Abstract
Enteric fever is responsible for significant morbidity in South Asia and high prevalence of severe disease is seen in children under two years of age. Effective typhoid vaccines are available, but they cannot be used for children under two years of age and also have some limitations in older age groups. Participants supported development of a Salmonella Typhi conjugate vaccine able to induce effective, long-lasting immunity in young children. The role of Salmonella Paratyphi A as a cause of enteric fever was discussed and consensus reached that a bivalent S. Typhi-S. Paratyphi A conjugate vaccine is highly desirable; however, considering disease epidemiology and the advanced status of vaccine development, rapid introduction of monovalent S. Typhi conjugate vaccine into vaccination programs of South Asia was recommended. Prevention should be emphasized, available vaccines used, and efforts toward improving sanitation continued. Success of the new vaccine will depend on several factors, including delivery costs and governmental ability to adopt and implement suitable immunization programs. To ensure good immunization coverage, the conjugate vaccine could be administered either to young infants, concomitantly with infant EPI vaccines, or to older infants, concomitantly with measles vaccine, currently given at 9 to 12 months. The need for new combination vaccines, containing both EPI and typhoid antigens, was discussed as a tool to increase coverage and reduce the number of injections and priority conflicts in a crowded infant vaccination schedule. However, stand-alone enteric fever conjugate vaccines would allow more flexibility to immunize different age groups and therefore should be rapidly developed.
Highlights
Introduction and backgroundScope of the conferenceThis two-day meeting, which was organized by the Novartis Vaccines Institute for Global Health, was held on 30 November and 1 December 2009, in New Delhi, under the aegis of the Indian Council of Medical Research (ICMR) and the Dr B
Various options for the development of a vaccine against enteric fever tailored to local public health needs, including preferred vaccine regimes, target age groups, and vaccine formulations and strategies for rapid introduction of new vaccines into national immunization programs were examined
Overall discussion and conclusions The meeting provided the participants with a consolidated view of the available data, both published and unpublished, confirming the high burden of typhoid and paratyphoid fever in urban areas of Bangladesh, India, and Pakistan, including in children under two years of age
Summary
This two-day meeting, which was organized by the Novartis Vaccines Institute for Global Health, was held on 30 November and 1 December 2009, in New Delhi, under the aegis of the Indian Council of Medical Research (ICMR) and the Dr B. L. Kapur (BLK) Memorial Hospital of New Delhi to discuss enteric fever in South Asia and the potential of new conjugate vaccines. Meeting participants discussed epidemiology and vaccination needs with the aim of facilitating decisions concerning the future health care requirements of the region. Various options for the development of a vaccine against enteric fever tailored to local public health needs, including preferred vaccine regimes, target age groups, and vaccine formulations and strategies for rapid introduction of new vaccines into national immunization programs were examined
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