Take On Typhoid Newsletter December 2018

Taking on Typhoid

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In this issue:

TyVAC in 2018

Photo credit: Dr. Melita Gordon, MLW

The past year has been a whirlwind of activity for TyVAC. From global policy changes to initial safety and immunogenicity data from our trials in Malawi and Nepal, the global community is on track to accelerate the introduction of typhoid conjugate vaccine (TCV) and reduce the burden and impact of typhoid on the most vulnerable populations.

Despite the enormous strides we have made this year, there are still challenges ahead. Increasing recognition of the typhoid burden in young children, continued outbreaks, lagging improvements in water, sanitation, and hygiene (WASH), and rising drug resistance are reminders that typhoid continues to be a substantial public health threat. Growing multidrug-resistant typhoid and extremely drug-resistant strains make typhoid harder to treat and control. These challenges reinforce the importance of prevention, especially in resource-poor and densely populated areas. Vaccines can slow the pace of drug resistance by reducing the number of cases, thereby limiting the use and misuse of antibiotics. Bharat Biotech’s Typbar-TCV® is currently being used for outbreak response in Pakistan, and plans are underway to use the TCV for outbreak control in Zimbabwe beginning in January. The vaccine is also being used in the TyVAC studies in Nepal, Bangladesh, Malawi, and Burkina Faso.

As 2018 comes to an end and we look ahead to 2019, there are many things to be thankful for―the World Health Organization (WHO) prequalified TCV and an open Gavi, the Vaccine Alliance funding window, providing countries a viable avenue for typhoid prevention and control.

Wishing everyone a safe, happy, and healthy New Year.
The Take on Typhoid team

TyVAC’s commitment to fight drug-resistant typhoid

November 12–18 was World Antibiotic Awareness Week―a time dedicated to raising awareness about the growing threat of drug resistance and instilling a sense of urgency to protect the effectiveness of antibiotics through appropriate use. Drug-resistant typhoid is an urgent and growing issue that can be slowed with TCVs, which help to prevent illness and the need for antibiotics in the first place.

TyVAC committed to the United States’ Government’s year-long Antimicrobial Resistance (AMR) Challenge. The AMR Challenge focuses on accelerating the fight against drug resistance across multiple disease areas, governments, and sectors. TyVAC committed to generating data on the impact, effectiveness, safety, immune response, and associated costs of TCVs in Africa and Asia. We also committed to raising awareness about typhoid as a public health threat, particularly in light of increasing drug resistance, and importantly, we committed to supporting TCV introduction in typhoid-endemic countries.

In order to draw attention to the urgency of drug-resistance, Take on Typhoid developed a resource page of materials related to drug-resistant typhoid and the importance of TCVs to prevent and control further evolutions of drug-resistant strains. We also published two blogs, sharing experiences from Pakistan and Zimbabwe, two countries working to combat ongoing outbreaks of drug-resistant typhoid.

Burkina Faso – TyVAC’s 2nd site in Africa

TyVAC has partnered with Groupe de Recherche Action en Santé (GRAS) in Burkina Faso for the first West African and the first francophone study of Typbar-TCV. The study launched on December 3, 2018 in Ouagadougou, Burkina Faso, and will include up to 250 children younger than two years of age.

Photo credit: Dr. Matt Laurens, CVD

While there is extensive research on TCVs in Asia, data in Africa are limited to the TyVAC clinical trial in Malawi, the first trial of a TCV in Africa. The Burkina Faso study will provide additional and complementary data to the safety, immunogenicity, and efficacy study in Malawi, as well as co-administration data on the response to TCV when given with other common childhood vaccines such as measles-rubella, yellow fever, and meningococcal A conjugate vaccine. These data are needed to inform policy- and decision-makers about vaccine introduction options. A West African site is important for generalizability given differences in population characteristics, typhoid epidemiology, and vaccination schedules.

New results from Surveillance of Enteric Fever in Asia Project published in journal supplement

A supplement of 13 papers sharing new data from Phase I of the Sabin Vaccine Institute’s Surveillance of Enteric Fever in Asia Project (SEAP) was published this month in the Journal of Infectious Diseases. The publication contains a retrospective data review of typhoid disease burden at sites in Bangladesh, India, Nepal, and Pakistan. Each of these papers examines the local typhoid burden in terms of blood culture positivity rate, age and gender distribution, and antimicrobial susceptibility patterns. While these data were retrospective and therefore limited in nature, the study findings were crucial to informing the design of prospective surveillance, currently ongoing.

