Pakistan and the New Typhoid VaccineTyphoid is a disease caused by Salmonella Typhi that spreads through contaminated food and water, disproportionately affecting children. There were nearly 11 million typhoid cases and more than 116,000 deaths worldwide. In Pakistan, children younger than 15 years old made up 70 percent of deaths from typhoid in 2017. Treatment with antibiotics is essential in controlling and preventing the spread. Further, vaccination helps to protect people from contracting typhoid disease.

There are several ways of preventing and treating typhoid. Preventative measures include improved sanitation, hygiene and water supply. Additionally, treatments include the use of effective antibiotics and vaccines. However, with the rising drug-resistant typhoid outbreak, the antibiotics have become ineffective.

Pakistan and the New Typhoid Vaccine

Pakistan is facing an extensively drug-resistant typhoid outbreak. However, the opportunity arose to revamp its vaccine strategy. This strategy now includes a typhoid conjugate vaccine as part of the routine immunization program. Pakistan in the first country to pilot the new typhoid conjugate vaccine. It hopes that the vaccine will be a breakthrough in the face of drug-resistant antibiotics.

The country’s drug-resistant outbreak “has infected more than 10,000 people.” This is the first-ever reported outbreak to be resistant to the drug ceftriaxone and to all but one oral antibiotic for typhoid. These challenges make the disease costly to treat. However, the new vaccine has been proven successful and safe to use as part of the outbreak response since April 2019. This vaccine establishes Pakistan as the first country in the world to introduce a vaccine set to protect 10 million children within its first two weeks.

The Importance of the Vaccine in Pakistan

Historically, Pakistan makes up one of three countries bearing the burden of the high prevalence of typhoid, along with Bangladesh and India. Typhoid is often referred to as a disease of the poor. It has been neglected by many organizations in terms of investment in vaccines. Dr. Samir Saha, Executive Director of the Child Health Research Foundation at Dhaka Shishu Hospital, states, “vaccination is not the end of the story…we need to continue surveillance to measure the impact of TCV introduction on typhoid burden and the improvement of the overall health system.”

The World Health Organization has recommended and approved this new vaccine. Additionally, the Global Alliance for Vaccines and Immunizations (GAVI) will provide the vaccine to Pakistan at no cost. The government of Pakistan is launching the vaccine introduction with the central focus and campaign beginning in Sindh Province. This location is the center of an ongoing drug-resistant (XDR) typhoid outbreak that began in November 2016. The vaccine’s improved characteristics include a stronger immune response, a longer duration of protection and usability in infants as young as 6 months.

Pakistan’s Health Authorities have reported a notable ongoing outbreak of the drug-resistant strain. Further, the resistant strains of Salmonella Typhi pose a public health concern for the country’s population. However, with the funding support from GAVI, the new typhoid vaccine introduction will initiate a two-week vaccination campaign. Once the campaign ends, Pakistan will routinize the immunization of infants. The government announced plans to introduce the vaccine in neighboring areas of Pakistan next year and then nationally in 2021.

Na’Keevia Brown
Photo: Flickr

Typhoid Fever in Asia
Typhoid fever is a menace to developing nations, especially those that lack access to proper sanitation facilities. Nowhere is this more problematic than in Asia, where most typhoid fever fatalities occur. However, plenty of groups are doing their part to end the scourge of typhoid fever in Asia through the spread of clean water and proper sanitation.

What is Typhoid Fever?

Food and water contaminated with excrement that contains the bacteria Salmonella enterica causes the transmission of typhoid fever. Due to this, typhoid fever was once incredibly prevalent in urban areas throughout Europe and the United States during the 19th century as these countries frequently lacked sound sewage systems to deal with human waste. In the modern era, people only commonly see typhoid fever in the developing world, specifically in areas with poor sanitary conditions.

Common symptoms of typhoid fever are a sustained fever that can peak at around 103-104˚F, fatigue, bowel issues, wheezing and stomach pains. Typhoid fever risk factors in endemic areas include contaminated water, housing with subpar hygiene facilities and contact with a recently infected individual. Those affected can become chronic infectors, people who have on and off symptoms for extended periods and can transmit the disease to others regardless of if they are having an episode or not.

Typhoid fever has been treatable with vaccines since 1948, and mass immunization has proven successful in the past. However, typhoid that is resistant to the most common type of treatment (chloramphenicol) is now emerging. With approximately 16 million cases of typhoid fever reported each year, a treatment-resistant strain is a horrifying prospect. Thankfully, full resistance to treatment is exceedingly rare.

Why Asia and Who is Helping?

Most typhoid fever deaths happen in Asia, where 90 percent of all typhoid related deaths occur. Countries, where typhoid fever in Asia is endemic, include India, China, Vietnam, Pakistan and Indonesia. A significant factor contributing towards the spread of typhoid fever is a lack of sanitary water facilities, and thankfully, NGOs like Charity: Water have made it their mission to bring clean water to all developing nations.

Charity: Water does this by promoting and financing projects aimed at the creation and distribution of sanitary water facilities like latrines, hand-dug and drilled wells and piped water systems.  One of the countries that Charity: Water has had a significant impact on is India. The organization has been working there since 2008 and has funded 4,479 projects with a total of $10,738,062 spread across all these projects.

The Future of Typhoid Fever

Typhoid fever was once a prominent issue in the United States and Europe, but with proper water and waste management systems, they have thoroughly eradicated it. Typhoid fever in Asia is a problem that countries can handle through the creation of clean water facilities. With the help of NGOs like Charity: Water, the world can finally eliminate typhoid fever once and for all, not just from the United States and Europe, but all across the globe.

– Ryan Holman
Photo: Flickr