(Cases/ 100 000 person-years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003e2024 (until September)\u003c/p\u003e\u003cp\u003e(Cases/ 100 000 person-years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u003cp\u003eAverage incidence (2022- September 2024)\u003c/p\u003e\u003cp\u003e(Cases/ 100 000 person-years)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBelow 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBelow 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eBelow 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e15 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eBelow 15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e15 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eAizawl\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e195\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e180\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e286\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 [12\u0026ndash;26]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 [8\u0026ndash;15]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14 [11\u0026ndash;17]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e41 [31\u0026ndash;51]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e43 [36\u0026ndash;51]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e43 [37\u0026ndash;49]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e16 [9\u0026ndash;24]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e4 [1\u0026ndash;6]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e8 [5\u0026ndash;11]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e26 [21\u0026ndash;31]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e21 [18\u0026ndash;24]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e23 [20\u0026ndash;25]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eChamphai\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e173\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e204\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e338\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88 [56\u0026ndash;119]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e58 [40\u0026ndash;76]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e68 [52\u0026ndash;83]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e190 [143\u0026ndash;237]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e156 [127\u0026ndash;185]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e167 [142\u0026ndash;192]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e169 [118\u0026ndash;220]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e98 [72\u0026ndash;125]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e121 [97\u0026ndash;145]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e147 [122\u0026ndash;172]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e105 [90\u0026ndash;119]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e118 [106\u0026ndash;131]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eHnahthial\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 [-8-26]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25 [5\u0026ndash;44]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20 [5\u0026ndash;34]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e61 [16\u0026ndash;106]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e218 [159\u0026ndash;277]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e168 [125\u0026ndash;210]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0 [0\u0026ndash;0]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e27 [3\u0026ndash;51]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e19 [2\u0026ndash;35]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e25 [8\u0026ndash;43]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e96 [72\u0026ndash;119]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e73 [56\u0026ndash;90]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eKhawzawl\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 [0\u0026ndash;0]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 [0\u0026ndash;0]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0 [0\u0026ndash;0]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8 [-8-25]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8 [-3-19]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e8 [-1-17]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0 [0\u0026ndash;0]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e11 [-4-25]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e7 [-3-17]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e3 [-3-9]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e6 [0\u0026ndash;11]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e5 [1\u0026ndash;9]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eKolasib\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e275\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e146\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e278\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e424\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66 [39\u0026ndash;93]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35 [22\u0026ndash;49]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e45 [32\u0026ndash;58]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e296 [239\u0026ndash;354]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e234 [199\u0026ndash;269]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e254 [224\u0026ndash;284]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e77 [43\u0026ndash;110]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e144 [113\u0026ndash;176]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e123 [99\u0026ndash;147]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e153 [128\u0026ndash;178]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e137 [121\u0026ndash;153]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e142 [128\u0026ndash;155]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eLawngtlai\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e143\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e229\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e372\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e156\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e230\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e222\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e395\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e617\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 [1\u0026ndash;20]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10 [4\u0026ndash;16]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10 [5\u0026ndash;15]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e302 [253\u0026ndash;352]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e228 [198\u0026ndash;257]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e252 [226\u0026ndash;277]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e208 [161\u0026ndash;256]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e207 [174\u0026ndash;239]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e207 [181\u0026ndash;234]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e170 [147\u0026ndash;192]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e143 [129\u0026ndash;157]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e152 [140\u0026ndash;164]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eLunglei\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e156\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e242\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e221\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e377\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e598\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e225\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e345\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e570\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e532\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e878\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1410\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e194 [153\u0026ndash;235]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e166 [140\u0026ndash;192]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e175 [153\u0026ndash;197]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e499 [434\u0026ndash;565]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e401 [360\u0026ndash;441]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e432 [398\u0026ndash;467]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e678 [589\u0026ndash;767]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e489 [438\u0026ndash;541]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e550 [504\u0026ndash;595]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e437 [400\u0026ndash;474]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e340 [317\u0026ndash;362]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e371 [351\u0026ndash;390]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eMamit\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e121\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e203\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e289\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e134 [93\u0026ndash;174]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e119 [92\u0026ndash;145]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e124 [101\u0026ndash;146]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e89 [56\u0026ndash;122]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e99 [75\u0026ndash;123]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e96 [77\u0026ndash;115]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e68 [35\u0026ndash;101]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e116 [86\u0026ndash;146]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e101 [78\u0026ndash;124]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e99 [78\u0026ndash;120]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e111 [96\u0026ndash;126]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e107 [95\u0026ndash;119]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eSaiha\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e138\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e220\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e145\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e248\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e376\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 [-5-32]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25 [8\u0026ndash;42]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21 [8\u0026ndash;34]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e543 [426\u0026ndash;661]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e430 [358\u0026ndash;502]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e466 [405\u0026ndash;528]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e389 [274\u0026ndash;503]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e420 [338\u0026ndash;502]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e410 [343\u0026ndash;476]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e308 [255\u0026ndash;362]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e280 [245\u0026ndash;315]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e289 [260\u0026ndash;318]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eSaitual\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e262\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e285\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e547\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e387\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e603\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e508\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e705\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1213\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e164 [105\u0026ndash;222]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e85 [56\u0026ndash;114]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e110 [83\u0026ndash;137]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1431 [1258\u0026ndash;1604]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e732 [647\u0026ndash;818]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e956 [876\u0026ndash;1036]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1573 [1363\u0026ndash;1783]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1326 [1194\u0026ndash;1458]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1405 [1293\u0026ndash;1517]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1009 [921\u0026ndash;1097]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e659 [610\u0026ndash;708]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e771 [728\u0026ndash;814]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eSerchhip\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e177\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e165\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e545\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e710\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e235\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e608\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e843\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e453\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e1277\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1730\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e260 [190\u0026ndash;330]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e286 [236\u0026ndash;337]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e278 [237\u0026ndash;319]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e810 [686\u0026ndash;933]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1258 [1153\u0026ndash;1364]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1115 [1033\u0026ndash;1197]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1537 [1341\u0026ndash;1734]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1872 [1723\u0026ndash;2021]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1765 [1646\u0026ndash;1884]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e808 [734\u0026ndash;883]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e1072 [1013\u0026ndash;1131]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e988 [941\u0026ndash;1034]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eMizoram\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e299\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e520\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e819\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3247\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e890\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1804\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2694\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e2324\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e4436\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e6760\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e72 [64\u0026ndash;80]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e59 [54\u0026ndash;64]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e63 [59\u0026ndash;68]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e274 [258\u0026ndash;290]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e240 [230\u0026ndash;250]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e251 [242\u0026ndash;259]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e286 [268\u0026ndash;305]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e273 [261\u0026ndash;286]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e277 [267\u0026ndash;288]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e204 [196\u0026ndash;212]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e183 [178\u0026ndash;189]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e\u003cb\u003e190 [185\u0026ndash;194]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"14\"\u003eNote: The population was taken from Harvard population estimates for 2022 except for Saitual.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"14\"\u003eThe population for Saitual was calculated from the percentage increase of Aizawl and the population of the 2011 census of Saitual.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"14\"\u003eIncidence was calculated as cases per 100000 child-years for \u0026lt;\u0026thinsp;15 years age group and cases per 100000 person-years for \u0026ge;\u0026thinsp;15 years age group.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"14\"\u003eAverage annual incidence calculated for the study period of 2 years, 9 months\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFor children\u0026thinsp;\u0026lt;\u0026thinsp;15 years, Mamit, Lunglei, and Lawngtlai, the districts bordering Bangladesh, reported typhoid incidence of 697 (95% CI:641\u0026ndash;753), 1526 (95% CI:1457\u0026ndash;1595) and 499 (95% CI:461\u0026ndash;538) cases per 100 000 child-years, respectively, and for the age group\u0026thinsp;\u0026ge;\u0026thinsp;15, the incidence was 581 (95% CI:546\u0026ndash;616), 1015 (95% CI:976\u0026ndash;1054) and 291 (95% CI:271\u0026ndash;311) cases per 100 000 person-years, respectively. The paratyphoid incidence for children\u0026thinsp;\u0026lt;\u0026thinsp;15 years in Mamit, Lunglei, and Lawngtlai was 99 (95% CI:78\u0026ndash;120), 437 (95% CI:400\u0026ndash;474), and 170 cases per 100 000 child-years (95% CI:147\u0026ndash;192) respectively, and for age group\u0026thinsp;\u0026ge;\u0026thinsp;15, the incidence was 111 (95% CI:96\u0026ndash;126), 340 (95% CI:317\u0026ndash;390) and 143 (95% CI:129\u0026ndash;157), respectively. The typhoid incidence in Champhai district for the age group\u0026thinsp;\u0026lt;\u0026thinsp;15 years was 1067 (95% CI:1000\u0026ndash;1134) and 636 cases per 100 000 child-years (95% CI:600\u0026ndash;671) in the age group\u0026thinsp;\u0026ge;\u0026thinsp;15. In the Champhai district, the paratyphoid incidence was 147 (95% CI:122\u0026ndash;172) and 104 cases per 100 000 person-years (95% CI:90\u0026ndash;119) for \u0026lt;\u0026thinsp;15 and \u0026ge;\u0026thinsp;15 years, respectively.