Prevention Of Typhoid Fever Research Articles

Evolving Strategies in Typhoid Prevention and Control: Recent Advancements and Future Directions

Evolving Strategies in Typhoid Prevention and Control: Recent Advancements and Future Directions

Efficacy of typhoid vaccines against culture-confirmed Salmonella Typhi in typhoid endemic countries: a systematic review and meta-analysis

Typhoid is a serious public health threat in many low-income and middle-income countries. Several vaccines for typhoid have been recommended by WHO for typhoid prevention in endemic countries. This study aimed to review the efficacy of typhoid vaccines against culture-confirmed Salmonella enterica serovar Typhi. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase for studies published in English between Jan 1, 1986 and Nov 2, 2023. We included randomised controlled trials (RCTs) comparing typhoid vaccines with a placebo or another vaccine. This meta-analysis evaluated the efficacy and safety of several typhoid vaccines, including live attenuated oral Ty21a vaccine, Vi capsular polysaccharide (Vi-PS), Vi polysaccharide conjugated to recombinant Pseudomonas aeruginosa exotoxin A vaccine (Vi-rEPA), and Vi-tetanus toxoid conjugate vaccine (TCV). The certainty of evidence for key outcomes was evaluated using Grading of Recommendations, Assessment, Development, and Evaluations methodology. The outcome of interest was typhoid fever confirmed by the isolation of Salmonella enterica serovar Typhi in blood and adverse events following immunisation. This study is registered with PROSPERO (CRD42021241043). We included 14 RCTs assessing four different vaccines (Ty21a: four trials; Vi-PS: five trials; Vi-rEPA: one trial; TCV: four trials) involving 585 253 participants. All trials were conducted in typhoid endemic countries and the age of participants ranged from 6 months to 50 years. The pooled efficacy against typhoid fever was 45% (95% CI 33-55%; four trials; 247 649 participants; I2 59%; moderate certainty) for Ty21a and 58% (44-69%; five trials; 214 456 participants; I2 34%; moderate certainty) for polysaccharide Vi-PS. The cumulative efficacy of two doses of Vi-rEPA vaccine at 2 years was 91% (88-96%; one trial; 12 008 participants; moderate certainty). The pooled efficacy of a single shot of TCV at 2 years post-immunisation was 83% (77-87%; four trials; 111 130 participants; I2 0%; moderate certainty). All vaccines were safe, with no serious adverse effects reported in the trials. The existing data from included trials provide promising results regarding the efficacy and safety of the four recommended typhoid vaccines. TCV and Vi-rEPA were found to have the highest efficacy at 2 years post-immunisation. However, follow-up data for Vi-rEPA are scarce and only TCV is pre-qualified by WHO. Therefore, roll-out of TCV into routine immunisation programmes in typhoid endemic settings is highly recommended. There was no funding source for this study.

Extensive Drug-Resistant Typhoid Fever Prevention and Management in Pakistan: A Challenge to Public Health

Typhoid fever is a bacterial infection that largely spreads through contamination in food and water, as well as close contact, and displays many cold-like symptoms in addition to more severe gastrointestinal, muscle, and life-threatening states. The emergence of a new, extensive drug-resistant (XDR) strain in Hyderabad, Pakistan in 2016 resulted in the need for stronger antimicrobials to combat the pathogen. Despite vaccination and contact tracing interventions, the multi-drug resistance and fitness of the H58 strain Salmonella enterica serovar Typhi contributed to rapid spread of typhoid fever in Pakistan. Vaccination is at the forefront of efforts attempting to combat XDR typhoid fever cases in Pakistan, and public education systems and schools should prioritize health classes that pertain to the spread of disease, and what steps individuals can take to be safe, as well as social media infographics circulated through Instagram and Facebook with popular hashtags to reach target audiences. A robust and forward-thinking approach needs to be taken by the Pakistani government to use its budget and international funding in the sectors of health and education to ensure disease prevention.

Using Typhoid Conjugate Vaccines to Prevent Disease, Promote Health Equity, and Counter Drug-Resistant Typhoid Fever.

