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What's Missing in the Effort to Stop the Spread of Typhoid Fever

What does it really take to control and ultimately eliminate diseases of poverty? If you read the headlines, you might think it requires more money, vaccines, education or a combination of those. Unfortunately, even when we can have all of those tools at our fingertips, there are times when we still cannot effectively reach the people that most need our help.

Typhoid fever is the perfect example.

Typhoid is a disease that still affects more than 21 million people around the world, despite that fact that we have accessible, low-cost vaccines. Endemic disease, although common in Asia and Africa, is often overlooked. Outbreaks occur when common water and food sources become contaminated with infected human waste. The symptoms -high fever, flu-like symptoms, abdominal pain, constipation or diarrhoea - result in approximately 200,000 deaths annually, mostly among school and pre-school aged children.

Within the South and Southeast Asian region, there are prime examples of countries that showcase both the positive impact of government involvement and the growing number of typhoid outbreaks that occur in countries without comprehensive disease control policies that include immunisation. These regions have the greatest documented burden of typhoid in the world, but only a handful of countries have policies for typhoid vaccines and even fewer have implemented vaccination programs.

In Vietnam, the Ministry of Health began vaccination of children in high-risk districts in 1997 and, since then, more than 5.3 million children have been protected. Correspondingly, the incidence of typhoid fever in high-risk districts has dropped dramatically.

In India and Indonesia, national pediatric associations recognise the great need for widespread and immediate introduction of typhoid vaccines, but implementation has been extremely limited. Hundreds of cases have been reported in India just in this past year, largely from the states of Uttar Pradesh, Punjab, Maharashtra and Bihar, and tens of thousands more go unreported. Alarmingly, the proportion of drug-resistant cases seems to be rising, as recent reports have indicated that more than 70 per cent of cultures were resistant to commonly-used antibiotics. In Indonesia, even the first lady, Ani Yudhoyono, was infected with typhoid and hospitalised in late December 2011 with typhoid fever, demonstrating the pervasive effects of typhoid in all social strata. But the situation is even more precarious in other countries in the region. In Bangladesh, Pakistan, Cambodia and Laos, pediatric societies and national immunisation technical advisory groups have yet to prioritise typhoid control and therefore the disease continues to spread.

promoting improved hygiene

In Fiji, ongoing reports of typhoid among school children and others have prompted community leaders to ban all non-essential gatherings. Community members and local health officers are also working to promote improved hygiene and sanitation practices in their communities in an effort to prevent disease.

To help raise awareness about this pandemic and prompt regional policymakers to take action, the Coalition against Typhoid (CaT) is organising a call to action to highlight the disease burden in the region and to call upon stakeholders and policymakers to make informed decisions around the use of typhoid vaccines to control disease.

We desperately need ministries of health and international funders to come together to make typhoid vaccines more accessible to those who need them most - mainly school and pre-school children who don't have access to safe water.

Moving forward, it is critical that policymakers and all stakeholders, including pediatric and national societies and immunisation technical advisors, make informed decisions on the use of typhoid vaccines to prevent disease, disability and death. Control of typhoid fever will require a comprehensive approach, including the availability of safe drinking water, the promotion of good hygiene practices, access to appropriate and timely treatment, and vaccination in high-risk communities.

By prioritising typhoid on the global health agenda and developing a comprehensive work plan to combat this disease, CaT and global health leaders around the world anticipate a world free of death and disability caused by typhoid.

Dr Christopher Nelson is director of the Coalition against Typhoid (CaT). CaT was established in 2009 to advocate for the millions of people suffering from typhoid fever who cannot speak for themselves. CaT supports research into next generation typhoid vaccines and improved diagnostics and advocates for the use of effective vaccines that are already available and recommended by the WHO. Our members are working with local stakeholders and national governments to make informed decisions regarding the use of typhoid vaccines to prevent disease, disability and death.


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