Typhoid fever, a serious disease affecting between 11 and 21 million people worldwide, is commonly found in the developing regions of Asia, Africa and Latin America. Symptoms include high fevers, weakness, stomach pains, headaches, loss of appetite and diarrhea. Severe cases even lead to serious health complications and even death. Typhoid occurs most often in areas with poor sanitation and contaminated food and water. There are 128,000 to 161,000 typhoid-related deaths every year.

Typhoid in Zimbabwe

On 24 February 2018, the Harare City Health Department (HCHD) suspected 3,187 cases and confirmed 191 cases of typhoid in Zimbabwe. This was the latest major typhoid outbreak in Zimbabwe. Most typhoid outbreaks in the capital, Harare, are caused by municipal water shortages and the use of contaminated boreholes and shallow wells. HCHD works to improve water, sanitation and hygiene (WASH) throughout the city in order to lower typhoid cases and outbreaks in Zimbabwe. They repair boreholes, fix burst sewers, conduct water testing and sampling and educate local residents about water quality and typhoid.

Resistance to antibiotics creates another problem. Around one in five typhoid patients are already resistant to the common typhoid antibiotics and in some areas, resistance raises to a staggering 73 percent. For example, ciprofloxacin is an antibiotic widely used in the treatment of typhoid. However, 20 percent of typhoid patients in Harare show resistance to ciprofloxacin. Alternative antibiotics are more expensive and less available to patients, and although the sale of these medications without a prescription is illegal, over-the-counter purchases are a common practice.

The Typhoid Conjugate Vaccine

A solution to the problem of ineffective medicine is the typhoid conjugate vaccine (TCV). The current typhoid vaccines can only provide short-term protection to patients and more importantly, cannot be given to children. The typhoid conjugate vaccine can reduce the need for antibiotics and unlike other vaccines, it provides longer-lasting protection, requires only one dose and works for children older than six months. The creation of the typhoid conjugate vaccine is a large step in global health.

Kathy Neuzil, leader for the Typhoid Vaccine Acceleration Consortium at the University of Maryland, said: “I have been in my career for around 25 years but these sorts of opportunities, where everything comes together, don’t happen very often. Here we had a vaccine that had been tested but wasn’t being used. Now it is licensed by the World Health Organization and Gavi is supporting countries to introduce it.” The TCV is making history, especially helping with typhoid in Zimbabwe.

The Typhoid Conjugate Vaccine in Zimbabwe

A major vaccine campaign began in Harare on 22 February 2019. Approved by the World Health Organization (WHO), carried out by Zimbabwe’s Ministry of Health and funded by Gavi, The Vaccine Alliance, this campaign is the first in Africa to use the typhoid conjugate vaccine. It targets children aged from six months to 15 years old, and in high-risk areas, it will provide adults up to 45-years-old with the typhoid conjugate vaccine. By the end of the campaign on 3 March 2019, the typhoid conjugate vaccine will be available to 325,000 people throughout the capital city.

Dr. Seth Berkley, CEO of Gavi, is optimistic about the typhoid conjugate vaccine, saying: “These new conjugate vaccines will be a game-changer, not only in the battle against typhoid but also in the global effort to tackle drug resistance. The fact that they are now ready to be used to contain this devastating outbreak in Zimbabwe is fantastic news.”

Although vaccination campaign will significantly decrease typhoid outbreaks in Zimbabwe, vaccines are only a short-term solution. Completely eradicating typhoid in Zimbabwe will also require sustainable solutions for clean water and improved sanitation and hygiene. Together, the typhoid conjugate vaccine and sustainable WASH measures in Harare and other cities will help control and fight typhoid in Zimbabwe.

– Natalie Dell
Photo: Flickr