Take on Typhoid Newsletter June 2020

Taking on Typhoid

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In this issue:

As the first half of 2020 closes, we can’t help but reflect on how this year evolved in unimaginable ways. When we last reached you in February, we were eager to build on the momentum of 2019 and hopeful about our work ahead to accelerate the introduction of typhoid conjugate vaccine (TCV). However, as the world quickly turned to the COVID-19 pandemic response, we saw a pause in many activities related to our work. TCV introduction campaigns in Liberia and Zimbabwe, as well as the next phase of Pakistan’s introduction, have been delayed. Many research and surveillance studies, including those on TCV effectiveness and cost of illness, have reorganized activities and data collection based on local lockdown and social distancing requirements.

Despite the urgency to bring COVID-19 under control, we cannot forget about the importance of maintaining routine immunization and other essential health services during this time. The realities of post-pandemic outbreaks of measles and polio are worrisome; so is the ongoing spread of drug-resistant typhoid. During this unprecedented time, we remain committed to our work to take on typhoid, to our partners working around the world to maintain access to vaccines, and the efforts to keep our families and communities safe. Thank you for your ongoing work, collaboration, and partnership. We are eager to reconnect and resume our activities as soon as safely possible.

New and updated resources to take on typhoid coming soon

We are refreshing our website! Updates will include the latest data and progress made to take on typhoid and a continued focus on typhoid prevention and control through proven interventions, including TCVs and improvements in water, sanitation, and hygiene. The refresh includes new resources and tools for decision-makers and advocates on typhoid and the potential of TCVs, including a series of six briefs on typhoid and issues such as climate change, urbanization, and universal health coverage and the sustainable development goals; an infographic on the power of vaccines to prevent health and economic burdens of typhoid on children and their families; and a brief outlining global policies for effective and efficient typhoid prevention and control. The site will also feature new interactive maps that help visualize the emergence and evolution of drug-resistant typhoid and focus on the importance of vaccines to curb transmission of these deadly strains.

Hot off the press and more to come

Data, and a lot of it, are needed to inform country decision-making and accelerate TCV introduction. TyVAC and its partners have been busy putting pen to paper to publish data essential to take on typhoid. In the last couple of months, publications on historical aspects of typhoid transmission in the US; intestinal perforations, a severe complication of untreated typhoid requiring surgery, in children in sub-Saharan Africa; and bloodstream infections in febrile patients, an important guide for treatment of fevers, help inform clinicians and fill much needed data gaps. In December 2019, TyVAC published exciting interim results from an efficacy study in Nepal that showed that TCV prevented over 80 percent of typhoid cases. Keep your eyes and ears open for TyVAC publications later this year on safety and immunogenicity results from our studies in Malawi and Burkina Faso.

WHO updates first-line treatment recommendations for typhoid and paratyphoid

In June 2019, a team from Oxford University successfully applied to have enteric fever included as a special indication in the World Health Organization Essential Medicines List (WHO EML). The WHO EML sets global best practice and normative guidelines to help policymakers align local policies and guidelines with global recommendations. In the 2019 update, the review committee endorsed the listing of ciprofloxacin, ceftriaxone, and azithromycin as first-line treatments for typhoid and paratyphoid. Ciprofloxacin is identified as the first choice where fluroquinolone resistance is low; ceftriaxone and azithromycin are favored where fluoroquinolone resistance is high. The data submitted by the consortium from Oxford highlights the importance of knowing local resistance patterns to make treatment decisions. This update is the first time the WHO EML expert committee has considered resistance patterns while making specific recommendations for empiric treatment.

Outbreak reports

As global health efforts shift to respond to COVID-19, low- and middle-income countries continue to face a myriad of other infectious diseases, including typhoid. The ongoing water crisis puts Zimbabwe on the path of yet another potential typhoid outbreak in the suburbs of Harare. Cyclone Harold wreaked a path of destruction through the Pacific in early April, resulting in reported cases of typhoid in Fiji, among other diseases. Further assessments and relief efforts may be further hampered by COVID-19 concerns and restrictions. Papua New Guinea declared a typhoid outbreak within a correctional facility in the Western Province capital Daru, which health officials have linked to poor sanitation.

Scientific publications


Adverse events following immunization with typhoid conjugate vaccine in an outbreak setting in Hyderabad, Pakistan

Estimation of Incidence of Typhoid and Paratyphoid Fever in Vientiane, Lao People’s Democratic Republic

Genomic profiling of antimicrobial resistance genes in clinical isolates of Salmonella Typhi from patients infected with Typhoid fever in India

Morbidity and Mortality of Typhoid Intestinal Perforation Among Children in Sub-Saharan Africa 1995–2019: A Scoping Review

A prospective study of bloodstream infections among febrile adolescents and adults attending Yangon General Hospital, Yangon, Myanmar

Progress in the overall understanding of typhoid fever: implications for vaccine development

Visit our publications page for more recent research

For refugees, every action counts when we #TakeOnTyphoid

Beyond COVID-19: Immunization is a smart investment for societies and economies

Protecting our pediatric population from perforations

Stories of Typhoid: Fatia Ferdousi

When It Comes to Hand Hygiene, There’s No Time for “Pang’ono Pang’ono”

A delicate and difficult balance

Health outcomes must be matched by strong health systems—for COVID-19 and beyond

Toilet paper hoarding: What’s it really about?

The secret to good health and taking on typhoid? Clean, safe water

All posts available on the blog