Typhoid fever is a serious disease that disproportionately impacts children in low-resource settings in sub-Saharan Africa, South and Southeast Asia, and the Western Pacific. The prevalence of antimicrobial-resistant strains of S. Typhi continue to increase worldwide. Two safe, effective, and cost-effective typhoid conjugate vaccines (TCVs) are World Health Organization-prequalified for the prevention of typhoid fever in children as young as 6 months. Typhoid conjugate vaccines have proven effectiveness in preventing drug-resistant S. Typhi and have been deployed successfully in outbreak response and routine immunization scenarios. Broad and equitable distribution of TCVs is essential to combat the spread and potentially devastating consequences of typhoid fever. It is vital to empower decision-makers in typhoid-endemic countries to introduce TCVs and for leaders to embrace this critical tool to prevent typhoid fever, slow the spread of drug-resistant S. Typhi strains, promote health equity, and save lives.

Occurrence of <i>Salmonella</i> Enteric Serovar Typhi Antibodies among Blood Donors in Ghana

Background: Donated blood contaminated with S. Typhi can cause post-transfusion sepsis. This study aimed to determine the correlation between some risk factors of typhoid fever and seroprevalence of antibodies against S. Typhi among blood donors. Methodology: Following informed consent, socio-demographic and information on risk factors of typhoid infection was obtained using pre-structured questionnaires from 400 apparently healthy blood donors at the Tema General Hospital. Blood was also collected for serology and cultured for identification of pathogens by standard bacteriological method. Results: Blood culture did not reveal any S. Typhi isolate out of the tested 400 (348 males and 52 females) samples from apparently healthy blood donors. However, IgM and IgG antibody seroprevalence of 9.3% and 3.5% were detected. Age group of 17 - 24 years was the highest risk group, persons with a history of typhoid infection, and sources of drinking water were major risk factors for typhoid infection. It was also observed that prevalence of IgM was highest among new donors (62.2%), but lower in donors with a history of 1 to 3 blood donations (32.4%) and least among regular donors (>3 donations (5.4%)). In addition, typhoid prevention awareness and typhoid knowledge (knowledge about typhoid transmission) among the donors were poor (4.3% and 5.9% respectively). Conclusions: This study has shown an overall seroprevalence of 9% and 3.5% for IgM and IgG antibodies respectively among blood donors in the Tema area in Ghana. We advocate for the mandatory screening of donor units intended for transfusion for S. Typhi. Furthermore, there is an urgent need for the health education of all persons in Ghana on preventive measures and the spread of S. Typhi.

Effect of Disease Education on Knowledge and Attitude of Nursing Mothers towards Typhoid Prevention in Akinyele local Government Area of Oyo State, Nigera

Backgroud: This is a disease is most predominant with great mortality among children of under five years of age especially in low and middle income countries where poor sanitation and poor hygiene favors the transmission of the disease. This study therefore focused on determining the effects of disease education on knowledge and attitude towards typhoid prevention among nursing mothers in Akinyele Local Government area of Oyo state.
 Methods: The desig for this study was pretest-protest control group, quasi-experimental research design using 2×2 factorial matrix. The study used factorial matrix design based on the fact that the study involved the use of independent variables at two levels; treatment and control. Moderating variable of educational background at two levels (none formal education and formal education), multistage sampling procedure was adopted to select participants of two hundred (200) registered nursing mothers as sample. A self-developed questionnaire was used for data collection with reliability value of 0.72. the inferential statistics of analysis of covariance (ANCOVA) to test the hypotheses at 0.05 alpha level.
 Result: The result revealed that there was significant main effect of treatment on knowledge and attitude of nursing mothers towards typhoid prevention among nursingnmothers in Akinyele Local Government, Oyo State with (F(1/170) = 12.82, p <.05, ɳ2 = 0.07). (F(1/170) = 271.99, p <.05, ɳ2= 0.62) respectively.
 Conclusion: It was concluded that disease education was very effective and has positive influence in improving the knowledge and attitude of nursing mothers towards typhoid prevention in Akinyele Local Government Area of Oyo State., recommended was made that there is need for massive health education campaign to educate the nursing mothers and generality of the populace by governmental and non-governmental agencies to correct the wrong perception they have about malaria and typhoid fever for effective prevention, treatment and control of the diseases.

Prevention of Typhoid Fever by Existing Improvements in Household Water, Sanitation, and Hygiene, and the Use of the Vi Polysaccharide Typhoid Vaccine in Poor Urban Slums: Results from a Cluster-Randomized Trial.

