Programmatic Effectiveness of a Pediatric Typhoid Conjugate Vaccine Campaign in Navi Mumbai, India

Abstract

Background:The WHO recommends vaccines for prevention and control of typhoid fever, especially where antimicrobial-resistant typhoid circulates. In 2018 the Navi Mumbai Municipal Corporation (NMMC), implemented a TCV campaign. The campaign targeted all children aged 9-months through 14-years within NMMC boundaries (~320,000 children) over 2 vaccination phases. The phase 1 campaign occurred from July 14-August 25, 2018 (71% coverage, ~113,420 children). We evaluated the campaign's programmatic effectiveness in reducing typhoid cases at the community level.Methods:We established prospective, blood culture-based surveillance at 6 hospitals in Navi Mumbai, offering blood cultures to children presenting with fever for at least 3 days. We employed a cluster-randomized test-negative design to estimate the effectiveness of the vaccination campaign on pediatric typhoid cases. We matched culture-confirmed typhoid cases with up to 3 culture-negative controls by age and date of blood culture and assessed community vaccine campaign phase as an exposure using conditional logistic regression.Results:Between September 1, 2018-March 31, 2021, we identified 81 typhoid cases and matched these with 238 controls. Cases were 0.44 times as likely to live in vaccine campaign communities (campaign effectiveness, 56%, 95%CI: 25%-74%, p=0.002). Cases ≥ 5-years-old were 0.37 times as likely (95% CI: 0.19-0.70; p-value = 0.002) and cases during the first year of surveillance were 0.30 times as likely (95% CI: 0.14-0.64; p-value = 0.002) to live in vaccine campaign communities.Conclusions:Our findings support the use of TCV mass vaccination campaigns as effective population-based tools to combat typhoid fever.

23-year trends indicate low rates of antimicrobial resistance inSalmonellaParatyphi A

“…This single-dose conjugate vaccine provides immunity against Salmonella Typhi, the causative agent of typhoid fever, and has been recommended by the Strategic Advisory Group of Experts for routine use in countries where typhoid fever is endemic [4,5]. Studies from Nepal, Bangladesh, India, Pakistan and Malawi have shown high efficacy of Typbar in preventing typhoid fever [6][7][8][9][10]. In 2020 a second TCV, TYPHIBEV, was prequalified by WHO and clinical trials are ongoing [11,12].…”

Gateway to Typhoid Conjugate Vaccine Introduction in India and Beyond—Programmatic Effectiveness of a Public Sector Typhoid Conjugate Vaccine Campaign in Navi Mumbai

“…In this issue of Clinical Infectious Diseases , Dr Seth Ari Sim-Son Hoffman and colleagues [ 19 ] share results from an effectiveness evaluation of a pediatric vaccination campaign using a WHO Prequalified TCV, Typbar-TCV® (Vi polysaccharide conjugated to tetanus toxoid, Bharat Biotech India Ltd., Hyderabad, India). This public sector campaign, which targeted children 9 months to 14 years of age, was conducted by the Navi Mumbai Municipal Corporation (NMMC) in Maharashtra, India in 2018.…”