September 23, 2021
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Source:
Patel, P, et al. N Engl J Med. 2021; doi: 10.1056 / NEJMoa2035916
Disclosure:
Neuzil does not report any relevant financial information. Please refer to the study for all relevant financial information from the other authors.
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As typhoid fever becomes more resistant to antibiotics, a study recently published in the New England Journal of Medicine showed that a conjugated vaccine was shown to be effective against the disease in Malawi’s younger population.
One of the authors of the study, Kathleen M. Neuzil, MD, MPH, is director of the Center for Vaccine Development and Global Health at the University of Maryland School of Medicine and directs the school’s Typhoid Vaccine Acceleration Consortium.
“Typhoid fever is practically eradicated in countries like the United States and other high-income countries, mainly through improved water and sanitation,” Neuzil said in an interview with Healio. “But unfortunately they still exist in many parts of the world that don’t have these advantages.”
Now, Neuzil said, after years of treating the disease with oral antibiotics, the bacteria
Salmonella Typhi has developed resistance.
“It’s getting harder to deal with,” said Neuzil. “So we are almost going back to the pre-antibiotic era, where the death rate and serious complications are increasing because these infections are more difficult to treat with simple oral antibiotics.”
Over a period of 2 years, Neuzil and colleagues tested the vaccine Typbar-TCV (Bharat Biotech International) – a tetanus toxoid conjugated Vi polysaccharide typhoid conjugate vaccine (Vi-TCV), the 25 g Vi polysaccharide, prequalified by the WHO contains per 0.5 ml dose – in children aged 9 months to 12 years. They used a Group A conjugated meningococcal conjugate vaccine (MenA; MenAfriVac, Serum Institute of India) as a control vaccine at a dose of 10 g / 0.5 ml for children 1 year and older and at a dose of 5 g / 0.5 ml for children under 1 year.
The intention-to-treat analysis included 28,130 children who were randomly assigned to either the Vi-TCV vaccine (n = 14,069) or the MenA vaccine (n = 14,061).
Confirmed typhoid fever occurred in 12 children in the Vi-TCV group (46.9 events per 100,000 person-years) and in 62 children in the MenA group (243.2 events per 100,000 person-years). Overall, the effectiveness of Vi-TCV was 80.7% (95% CI 64.2-89.6) by intention-to-treat analysis and 83.7% (95% CI 68.1-91, 6) in the per-protocol analysis. In total, there were 130 serious adverse events (52 in the Vi-TCV group and 78 in the MenA group), including six deaths – all in the MenA group, in the first 6 months after vaccination.
“It can be given up to 6 months of age, it works well in infants and young children, it is immunogenic and should last longer than the 2 years we’ve seen with travel vaccines,” Neuzil said. “We can prevent it with a single dose of vaccine.”
The next step would be for the country of Malawi to work with an organization like Gavi, the Vaccine Alliance, to offer the vaccine to children aged 15 or younger.
“If Malawi wanted to run a one-off campaign and vaccinate all of its children up to the age of 15 with a single-dose typhoid conjugate vaccine, Gavi would pay for it,” Neuzil said. “They would pay for all of the vaccine and they would pay the running costs for it. Then, if Malawi said they wanted to add this vaccine to their routine vaccination program now at 9 months of age, Gavi would provide them with this vaccine at 20 cents a dose. So that removes the financial barrier of a poor country introducing this vaccine. “
References:
Patel, P, et al. N Engl J Med. 2021; doi: 10.1056 / NEJMoa2035916
WHO. Typhus. https://www.who.int/news-room/fact-sheets/detail/typhus. Accessed September 22, 2021.
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