ABSTRACT.Modest improvements in household water, sanitation, and hygiene (WASH) and typhoid vaccination can reduce typhoid risk in endemic settings. However, empiric evaluation of their combined impact is lacking. A total of 62,756 persons residing in 80 clusters in a Kolkata slum were allocated randomly 1:1 to either the typhoid Vi polysaccharide (ViPS) vaccine or hepatitis A (Hep A) vaccine. Surveillance was conducted for 2 years before and 2 years after vaccination. We classified households as having “better” or “not better” WASH, and calculated the prevalence of better WASH households in clusters using previously validated criteria. We evaluated the protection by better household WASH, better household WASH prevalence, and ViPS vaccination against typhoid in all cluster members present at baseline using Cox proportional hazard models. Overall, ViPS vaccination was associated with a 55% (P < 0.001; 95% CI, 35–69) reduction of typhoid risk and was similar regardless of better WASH in the residence. Living in a better WASH household was associated with a typhoid risk reduction of 31% (P = 0.16; 95% CI, –16 to 59) overall. The reduction was 48% (P = 0.05; 95% CI, –1 to 73) in Hep A clusters, 6% (P = 0.85; 95% CI, –82 to 51) in ViPS clusters, and 57% (P < 0.05; 95% CI, 15–78) in the population during the 2 years preceding the trial. These findings demonstrate a preventive association of better household WASH in the non-ViPS population, but, unexpectedly, an absence of additional protection from ViPS by better WASH in the ViPS population. This analysis highlights the importance of assessing the combination of WASH in conjunction with typhoid vaccines, and has implications for the evaluation of new-generation typhoid conjugate vaccines.

Immune persistence and response to booster dose of Vi-DT vaccine at 27.5 months post-first dose

Vaccination with typhoid conjugate vaccines (TCV) is a major part of typhoid prevention. However, little is known about long-term immune persistence following vaccination with TCVs. In this phase-2, randomized double-blind trial (NCT03527355), 285 children aged 6–23 months were randomized to one of three groups: (1) the group that received a first dose of Vi polysaccharide conjugated to diphtheria-toxoid (Vi-DT) vaccine followed by an “early booster” at 24 weeks, (2) the group that which received a first dose of Vi-DT followed by a “late booster” at 96 or 110 weeks, and (3) comparator group. Safety and immunogenicity of anti-Vi IgG GMTs were assessed at weeks 0, 4, 24, 28, 60, 96, 110, and 114 since the first dose. Here, we describe persistence of immune responses at weeks 60, 96, 110, and 114 post first dose. The anti-Vi IgG seroconversion rate after 27.5 months of follow-up was 88.16% (95% CI: 79.00, 93.64) in late-booster and 94.76% (95% CI: 86.91, 97.88) in early booster Vi-DT groups (p = 0.081). Whereas anti-Vi IgG GMTs were significantly higher in the early booster group (11.95 [95% CI: 9.65, 14.81]) than prebooster GMTs in the late booster group (5.50 [95% CI: 4.44, 6.80], p < 0.0001). GMT in the late booster group significantly increased to 351.76 (95% CI: 265.01, 466.93) (p < 0.0001) when measured 4 weeks after they received their “late-booster” shot. In conclusion, late booster dosing with Vi-DT at 27.5 months post first dose was safe and elicited robust anti-Vi IgG immune responses. Anti-Vi IgG seroconversion rates were persistently comparable in early and late-booster Vi-DT groups.

Hubungan Pengetahuan dan Sikap Dengan Perilaku Pencegahan Demam Tifoid Pada Penjamah Makanan

Typhoid fever is a disease that attacks the digestive tract, caused by the bacteria Salmonella typhi. This disease can occur due to low personal hygiene, slum environmental sanitation, and habit of snacking carelessly. Typhoid fever prevention behavior in food handlers is needed to reduce the incidence of typhoid fever, where this behavior is influenced by the knowledge and attitudes of the food handlers about the prevention of typhoid fever. The purpose of this research was to determine the correlation between knowledge and attitudes about typhoid fever prevention with typhoid fever prevention behavior in food handlers in Air Hitam Sub District Payung Sekaki District Pekanbaru City. The research method used an analytic survey with a cross sectional approach. The sampling technique used accidental sampling with a sample size of 30 respondents. The data analysis used the Spearman correlation test, because the data were not normally distributed. There was a relationship between knowledge about typhoid fever prevention and typhoid fever prevention behaviors among food handlers with moderate correlation strength and positive correlation direction (p-value = 0.000; r = 0.555). There was also a relationship between attitudes about typhoid fever prevention and typhoid fever prevention behaviors among food handlers with strong correlation strength and positive correlation direction (p-value = 0.000; r = 0.674). The conclusion of this research was knowledge and attitude about typhoid fever prevention correlate with typhoid fever prevention behaviors among food handlers in Air Hitam Sub District Payung Sekaki District Pekanbaru City.