\u003c/p\u003e\u003cp\u003eIn the study years, the highest annual typhoid incidence in children\u0026thinsp;\u0026lt;\u0026thinsp;15 years was reported in 2023 at the Lunglei district [2386 cases per 100 000 child-years (95% CI:2242\u0026ndash;2530)], while for age group\u0026thinsp;\u0026ge;\u0026thinsp;15 years, it was 1633 cases per 100 000 person-years (95% CI:1472\u0026ndash;1793) in 2023 from Hnahthial district. For paratyphoid, in 2023, Saitual and Serchhip reported the highest incidence of 1431 (95% CI:1258\u0026ndash;1604) and 1258 (95% CI:1153\u0026ndash;1364) cases per 100 000 person-years for age groups\u0026thinsp;\u0026lt;\u0026thinsp;15 and \u0026ge;\u0026thinsp;15, respectively. Enteric fever incidence stratified by diagnostic tests across districts (\u003cb\u003eSupplementary Table\u0026nbsp;01\u003c/b\u003e) highlights incidence estimates by diagnostic method.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSociodemographic and clinical factors affecting the hospitalization of enteric fever cases in Mizoram\u003c/h3\u003e\n\u003cp\u003e\u003cem\u003eS\u003c/em\u003e. Typhi (87%), private hospitals (66%), urban residence (57%), provisional diagnosis of fever\u0026thinsp;\u0026lt;\u0026thinsp;7 days (54.5%), Widal test (54.1%), and age group 15\u0026ndash;44 years (40.5%) accounted for increased hospitalization rates of enteric fever (\u003cb\u003eSupplementary table 02)\u003c/b\u003e.\u003c/p\u003e\u003cp\u003eChildren\u0026thinsp;\u0026lt;\u0026thinsp;2 years have higher odds of hospitalization compared to older children (2\u0026ndash;4 years: AOR 0.52, 5\u0026ndash;14 years: AOR 0.37) and adults (15\u0026ndash;44 years: AOR 0.45). People in rural areas are less likely to be hospitalized (AOR 0.53) than those in urban areas. Hospital type is a significant determinant, with patients in private hospitals having higher odds of hospitalization (AOR 11.36) than in public hospitals (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e04\u003c/span\u003e). The odds of hospitalization for \u003cem\u003eS\u003c/em\u003e. Typhi and \u003cem\u003eS\u003c/em\u003e. Paratyphi were not statistically significant (p\u0026thinsp;=\u0026thinsp;0.958). The area under the ROC curve (0.83) (\u003cb\u003eSupplementary Fig.\u0026nbsp;02\u003c/b\u003e) and mean Variance Inflation Factor (2.45) indicates a strong discriminative ability to identify the hospitalized cases and a low correlation among variables, respectively.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 04\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFactors associated with hospitalization of enteric fever cases (n\u0026thinsp;=\u0026thinsp;15447)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudy variables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.96 (0.84\u0026ndash;1.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.525\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;2 years (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u0026ndash;4 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.52 (0.38\u0026ndash;0.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u0026ndash;14 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.37 (0.28\u0026ndash;0.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u0026ndash;44 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.45 (0.35\u0026ndash;0.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e45 years and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.84 (0.65\u0026ndash;1.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.101\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePlace of residence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrban (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.53 (0.45\u0026ndash;0.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProvisional diagnosis\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFever\u0026thinsp;\u0026lt;\u0026thinsp;7 days (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnly fever\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;7 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.02 (0.82\u0026ndash;1.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.835\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTyphoid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.41 (0.3500.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePathogen\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTyphi (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParatyphi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.99 (0.81\u0026ndash;1.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.958\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHospitalization type\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePublic (ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrivate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11.36 (9.69\u0026ndash;13.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eSpatial analysis\u003c/h3\u003e\n\u003cp\u003eAs seen in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e01\u003c/span\u003e, the enteric fever cases are clustered in and around the major urban centres of Mizoram\u0026mdash;Aizawl has more case locations, followed by the towns Serchhip, Lunglei, and Saiha. The towns/villages with \u0026gt;\u0026thinsp;500 cases are in the western districts of Lunglei and Mamit, bordering Bangladesh. Even though locations with 101\u0026ndash;500 cases are observed in all the districts, their proportions are very high in Aizawl, Serchhip, Hnahthial and Lunglei. Compared to 526 in 2022, the case locations increased to 741 in 2023. Similarly, 29 locations reported\u0026thinsp;\u0026gt;\u0026thinsp;101 cases in 2023 compared to five in 2022 Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e02\u003c/span\u003e. The year-wise proportions of typhoid and paratyphoid cases are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e03\u003c/span\u003e. In 2022, typhoid dominated across all the districts. However, in 2023, the paratyphoid proportion increased with higher concentrations across the Bangladesh border. Even though Lawangtlai reported higher single-digit case locations, majority of its case locations, especially in the villages bordering Bangladesh, reported paratyphoid cases in 2023 and 2024, with a significant shift from typhoid (2022) to paratyphoid (2023). Another district with a higher number of paratyphoid case locations is Saitual.