Pakistan Becomes the First Country to Introduce Typhoid Conjugate Vaccine

Pakistan today became the first country in the world to introduce typhoid conjugate vaccine (TCV) into its routine immunization program. The government of Pakistan is launching the vaccine with a campaign in Sindh Province, where high number of drug-resistant (XDR) typhoid cases have been reported since November 2016.

“Children are disproportionately affected by typhoid and its associated complications, and we strongly believe that TCV would protect our children against potentially fatal disease of Typhoid,” said Dr. Zafar Mirza, Special Assistant to the Prime Minister on Health. “Starting with Sindh Province, where the need is most urgent, the government of Pakistan has planned a phased national introduction strategy with strong, coordinated support from global and local partners.”

In 2017, 63% of typhoid cases and 70% of typhoid deaths in Pakistan were among children younger than 15 years of age. To prevent these deaths, the phased introduction will begin with a two-week campaign targeting 10.1 million children 9 months to 15 years of age in more than 460 urban union councils of Sindh province withthe funding support from Gavi, the Vaccine Alliance.  This will include 4.7 million children from Karachi. As the campaign needs to reach older children, schools will play a major role. Following the campaign, the vaccine will be given to 9-month old infants as part of routine immunization at EPI centers in all parts of the province.

“Typhoid is a highly contagious disease that spreads more quickly and easily when people live in crowded neighborhoods with weak water and sanitation infrastructure. Beginning the vaccination in urban areas is critical in preventing the disease among the communities most at risk,” said Dr. Azra Fazal Pechuho, Provincial Minister of Sindh for Health, and Population Welfare. “Typhoid is preventable. Prevention through vaccination is one of the most effective interventions to reduce typhoid infections. The TCV campaign will be conducted from 18^th to 30^th November in Sindh and will be followed by TCV being a part of the Routine Immunization Program in December.” The government is also promoting WASH solutions (water, sanitation and hygiene) alongside TCV introduction.

Typhoid, a serious illness caused by Salmonella Typhi, is spread through contaminated food and water and disproportionally impacts children and low-resource communities in the developing countries.TCV is a safe and effective vaccine prequalified and recommended by the World Health Organization.

“A typhoid conjugate vaccine offers a very good solution to protect children from falling ill and from drug-resistant typhoid. We commend the government of Pakistan for prioritizing the health of children with the introduction of the vaccine. We also commend the Federal Pakistan and Sindh governments for the tremendous efforts they have made to reach every child during this important campaign” said Dr. Palitha Mahipala, WHO Representative in Pakistan.

Pakistan’s current typhoid outbreak has sickened more than 15,000 people in Sindh Province alone, and more than 10,000 of those cases were identified as extensively drug resistant (XDR).This is the first-ever reported outbreak of typhoid resistant to the drugs, making it increasingly challenging and costly to treat.

UNICEF Representative in Pakistan: “We applaud the Government of Pakistan for prioritizing immunization of children at risk of typhoid,” said Aida Girma, UNICEF Representative in Pakistan.

“Their phased national introduction plan for TCV will ensure that the vaccine will reach the children most at risk first.”

TCV is a one-dose vaccine, injected intramuscularly, that is lower cost, has higher efficacy, and is expected to provide long lasting immunity in adults, children, and infants older than 9 months of age.

“Before the discovery of antibiotics, typhoid would kill as many as one in five people who contracted it,” said Dr Seth Berkley, CEO of Gavi. “The rise of extreme drug resistant typhoid risks bringing us back to levels of mortality not seen since the 19^th century, posing a risk to all of us. That’s why typhoid conjugate vaccine is so important and why the government of Pakistan deserves praise for being the first to introduce this lifesaver into its routine immunization program.”

“We are proud to work in partnership with Gavi to help high-burden countries introduce this new typhoid conjugate vaccine,” said Dr. Kathleen M. Neuzil, Director of the Center for Vaccine Development and Global Health at the University of Maryland School of Medicine and Director of the Typhoid Vaccine Acceleration Consortium. “This typhoid conjugate should prevent disease in the near-term while governments work on more integrated prevention and treatment approaches that also include improvements in safe water, sanitation and hygiene.”