A Bayesian approach for estimating typhoid fever incidence from large-scale facility-based passive surveillance data.

Decisions about typhoid fever prevention and control are based on estimates of typhoid incidence and their uncertainty. Lack of specific clinical diagnostic criteria, poorly sensitive diagnostic tests, and scarcity of accurate and complete datasets contribute to difficulties in calculating age‐specific population‐level typhoid incidence. Using data from the Strategic Typhoid Alliance across Africa and Asia program, we integrated demographic censuses, healthcare utilization surveys, facility‐based surveillance, and serological surveillance from Malawi, Nepal, and Bangladesh to account for under‐detection of cases. We developed a Bayesian approach that adjusts the count of reported blood‐culture‐positive cases for blood culture detection, blood culture collection, and healthcare seeking—and how these factors vary by age—while combining information from prior published studies. We validated the model using simulated data. The ratio of observed to adjusted incidence rates was 7.7 (95% credible interval [CrI]: 6.0‐12.4) in Malawi, 14.4 (95% CrI: 9.3‐24.9) in Nepal, and 7.0 (95% CrI: 5.6‐9.2) in Bangladesh. The probability of blood culture collection led to the largest adjustment in Malawi, while the probability of seeking healthcare contributed the most in Nepal and Bangladesh; adjustment factors varied by age. Adjusted incidence rates were within or below the seroincidence rate limits of typhoid infection. Estimates of blood‐culture‐confirmed typhoid fever without these adjustments results in considerable underestimation of the true incidence of typhoid fever. Our approach allows each phase of the reporting process to be synthesized to estimate the adjusted incidence of typhoid fever while correctly characterizing uncertainty, which can inform decision‐making for typhoid prevention and control.

Clinical Perspectives of Multiple and Extensively Drug-Resistant Typhoid; result from a tertiary care hospital from Pakistan.

Typhoid fever remains a problem in developing countries, including Pakistan. The emergence of multidrug-resistant and, since 2016, of extensively drug-resistant cases is a continuous challenge for health care workers. The COVID-19 pandemic is making management more difficult. In the present study, a total of 52 confirmed cases of typhoid have been studied during 2019. Detailed clinical features, complications and, lab findings were studied. Typhoid culture and sensitivity were recorded and patients were treated accordingly. Patients were asked about risk factors to aim at informing prevention. Out of the 52 having blood culture positive for Salmonella Typhi 47 (90.4%) and Salmonella Paratyphi 5 (9.6%), 4 (7.7%) were sensitive to first-line (Non-resistant), 11 (21.2%) MDR and 37 (71.2%) patient were XDR. One case was resistant to azithromycin. Nausea, vomiting or, abdominal pain was present in 12 (23%), abdominal distension present in 9 (17.3%), abdominal tenderness in 8 (15.4%), hepatomegaly in 10 (19.2%) and, splenomegaly in 22 (42.3%).There were ultrasound abnormalities in 58% of patients and GI complications in 19% of patients. No significant difference was found in clinical findings and complications between resistant and non-resistant cases. Only 23-27% of patients were aware of typhoid prevention and vaccination measures. The increasing prevalence of resistance and higher degree of complications seen in typhoid fever raises the concern further about prevention and effective infection management in the community as well as clinical settings. Moreover, judicial use of antibiotics is much needed in developing countries like Pakistan.

Typhoid and Paratyphoid Cost of Illness in Nepal: Patient and Health Facility Costs From the Surveillance for Enteric Fever in Asia Project II.

BackgroundEnteric fever is endemic in Nepal and its economic burden is unknown. The objective of this study was to estimate the cost of illness due to enteric fever (typhoid and paratyphoid) at selected sites in Nepal.MethodsWe implemented a study at 2 hospitals in Nepal to estimate the cost per case of enteric fever from the perspectives of patients, caregivers, and healthcare providers. We collected direct medical, nonmedical, and indirect costs per blood culture–confirmed case incurred by patients and their caregivers from illness onset until after enrollment and 6 weeks later. We estimated healthcare provider direct medical economic costs based on quantities and prices of resources used to diagnose and treat enteric fever, and procedure frequencies received at these facilities by enrolled patients. We collected costs in Nepalese rupees and converted them into 2018 US dollars.ResultsWe collected patient and caregiver cost of illness information for 395 patients, with a median cost of illness per case of $59.99 (IQR, $24.04–$151.23). Median direct medical and nonmedical costs per case represented ~3.5% of annual individual labor income. From the healthcare provider perspective, the average direct medical economic cost per case was $79.80 (range, $71.54 [hospital B], $93.43 [hospital A]).ConclusionsEnteric fever can impose a considerable economic burden on patients, caregivers, and health facilities in Nepal. These new estimates of enteric fever cost of illness can improve evaluation and modeling of the costs and benefits of enteric fever–prevention measures.