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study sheds key insight into the huge burden of typhoid and paratyphoid, their spatial distribution across the districts, hotspots, and hospitalization rates in Mizoram. The great strength of this data is that it is reported from health units distributed across the state, where enteric fever diagnostics is integrated into routine screening, and thus provides information on the true burden at village-level across the districts of an entire state in India. Cao et al., 2021, based on geospatial statistical modelling, have predicted India\u0026rsquo;s and Mizoram\u0026rsquo;s typhoid incidence rate to be 360 and 444 cases per 100 000 person-years, respectively \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. At an average yearly incidence of 653 cases per 100 000 person-years (\u003cb\u003eSupplementary table 03\u003c/b\u003e), the incidence from Mizoram is ~\u0026thinsp;1.5 times higher than predicted by Cao et al., 2021. In children\u0026thinsp;\u0026lt;\u0026thinsp;15 years, with 1526 cases per 100 000 child-years, the typhoid incidence in the rural district of Lunglei, bordering Bangladesh, is on par with the estimates in the urban sites of Vellore (1955) and Chandigarh (1622), reported earlier \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Even though Mizoram is endemic for typhoid, the high incidence rates are observed only from 2022 onwards. When compared to 25,647 cases reported from 2011-21 \u003cb\u003e(Supplementary Fig.\u0026nbsp;03)\u003c/b\u003e \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e, there were 4499, 15193, and 10308 cases reported in 2022, 2023, and 2024 (up to September), respectively. The recent increase in enteric fever cases might be due to multiple factors, including improved health-seeking behavior for febrile illness \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e, increased use of point-of-care testing combined with clinical diagnosis, and implementation of real-time reporting in the Integrated Health Information Platform \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Widal test and Typhidot test, despite their widespread use in peripheral healthcare units, have low diagnostic specificity \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Notably, Typhidot has been shown to yield false-positive results in patients with dengue fever due to serological cross-reactivity, which is concerning in dengue-endemic regions \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. However, the poor infrastructure and lack of training allow the peripheral health centers to rely on these tests instead of the gold standard blood/bone marrow culture. In addition, there is growing concern about the emergence of antimicrobial-resistant strains in Mizoram.\u003c/p\u003e\u003cp\u003eAntimicrobial resistance (AMR) poses a serious threat to enteric fever control efforts in South Asia. Pakistan has reported outbreaks of extensively drug-resistant \u003cem\u003eS\u003c/em\u003e. Typhi \u003csup\u003e\u003cspan additionalcitationids=\"CR28 CR29\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Azithromycin-resistant \u003cem\u003eS\u003c/em\u003e. Typhi has also been reported in Pakistan, Bangladesh and Nepal. Mizoram shares its international borders with typhoid-endemic countries of Bangladesh \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e and Myanmar \u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. Azithromycin resistance to \u003cem\u003eS\u003c/em\u003e. Typhi and \u003cem\u003eS\u003c/em\u003e. Paratyphi has been reported in Bangladesh, with the first case identified as early in 2013 \u003csup\u003e34\u003c/sup\u003e. While no data on enteric fever AMR is available from Myanmar, AMR to first-line antibiotics for other bacterial infections is prevalent \u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. In recent years, Mizoram has seen an influx of refugees from Bangladesh and Myanmar \u003csup\u003e\u003cspan additionalcitationids=\"CR37\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e; genomic analysis could give important insights into the population structure of the circulating enteric fever strains and drug resistance. Mizoram also has a huge burden of scrub typhus and other rickettsial infections \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e; the incidence rates are the highest in India. Across Mizoram, there is a continuous and heavy use of antibiotics, including azithromycin, to treat scrub typhus and enteric fever; sustained antibiotic use could lead or have led to the emergence of drug-resistant \u003cem\u003eS\u003c/em\u003e. Typhi and \u003cem\u003eS\u003c/em\u003e. Paratyphi strains. Even though extensively drug-resistant \u003cem\u003eS\u003c/em\u003e. Typhi has not been reported in India, the recent reports of resistance to azithromycin \u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e and third-generation cephalosporins \u003csup\u003e\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e are worrying. With several districts in Mizoram reporting very high incidence rates, the status of drug resistance in the circulating strains of \u003cem\u003eS\u003c/em\u003e. Typhi and \u003cem\u003eS\u003c/em\u003e. Paratyphi in this region must be assessed urgently. Mizoram\u0026rsquo;s enteric fever incidence estimates reported here and status of drug resistance will be highly relevant for policy and intervention measures in the bordering districts of Bangladesh and Myanmar.