By Dr. Manuela Carugati
From 4th to 6th April 2017, Kampala hosted the 10th Conference on Typhoid and Other Invasive Salmonellosis. The conference provided a forum for more than 300 researchers, policy makers, immunization managers and advocates to come together to share the latest developments and best strategies to reduce the burden of typhoid on communities around the world. I was one of the attendees and I would like to share with you some crucial points about typhoid.
What is typhoid? Should I be interested in it?
Typhoid is a bacterial infection in humans caused by the bacteria SalmonellaTyphi. Every year, there are approximately 27 million cases of typhoid and 190,000 deaths caused by the disease. Without appropriate antibiotic therapy, the mortality rate for typhoid can reach 20%. The impact of typhoid in developing communities goes beyond physical illness and death. Typhoid infections can cause adverse pregnancy outcomes, impair physical and cognitive development, impact school attendance and performance, and limit productivity in the workforce.
Where is typhoid? Is typhoid affecting Uganda?
Typhoid is found mostly in countries and communities where many people lack access to clean water and basic sanitation, thereby exposing them to the conditions that enable typhoid to spread. Currently, one-third of the world’s population is at risk of contracting typhoid fever, and the infection remains a very real threat in developing countries. In Uganda, an outbreak of typhoid fever in Kasese District sickened 8092 persons from 27th December 2007 to 30th July 2009, resulting in at least 47 deaths. In 2011, numerous typhoid cases were again reported in Kasese and neighboring Bundibugyo District. From February 17, 2015 to June 12, 2015 Kampala City witnessed a large and persistent outbreak of typhoid fever with 10,230 cases identified.
Signs and symptoms of typhoid
Transmission most commonly occurs through ingestion of water or food contaminated by feces from an acutely ill or convalescent patient or an asymptomatic carrier. The incubation period is usually 1 to 2 weeks, but it can range from 3 to 60 days. The illness presents with sustained fever and a constellation of other symptoms including dry cough, fatigue, abdominal pain, diarrhea, and constipation.
How can typhoid be prevented?
Unlike many other diseases prevalent in low and middle-income countries, typhoid is preventable. Typhoid prevention is based on two pillars: sanitation and vaccination. Improved water, sanitation and hygiene (hand washing in soapy hot water after using the toilet, before eating, and before preparing food) have the potential to dramatically reduce the number of typhoid infections globally by inhibiting disease transmission. However, these systems are scarce in the developing world, leaving approximately one billion people without access to clean, safe drinking water, and 2.5 billion without proper sanitation. Vaccines can help ward off typhoid infection in endemic environments.
Great news. New vaccines on the horizon
Typhoid vaccines have primarily been targeted for use in the private or traveler’s markets and have not been widely supported for use at the country level. This means that the most vulnerable populations, such as infants and young children in sub-Saharan Africa and Asia, do not have access to the vaccine. Existing vaccines are not effective in young children (under age two) and only provide a moderate duration of protection (two to three years) before revaccination is required. The cost per dose is also too high to be feasible for vulnerable communities.
A new generation of vaccines, named typhoid conjugate vaccines (TCV), is in development. The conjugate vaccines offer a long duration of protection and can be used in infants starting at six months of age: they really present a new hope in the battle against typhoid. These vaccines are highly cost effective and can be administered through the routine immunization programs in typhoid endemic countries and through programs targeting at-risk populations, such as migrants. With the recent national licensure of a typhoid conjugate vaccine in India, and several other conjugate vaccines in the development pipeline, the roll out of a conjugate vaccine in endemic countries is now within reach.
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