Introduction of typhoid vaccine in the expanded immunization program of Pakistan

ABSTRACT

Worldwide, typhoid infects 11–20 million people each year. In Pakistan, the first extensively drug-resistant (XDR) typhoid was reported in 2016 resulting in an epidemic. To curb this battle of typhoid, the Expanded Program for Immunization (EPI) of Pakistan requested Global Alliance for Vaccines and Immunization (GAVI) for financial assistance. Hence becoming the first country to administer the vaccination against typhoid in children through EPI. To address the possible risk of endemic, it is needed that WHO and the United Nations should recommend all south Asian countries to avail of this golden opportunity provided by GAVI. Finally, the addition of typhoid vaccine in routine immunization will reduce mortalities, morbidities, health expenditure, and increase life expectancy in all low- and middle-income countries.

KEYWORDS:

• Typhoid
• Immunization
• Antibiotics
• Epidemic

Worldwide, typhoid infects 11–20 million people each year. The mortality rate of the disease is 128,000–161,000 around the world.¹ About 30% of typhoid victims are below the age of five years.² The major contributing factor was the extensive use of antibiotics In Pakistan, the first extensively drug-resistant (XDR) typhoid was reported in 2016 resulting in an epidemic and the mutant H58 haplotype strain to emerge. This strain started to circulate in South Asia involving the risk of an endemicity. To curb this battle of typhoid, the Expanded Program for Immunization (EPI) of Pakistan requested Global Alliance for Vaccines and Immunization (GAVI) for financial assistance, resulting in the addition of typhoid vaccine in the immunization program from 2019. Hence becoming the first country to administer the vaccination against typhoid in children through EPI.^3,4

GAVI also earmarked 85 million US$ funds to support the developing countries for the typhoid vaccine. African and Asian countries can apply for these funds to start the immunization of their children. Recently, the World Health Organization (WHO) announced the prequalification of the first typhoid conjugate vaccine. This vaccine provides prolonged immunity by a single administered dose. This vaccine is safe and effective for children aged between 6 months to 2 years. India and Nepal are already using this vaccine.^1,2

To address the possible risk of endemic, it is needed that WHO and the United Nations should recommend all south Asian countries to avail of this golden opportunity provided by GAVI. With the support of GAVI, vaccines will be available for all babies from developing countries. The vaccination against typhoid through routine immunization will be helpful for the vulnerable countries with an acute antimicrobial-resistant, high antibiotic consumption, and easy availability of antibiotics over the counter.^4,5 Finally, the addition of typhoid vaccine in routine immunization will reduce mortalities, morbidities, health expenditure, and increase life expectancy in all low- and middle-income countries.