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In the Literature, Clinical Infectious Diseases, Volume 46, Issue 12, 15 June 2008, Pages v–vi, https://doi.org/10.1086/599690
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Worldwide Control of Typhoid
World Health Organization. Typhoid vaccines: WHO position paper. Wkly Epidemiol Rec 2008; 83:49–59.
It is estimated that there are ∼21 million cases of typhoid fever annually in the world, with ∼90% occurring in Asia. Serious complications occur in 10% of cases, and as many as 4% of the infections are fatal, with most deaths occurring among children. The emergence of multidrug-resistant Salmonella enterica serotype Typhi (i.e., S. Typhi with resistance to chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole) has complicated the management of infection in countries where it is endemic. The more recent emergence of reduced susceptibility to fluoroquinolones is of further concern.
Two vaccines have replaced the older inactivated whole-cell vaccine: a live, orally administered Ty21 vaccine and an injectable Vi polysaccharide product. Each is capable of providing ∼70% protection. The Strategic Advisory Group of Experts on immunization of the World Health Organization has endorsed a position paper on the programmatic use of these vaccines to control endemic typhoid fever. This paper recommends consideration of implementation of a vaccine program with either the oral or injectable vaccine, with attention to high-risk groups and populations, as well as use of the vaccine for outbreak control. The decision to implement such a program should be based on knowledge of local epidemiology of typhoid and on the prevalence of antibiotic-resistant S. Typhi, as well as considerations of cost-effectiveness. School-aged and/or preschool-aged children are an important target population. Most importantly, “All typhoid vaccination programmes should be implemented in the context of other efforts to control the disease, including health education, water quality and sanitation improvements, and training of health professionals in diagnosis and treatment” (p. 51).