Decision Making and Implementation of the First Public Sector Introduction of Typhoid Conjugate Vaccine-Navi Mumbai, India, 2018.

Typhoid fever prevention and control efforts are critical in an era of rising antimicrobial resistance among typhoid pathogens. India remains one of the highest typhoid disease burden countries, although a highly efficacious typhoid conjugate vaccine (TCV), prequalified by the World Health Organization in 2017, has been available since 2013. In 2018, the Navi Mumbai Municipal Corporation (NMMC) introduced TCV into its immunization program, targeting children aged 9 months to 14 years in 11 of 22 areas (Phase 1 campaign). We describe the decision making, implementation, and delivery costing to inform TCV use in other settings. We collected information on the decision making and campaign implementation in addition to administrative coverage from NMMC and partners. We then used a microcosting approach from the local government (NMMC) perspective, using a new Microsoft Excel-based tool to estimate the financial and economic vaccination campaign costs. The planning and implementation of the campaign were led by NMMC with support from multiple partners. A fixed-post campaign was conducted during weekends and public holidays in July-August 2018 which achieved an administrative vaccination coverage of 71% (ranging from 46% in high-income to 92% in low-income areas). Not including vaccine and vaccination supplies, the average financial cost and economic cost per dose of TCV delivery were $0.45 and $1.42, respectively. The first public sector TCV campaign was successfully implemented by NMMC, with high administrative coverage in slums and low-income areas. Delivery cost estimates provide important inputs to evaluate the cost-effectiveness and affordability of TCV vaccination through public sector preventive campaigns.

Review on the Recent Advances on Typhoid Vaccine Development and Challenges Ahead.

Control of Salmonella enterica serovar typhi (S. typhi), the agent of typhoid fever, continues to be a challenge in many low- and middle-income countries. The major transmission route of S. typhi is fecal-oral, through contaminated food and water; thus, the ultimate measures for typhoid fever prevention and control include the provision of safe water, improved sanitation, and hygiene. Considering the increasing evidence of the global burden of typhoid, particularly among young children, and the long-term horizon for sustained, effective water and sanitation improvements in low-income settings, a growing consensus is to emphasize preventive vaccination. This review provides an overview of the licensed typhoid vaccines and vaccine candidates under development, and the challenges ahead for introduction.

Morbidity and Mortality of Typhoid Intestinal Perforation Among Children in Sub-Saharan Africa 1995\u20132019: A Scoping Review

BackgroundTyphoid fever incidence and complications, including intestinal perforation, have declined significantly in high-income countries, with mortality rates <1%. However, an estimated 10.9 million cases still occur annually, most in low- and middle-income countries. With the availability of a new typhoid conjugate vaccine licensed for children and recommended by the World Health Organization, understanding severe complications, including associated mortality rates, is essential to inform country-level decisions on introduction of this vaccine. This scoping review summarizes over 20 years of the literature on typhoid intestinal perforation in sub-Saharan Africa.MethodsWe searched EMBASE, PubMed, Medline, and Cochrane databases for studies reporting mortality rates due to typhoid intestinal perforation in children, under 18 years old, in sub-Saharan Africa published from January 1995 through June 2019.ResultsTwenty-four papers from six countries were included. Reported mortality rates ranged from 4.6–75%, with 16 of the 24 studies between 11 and 30%. Thirteen papers included postoperative morbidity rates, ranging from 16–100%. The most documented complications included surgical site infections, intra-abdominal abscesses, and enterocutaneous fistulas. High mortality rates can be attributed to late presentation to tertiary centers, sepsis and electrolyte abnormalities requiring preoperative resuscitation, prolonged perforation-to-surgery interval, and lack of access to critical care or an intensive care unit postoperatively.ConclusionsCurrent estimates of mortality related to typhoid intestinal perforation among children in sub-Saharan Africa remain unacceptably high. Prevention of typhoid fever is essential to reduce mortality, with the ultimate goal of a comprehensive approach that utilizes vaccination, improvements in water, sanitation, and hygiene, and greater access to surgical care.