\u003c/p\u003e\u003cp\u003eIn 2018, the WHO recommended the use of typhoid conjugate vaccines (TCV) to be prioritized in high-burden countries \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. As of 2024, WHO has prequalified the use of three typhoid conjugate vaccines due to their effectiveness, safety, single-use, protection\u0026thinsp;\u0026gt;\u0026thinsp;4 years and suitability to children\u0026thinsp;\u0026gt;\u0026thinsp;6 months of age \u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e. The regions with \u0026gt;\u0026thinsp;100 typhoid cases per 100 000 person-years are categorized as high burden \u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e. Mizoram, with typhoid incidence of 653 cases per 100 000 person-years and high hospitalization rates of children\u0026thinsp;\u0026lt;\u0026thinsp;2 years (OR\u0026thinsp;=\u0026thinsp;2.03) and adults\u0026thinsp;\u0026ge;\u0026thinsp;45 years (OR\u0026thinsp;=\u0026thinsp;2.71), would greatly benefit from vaccination with TCV. In India, the cost of enteric fever treatment is high and varies in different settings; the mean direct cost of severe enteric fever ranges from US\u003cspan\u003e$\u003c/span\u003e119.1 (95% CI, US\u003cspan\u003e$\u003c/span\u003e85.8\u0026ndash;152.4) in smaller hospitals in urban slums/rural/tribal settings and US\u003cspan\u003e$\u003c/span\u003e405.7 (95% CI, US\u003cspan\u003e$\u003c/span\u003e366.9\u0026ndash;444.4) in urban referral hospitals \u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e. Introducing TCV can prevent typhoid cases and deaths up to 17\u0026ndash;36% in urban areas and 19\u0026ndash;36% in rural areas \u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e. Vaccination with TCV is suggested to be cost-effective in countries with 300 or more typhoid cases per 100 000 person-years \u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e. Within the first 10 years of implementing a nationwide community-based catchup campaign targeting children aged 1\u0026ndash;15 years alongside routine vaccination in India, TCV could avert 21\u0026ndash;39\u0026nbsp;million cases and save \u003cspan\u003e$\u003c/span\u003e1.6\u0026ndash;\u003cspan\u003e$\u003c/span\u003e2.2\u0026nbsp;billion \u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e. However, it is important to note that TCV does not confer protection against \u003cem\u003eS\u003c/em\u003e. Paratyphi. Currently, there are no vaccines licensed to use against \u003cem\u003eS\u003c/em\u003e. Paratyphi; a bivalent vaccine against \u003cem\u003eS\u003c/em\u003e. Typhi and \u003cem\u003eS\u003c/em\u003e. Paratyphi was shown to be safe and immunogenic in a phase I trial \u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e, and in late 2024, the results on the efficacy of a paratyphoid vaccine in a controlled human infection model will be known \u003csup\u003e\u003cspan additionalcitationids=\"CR49\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAccording to GBD 2021, \u003cem\u003eS\u003c/em\u003e. Paratyphi is estimated to contribute 30% of the global enteric fever burden and 14 000 deaths per year \u003csup\u003e\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e. Mizoram\u0026rsquo;s \u003cem\u003eS\u003c/em\u003e. Paratyphi burden was ~\u0026thinsp;23% and showed an average annual incidence of 189 cases per 100 000 person-years. Saitual and Serchhip had high paratyphoid burden (770 and 987 cases per 100 000 person-years). Except for three districts (Aizawl, Hnahthial, and Khawzawl), the remaining eight districts reported\u0026thinsp;\u0026gt;\u0026thinsp;100 cases per 100 000 person-years. Interestingly, Hnahthial reported the highest incidence of typhoid (1434 cases per 100 000 person-years) in Mizoram, and typhoid incidence of other five districts (Champhai, Khawzawl, Lunglei, Mamit, Serchhip) is also higher than the state\u0026rsquo;s average, suggesting the dominant distribution of \u003cem\u003eS\u003c/em\u003e. Typhi over \u003cem\u003eS\u003c/em\u003e. Paratyphi in some regions in Mizoram. The paratyphoid incidence of Mizoram is higher than the previous studies reported in India \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e. Even though \u003cem\u003eS\u003c/em\u003e. Paratyphi incidence is less in Mizoram, the odds of hospitalization are statistically not significant for \u003cem\u003eS\u003c/em\u003e. Typhi, indicating the need for vaccination for both \u003cem\u003eS\u003c/em\u003e. Typhi and \u003cem\u003eS\u003c/em\u003e. Paratyphi to effectively control the burden of enteric fever. It remains to be seen if the implementation of TCV will increase the incidence of \u003cem\u003eS\u003c/em\u003e. Paratyphi in Mizoram and India. In 2021, paratyphoid was estimated to contribute almost one-fourth of the enteric fever\u003c/p\u003e\u003cp\u003eburden \u003csup\u003e\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e,\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u003c/sup\u003e, the observations of rise in paratyphoid cases may be due to increased vaccination against typhoid \u003csup\u003e\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe study has some notable limitations. Firstly, 97.2% of clinically suspected typhoid cases were diagnosed using the Widal test or the Typhidot RDT test, which has low diagnostic accuracy when compared to the gold standard blood/bone marrow culture. We could not calculate the CFR attributable to typhoid and paratyphoid due to the absence of mortality data. The duration of hospitalization is considered a proxy indicator of the severity; the duration of hospitalization in paratyphoid is shorter \u003csup\u003e\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u003c/sup\u003e. As we lacked data on the duration of hospitalization, we could not compare the recovery time in typhoid and paratyphoid. As enteric fever cases are reported from health units across Mizoram, the decision of the handling physician to perform enteric fever diagnosis could affect the final data from individual health units. Furthermore, segregation of Typhidot-positive cases to \u003cem\u003eS\u003c/em\u003e. Typhi and \u003cem\u003eS\u003c/em\u003e. Paratyphi based on the data from the Widal test and culture may not be entirely accurate.