Phase I found that the burden in Bangladesh and Pakistan was younger than in Nepal and India. The median ages of laboratory-confirmed cases were 3 years in Bangladesh and 7 years in Pakistan, while cases were older in Nepal and India, at 19 and 24 years, respectfully. Preliminary results from prospective work, taking into account healthcare seeking behavior, have confirmed these differences in burden across the countries and provided useful data to the WHO on decision-making about the TCV. The study also found a high proportion of typhoid cases in all countries were non-susceptible to ciprofloxacin and first-line antibiotics. With the current outbreak of ceftriaxone-resistant typhoid in Pakistan, these results add literature on the increasing amount of resistance in typhoid and the need for implementation of the TCV in these countries.

In addition, the supplement contains research and commentaries on the socio-economic burden of typhoid, policy implications for typhoid control in Southeast Asia, and the intersection of climate change, rapid urbanization, and typhoid. The supplement builds upon the body of research on the impact of enteric fever in South Asia and will help inform prevention and control policies including vaccine programs, as well as monitor drug-resistance and outbreaks.

Typhoid at ASTMH

Take on Typhoid joined thousands of global health professionals from across sectors and regions of the world for the American Society of Tropical Medicine and Hygiene’s annual meeting on October 29–November 1. With the theme of “Outbreaks”, the meeting was particularly relevant for typhoid researchers and advocates given recent typhoid outbreaks in Africa and Asia. Project partners presented at a symposium on the impact of integrated prevention and control methods to address typhoid alongside the policy decisions that aim to make these tools accessible. The symposium, organized by the Coalition against Typhoid, featured presentations sharing results from TCV campaigns in India and Pakistan, the importance of WASH for typhoid control, TCV decision-making at the country level, and next steps for countries to utilize global policy decisions to access TCVs. Additionally, Take on Typhoid hosted a reception that brought together researchers and advocates for a discussion about the progress in fighting drug-resistant typhoid.

Outbreak reports

Typhoid cases are rising in Ahmedabad and Woraiyur, India. Ahmedabad Municipal Corporation’s health department reports that the number of typhoid cases in October 2018 are significantly higher than typhoid cases reported in October 2017. In Woraiyur, the health department blamed the increase of typhoid cases on water contamination from a pipe leakage.

Health facilities is Rawalpindi, Pakistan, are receiving a high number of children with suspected typhoid, as well as other diarrheal diseases. In late October, hospitals were receiving nearly 150 pediatric typhoid patients a week.

Fiji’s Ministry of Health and Medical Services announced that typhoid cases have been reported in the villages of Nabaitavo, Waisasavua, and Uluiravo settlement in Naitasiri. Response teams from the Ministry of Health and Medical Services have distributed water purification kits to affected communities.

Scientific publications Blogs

Case-fatality ratio of blood culture-confirmed typhoid fever in Dhaka, Bangladesh

Extensively drug-resistant typhoid — Are conjugate vaccines arriving just in time?

Madagascar should introduce typhoid conjugate vaccines now

Phase I of the Surveillance for Enteric Fever in Asia Project (SEAP): An overview and lessons learned

A retrospective review of hospital-based data on enteric fever in India, 2014–2015

Salmonella enterica serovar Typhi in Bangladesh: Exploration of genomic diversity and antimicrobial resistance

A systematic review of antimicrobial resistance in Salmonella enterica serovar Typhi, the etiological agent of typhoid

Visit our publications page for more recent research

Today’s reality: A battle against multi-drug resistant typhoid in sub-Saharan Africa

Tracking diseases in Kenya – the Microbiology Hub-Kericho

Topography, tenancy, toilets, and typhoid conjugate vaccine in Malawi

In photos: A new vaccine to combat XDR typhoid in Pakistan

Drug resistance and typhoid in Zimbabwe: Using TCVs for outbreak control

Burkina Faso joins Malawi as the second TyVAC site in Africa

Taking on Typhoid at ASTMH
AKU celebrates the 100,000th typhoid conjugate vaccine in Hyderabad

Typhoid Mary’s missing ingredient

The importance of teachers to take on typhoid

Previous posts available on the blog