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


Seth A Hoffman, Christopher LeBoa, Kashmira Date, Pradeep Haldar, Pauline Harvey, Rahul Shimpi, Qian An, Chenhua Zhang, Niniya Jayaprasad, Lily Horng, Kirsten Fagerli, Priyanka Borhade, Debjit Chakraborty, Sunil Bahl, Arun Katkar, Abhishek Kunwar, Vijay Yewale, Jason R Andrews, Pankaj Bhatnagar, Shanta Dutta, Stephen P Luby


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 phase 1 campaign’s programmatic effectiveness in reducing typhoid cases at the community level.

We established prospective, blood culture-based surveillance at 6 hospitals in Navi Mumbai, offering blood cultures to children presenting with fever ≥ 3 days. We employed a cluster-randomized (by administrative boundary) test-negative design to estimate the effectiveness of the vaccination campaign on pediatric typhoid cases. We matched test-positive, culture-confirmed typhoid cases with up to 3 test-negative, culture-negative controls by age and date of blood culture and assessed community vaccine campaign phase as an exposure using conditional logistic regression.

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 (programmatic 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.

Our findings support the use of TCV mass vaccination campaigns as effective population-based tools to combat typhoid fever.

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