\u003c/p\u003e\u003cp\u003eFor decades, malaria has been the major public health concern in Mizoram. In recent years, the state is also witnessing a huge burden of scrub typhus and typhoid. The high incidence of infectious diseases in Mizoram is due to the integration of specific diagnostics in its healthcare units, which results in early diagnosis and prompt treatment. With efficient diagnostics and accurate reporting, a similar burden of enteric fever might also be seen in several parts of India, thus underlining a strong case for including typhoid vaccination in the immunization schedule.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe high incidence rates of enteric fever across Mizoram and increased hospitalization of children\u0026thinsp;\u0026lt;\u0026thinsp;2 years of age in the study present compelling evidence for the urgent implementation of TCV in Mizoram. The steep increase in enteric fever incidence in 2022 and 2023 warrants immediate assessment of the status of antibiotic resistance to the circulating strains of \u003cem\u003eS\u003c/em\u003e. Typhi and \u003cem\u003eS\u003c/em\u003e. Paratyphi. The findings of this study could also have important public health implications on enteric fever control in the districts of Bangladesh and Myanmar that border Mizoram.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLP, PTP, and PBN conceptualized, designed, and wrote the first draft of the manuscript. CV, and PTW contributed to the literature search. VC, VL, EZ, PKB, SKB, and KB contributed to the review and editing of the manuscript. PKB and PTP analysed the data, and KB made the figure. All authors have read and agreed to the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe IRB that waived informed consent for the research described was the Institutional Human Ethics Committee (IHEC), Central University of Kerala (CUK/IHEC/2024/D/07). We confirm that all methods performed in this study were in accordance with the protocol reviewed and approved by the IHEC. As it is a secondary data analysis with de-identified data, informed consent is not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from\u0026nbsp;the Integrated Disease Surveillance Program of Mizoram’s Health and Family Welfare Department and are not publicly available. The request for de-identified datasets should be made to Dr. Lalfakzuala Pautu, State Vector Borne Disease Control Programme, Health \u0026amp; Family Welfare Department, Mizoram, Email ID: [email protected].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding received to the current study\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBasnyat, B., Qamar, F. N., Rupali, P., Ahmed, T. \u0026amp; Parry, C. M. 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Epidemiology of Typhoid and Paratyphoid: Implications for Vaccine Policy. \u003cem\u003eClin. Infect. diseases: official publication Infect. Dis. Soc. Am.\u003c/em\u003e \u003cb\u003e68\u003c/b\u003e, S117\u0026ndash;S123. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/cid/ciy1124\u003c/span\u003e\u003cspan address=\"10.1093/cid/ciy1124\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2019).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Enteric fever, typhoid, paratyphoid, Mizoram, North-East India","lastPublishedDoi":"10.21203/rs.3.rs-6879929/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6879929/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eIndia is estimated to contribute greater than 50% of the global burden of enteric fever. Despite the huge burden, typhoid vaccination is currently not included in the national immunization schedule, mainly due to lack of reliable disease estimates, especially at the state and district levels.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eMizoram\u0026rsquo;s district-wise incidence rates of enteric fever cases (n\u0026thinsp;=\u0026thinsp;30000) from January 2022 to September 2024 were calculated per 100 000-person-years. A chi-square test and multivariate logistic regression were carried out to identify sociodemographic and clinical variables associated with hospitalization. The spatial distribution, including the proportion of typhoid and paratyphoid cases, was mapped using the geographic information system.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe incidence of typhoid and paratyphoid in Mizoram was 653 cases (95% CI: 645\u0026ndash;661) and 190 cases (95% CI: 185\u0026ndash;194) per 100 000 person-years, respectively. Age\u0026thinsp;\u0026lt;\u0026thinsp;2 years and fever\u0026thinsp;\u0026lt;\u0026thinsp;7 days were significant predictors of hospitalization; the hospitalization odds for \u003cem\u003eS\u003c/em\u003e. Typhi and \u003cem\u003eS\u003c/em\u003e. Paratyphi were not significant (p\u0026thinsp;=\u0026thinsp;0.958). A high proportion of paratyphoid cases occurred along the Bangladesh border.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe huge burden of enteric fever across the rural and urban districts of Mizoram provides compelling evidence for the inclusion of typhoid vaccination in the national immunization schedule.\u003c/p\u003e","manuscriptTitle":"Burden of enteric fever in the India-Bangladesh-Myanmar border region","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-22 10:20:39","doi":"10.21203/rs.3.rs-6879929/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d8f756e9-facf-4447-a438-418397437b7e","owner":[],"postedDate":"September 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":54947705,"name":"Health sciences/Diseases/Infectious diseases"},{"id":54947706,"name":"Health sciences/Health care/Health policy"},{"id":54947707,"name":"Health sciences/Health care/Health services"},{"id":54947708,"name":"Health sciences/Health care/Public health"}],"tags":[],"updatedAt":"2025-12-15T12:24:59+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-22 10:20:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6879929","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6879929","identity":"rs-6879929","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}