Typhoid vaccination, current status and the need to accelerate implementation

Global Immunization Meeting, 1-3 Feb 2010

SIDE MEETINGS
Dr Pem Namgyal, WHO/HQ, IVR/IMR

Typhoid vaccination: an opportunity missed

WHO estimates that about 21 million cases of typhoid fever occur annually, with 14% cases ending fatally, which is about 200,000 to 400,000 deaths There are two new generation typhoid vaccines; the injectable Vi polysaccharide (ViPS) and the live attenuated oral vaccine, Ty21a Large scale demonstration projects across many Asian countries have demonstrated the feasibility of introducing typhoid vaccine, and the significant impact it has on reducing the disease burden The Strategic Advisory Group of Experts (SAGE) made, in November 2007, several recommendations on the use of typhoid vaccines which were translated into a revised WHO Position Paper on Typhoid, published early 2008 Despite these, except for a few countries, it has failed to stimulate an active response from typhoid endemic countries We need to establish a clear understanding of the intentions and the barriers that impede countries from using typhoid vaccines to enable us to define better the type of support that countries may need

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GIM 2010: Side meeting on Typhoid | 02 Feb 2010

DOMI Disease Burden Study

Incidence of Culture-Confirmed Typhoid Fever
700.0 600.0 573 494 2-4 yo 5-15 yo

Incidence per 100,000

500.0 413 400.0 340

300.0 200.0 180 149

100.0 24 0.0 August 02 July 04 Karachi*

Ochiai et al. 2008 Bulletin of WHO

29

November 03 October 04 Kolkata

August 02 July 03 North Jakarta

July 02 June 03 Hue

August 01 July 02 Hechi

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GIM 2010: Side meeting on Typhoid | 02 Feb 2010

Priority regions (& countries) for typhoid control

Source: Crump, Bull of WHO, 2004

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GIM 2010: Side meeting on Typhoid | 02 Feb 2010

Progress till now in following up on SAGE

recommendations
Except for China, Viet Nam and India where typhoid vaccine is used (only in risk areas), no other countries have either policy to use or in actual use Since July 2009, discussions with all regions with primary focus on SEAR, WPR, EUR and EMR. There is very little information on typhoid occurrence in AFR although the disease is known to exist; in AMR, typhoid is no more a public health concern In SEAR:
Sri Lanka has plans to introduce in high risk districts and among displaced populations: plan being developed India NTAGI had one brief discussion on typhoid, next NTAGI will deliberate in more details. Also in discussion with ICMR to initiate surveillance in a few large cities Bhutan & Nepal has indicated some interest to review their current situation; IVI is planning a demonstration project in Nepal No information on intentions from Myanmar and Indonesia
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GIM 2010: Side meeting on Typhoid | 02 Feb 2010

Progress till now in following up on SAGE

recommendations
In WPR:
Fiji- a draft introduction plan developed and waiting for feedback No information from Cambodia or Laos

In EMR
Long discussions with WCO in Pakistan, NITAG was supposed to discuss on 22 Dec, minutes awaited IVI starting a demonstration project in Karachi

EUR:
Kyrgyzstan already has a plan ready, looking for funding No information from any other country
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Our discussions today How can we define country intentions with regards to typhoid vaccination and what barriers, if any, impede their decision to use typhoid vaccines? How can you assist in putting typhoid on the regional communicable diseases control agenda (immunization, diarrheal diseases, WatSan, etc.) through Programme Managers, Regional TAGs, National TAGs, RC, etc

Do you think that perhaps we should focus on a few priority countries and, if so, which countries?

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GIM 2010: Side meeting on Typhoid | 02 Feb 2010