Assessment of Knowledge and Attitude For patients and their Care Givers Regarding to Typhoid Disease in Outpatient Clinics in Fever Hospitals at Assiut Governorate

Introduction : Typhoid fever is a systemic bacterial illness of public health importance. The disease is transmitted person to person due to fecal contamination of food and water. Aim: Determine the incidence of typhoid disease for patient and caregiver in hospitals of Assuit governorate. Assess the knowledge, attitude of patient and their caregiver about typhoid fever. Methods: Descriptive cross sectional research design used in the present study. The study was carried out in the fever hospitals of Assuit governorate, which consists from (Assuit fever hospital, Dirout fever hospital, Elshamia fever hospital). Sample was total coverage to all cases attended to the previous setting during six months, the total cases around (400) cases (232) patients and (168) caregiver. Tools of the study was assess the knowledge of patient and caregivers about typhoid fever and their attitude reward typhoid disease. Data collection by direct interview to cases and their caregiver started from first January / 2018 to the end June / 2018, data was analyzed by SPSS version 20.0 Results: It was found that satisfactory knowledge of patient and caregiver related to typhoid disease. It was found that negative attitude of patients and caregivers regarding to typhoid disease. Conclusion and Recommendation: It was conclude that all patients and caregivers knowledge satisfactory while negative attitude were observed that toward typhoid fever. The study recommended that education at programs should be organized for patients and caregivers regarding management and prevention of typhoid fever.

Current trends in the epidemiology and management of enteric fever in Africa: A literature review

Enteric fever remains a tropical disease of public health significance in Africa, due to its high endemicity and transmission rates, more in sub-Saharan Africa with 7.2 million cases of typhoid fever annually and incidence rate of 762 per 100 000 person-years when compared with Northern Africa with a reported incidence rate of 557 per 100 000 person-years and lower. Recent studies show that almost all regions of sub-Saharan Africa are tending towards high incidence rates, especially Central and Western Africa. Though clinically indistinguishable from paratyphoid fever, typhoid fever causes more morbidity and mortality than paratyphoid fever, with a greater threat to children. Risk factors include consumption of contaminated water, patronizing food vendors and a history of contact with a case or a chronic carrier, amongst others. Environmental factors such as the rainy season, open sewers, contaminated water bodies and areas of low elevation have been implicated. Diagnosis in Africa is challenging due to resource constraints, as many centres still depend on clinical diagnosis and serodiagnosis using Widal test, in an era where more sensitive and specific tests exist. The polymerase chain reaction is one of the most sensitive diagnostic methods, while culture (particularly bone marrow) is considered to be one of the most specific. Quinolones (ciprofloxacin) and third-generation cephalosporins, amongst others, remain potent in the management of enteric fever, with resistance to quinolones gradually on the rise. Poor diagnostics, poor antibiotic stewardship and lack of drug (antibiotic) regulation are contributors to the problem of antibiotic resistance in Africa. Prevention of typhoid fever through vaccination, especially in children is still under investigation, with steady progress being documented. Overall, long term prevention strategies for typhoid fever should be based on improved sources of drinking water, good sanitation and hygiene, food safety and poverty alleviation.

Variations of binding, washing, and concentration of imidazole on purification of recombinant Fim-C Protein Salmonella typhi with Ni-NTA Resin

Typhoid fever is an endemic disease in Indonesia. Prevention of typhoid fever can be done by administering vaccines. It is known that one of the raw materials for vaccines is a recombinant protein. This study aims to obtain information on the optimum conditions for purification of Salmonella typhi Fim-C recombinant protein with Ni-NTA resin as vaccine raw material. The three main stages of the purification process in this study were binding, washing, and elution of S. typhi Fim-C recombinant proteins. The binding and washing variations of recombinant proteins were carried out twice, four times and six times, while the elution process was carried out at imidazole concentrations of 200 mM, 250 mM, and 300 mM. Purification with a binding process four and six times gave almost the same intensity of S. typhi Fim-C protein bands. Whereas protein was elution at an imidazole concentration of 300 mM showed higher band instability. The results of characterization using SDS-PAGE and analysis using software ImageJ gel analysis showed that the longer the incubation time and the repetition of the binding process, the more protein bound to the resin. