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New typhoid vaccine could transform fight against the infection

Could help to prevent millions of cases worldwide

Vaccine vial

A new vaccine against typhoid has shown impressive efficacy in large-scale field trials and could help prevent millions of cases of the life-threatening infection worldwide.

A single dose of the TCV vaccine developed by the Typhoid Vaccine Acceleration Consortium (TyVAC) – backed by the Bill and Melinda Gates Foundation – reduced cases of the disease by 81% in the trial, which involved more than 20,000 children aged from nine months to 16 years in Nepal.

Typhoid – caused by the Salmonella Typhi bacterium – is fast becoming a major public health threat around the world thanks to the emergence of resistant strains that defy treatment with the usual antibiotic drugs such as ciprofloxacin and ceftriaxone.

The disease is a particularly acute problem in low- and middle-income countries, as typhoid is linked to impoverished living conditions such as contaminated water. It is responsible for nearly 11 million cases and more than 116,000 deaths a year worldwide.

Around nine million children are being immunised with the vaccine in Pakistan, where resistant strains of typhoid are very common. The country is in the grip of the first-ever reported outbreak of ceftriaxone-resistant typhoid, which according to TyVAC ‘represents an alarming trend in the spread of drug-resistant typhoid’.

Until now TCV had only been tested in healthy volunteers in the UK, and the result of the Nepal trial – which used the Group A meningococcal (MenA) vaccine – has far exceeded the expectations of the researchers behind the shot.

There are already two vaccines for typhoid available but one is only approved for use in children aged over six, because it is formulated in a very large capsule, and the other injectable product isn’t effective in children below two years of age.

TyVAC director Dr Kathleen Neuzil said the results in a region where typhoid is endemic “adds to a growing body of evidence supporting the use of TCV to reduce disease and save lives in populations that lack clean water and improved sanitation”.

The results of the phase 3 Nepal trial have been published in the New England Journal of Medicine (NEJM).

The children in Nepal, as well as others receiving the vaccine in field trials in Malawi and Bangladesh, will continue to be followed up to see how long the protection from the immunisation lasts.

Such is the threat posed by typhoid in lower-income countries that the World Health Organisation (WHO) recommended the introduction of TCV for infants and children over six months of age in typhoid-endemic countries last year, and added it to its list of prequalified vaccines.

TCV was originally developed by Indian drugmaker Bharat Biotech, but the company wasn’t involved in the Nepal trial. TyVAC is a partnership between Oxford University, the University of Maryland School of Medicine and health non-governmental organisation (NGO) PATH.

Article by
Phil Taylor

5th December 2019

From: Research

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