Hyper-Endemic Typhoid in Africa Takes Spotlight at Cannes

Important new evidence revealing hyper-endemic typhoid in Africa will be presented by global health experts and scientists at the 6th International Conference on Vaccines for Enteric Diseases (VED) 2011 on September 14-16 in Cannes, France. The findings, presented by the Sabin Vaccine Institute's Coalition against Typhoid (CaT), could help accelerate regional control of typhoid, a disease that afflicts 21.6 million people worldwide. This conversation is part of CaT's ongoing effort to ensure the delivery of typhoid vaccines to the populations that need them most.
This latest study from Nairobi, recorded by Robert Breiman, M.D. and his team at the Center for Disease Control Kenya, provides new evidence of a previously unrecognized burden of typhoid fever, especially in rapidly growing urban areas. The team used population-based surveillance and laboratory techniques to confirm the presence of typhoid in approximately 2 percent of all children 2-9 years of age. Alarmingly, nearly 75 per cent of cases were antibiotic resistant.
"Our findings have important policy implications for the use of typhoid vaccines in an increasingly urban Africa," says Dr. Breiman. "As it currently stands, there is limited awareness of typhoid in Africa. Before we can control the disease, we need to provide local evidence of the problem."
A team led by researchers from Michigan State University found similar typhoid infection rates in Abuja, Nigeria, where 20 percent of children 0-5 years of age who tested positive for bacterial infection were infected with Salmonella typhi- the causative agent of typhoid fever.
"Typhoid was the number one cause of invasive bacterial infection in children under 5 in our study," says Stephen Obaro, M.D., visiting consultant pediatrician at the National Hospital in Abuja and lead researcher of the study in Nigeria, "but currently, no country in sub-Saharan Africa implements routine immunization with typhoid vaccine. Our pilot data suggest that there may well be a need for implementing routine immunization with available vaccines."
Recognizing the threat of typhoid fever, Kenyan Ministry of Public Health and Sanitation officials have begun vaccinating food service workers in area schools. The implementation of current typhoid vaccines is recommended by the WHO and is prioritized but not yet funded by the GAVI Alliance. The first typhoid vaccine recently earned WHO pre-qualification status, allowing for procurement by UNICEF and other UN agencies.
"Despite the availability of low cost typhoid vaccines, a WHO recommendation for their use and successful vaccination programs in many countries, typhoid vaccines have not yet reached those most impacted by the disease," said Christopher Nelson, Ph.D., M.P.H., Director of the Coalition against Typhoid Secretariat at the Sabin Vaccine Institute. "CaT is committed to overcoming access barriers and ensuring the widespread use of these safe, affordable and life-saving typhoid vaccines."