When Fevers Steal Futures

Each year between February and May, more than 20 million Indian students sit for their 10th and 12th board examinations — a milestone that determines college admissions and future career trajectories. Yet during the same months, India also witnesses a seasonal rise in enteric fevers, particularly typhoid and paratyphoid. While hospital wards and public health bulletins capture the medical impact, the educational loss — students too sick to appear for board exams — often goes uncounted. New data now make it possible to estimate this link more clearly.

The Latest Evidence: Typhoid and Paratyphoid in India (2024–2025 Data)

According to the 2025 national modeling study on typhoid and paratyphoid burden in India (M. Vijayalaxmi et al. 2025), the estimated annual incidence of typhoid fever is approximately:

• ~4.7 million cases (4.1–5.3 million) nationally in 2023
• Age-standardized incidence of ~320–360 per 100,000 person-years
• Higher-than-average rates among 15–19-year-olds, especially in urban and peri-urban areas

The report also estimates that paratyphoid fever accounts for an additional ~0.8 million cases yearly, bringing the combined enteric fever burden close to 5.5 million infections. Notably, over 35–40% of all cases occur between February and May, overlapping directly with India’s high-stakes examination period.

Mapping the Burden to Exam-Age Groups

Based on Census projections:

• 10th Board Examinees (14–16 years): ~76 million
• 12th Board Examinees (16–18 years): ~72 million
• Total (14–18 years): ~148 million adolescents

Using the study’s mean incidence (340 per 100,000/year), and adjusting for a 4-month exposure window (one-third of the year), we derive:

Age Group	Population (millions)	Adjusted 4-month incidence (per 100k)	Estimated cases (Feb–May)
14–16 yrs (10th)	76	113	86,000
16–18 yrs (12th)	72	113	81,000
Total (14–18 yrs)	148	—	≈167,000 cases

Adding 15–20% contribution from paratyphoid infection, the combined enteric fever burden among board-age students during exam months is approximately 190,000–200,000 infections annually.

From Illness to Missed Exams

Clinical data show that typhoid typically causes:

• 10–14 days of sustained high fever
• 2–3 weeks of convalescence
• Post-febrile fatigue lasting 7–10 days

For students infected during March–April, this timeline overlaps with board exams and preparation periods. Even those who recover may experience fatigue, dehydration, and reduced cognitive performance.

If we conservatively assume:

• 60% of infected students fall sick during or immediately before exams
• 50% of those are unable to appear or complete all papers

Then roughly 55,000–60,000 students likely missed or underperformed in their 2024 board exams due to enteric fever.

The Hidden Equity Dimension

The 2025 dataset highlights:

• Higher incidence (up to 700 per 100,000) in urban informal settlements
• Lower vaccination coverage among adolescents
• Persistent gaps in piped water quality and sanitation

These are the same communities where students already face limited educational resources, meaning illness further widens educational inequities.

Implications for Public Health and Education Policy

1. Strengthen Adolescent Typhoid Vaccination: Include adolescents (up to 18 years) in TCV immunization, especially in high-burden districts.
2. Integrate Health Surveillance with Exam Boards: Coordinate health monitoring with education departments between February and May.
3. Provide Medical Re-Examinations: Institutionalize supplementary exams for students who miss papers due to certified illness.
4. School-Level Health Drives: Promote hydration, hygiene, and early medical care during exam season.

Conclusion: When Public Health Protects Education

The 2025 national typhoid burden data highlight that enteric fever is not just a medical issue — it’s an educational one. Around 200,000 adolescents may suffer from typhoid or paratyphoid during exam months each year, and tens of thousands may lose their chance to perform well or even appear for their exams.

Reducing this hidden loss requires collaboration between health authorities, education boards, and local governance to protect students from preventable infections.

Reference

Mogasale, Vijayalaxmi et al. (2025). Typhoid Fever Burden by Age, State, and Antimicrobial Resistance in India, 2023. SSRN: https://ssrn.com/abstract=5413588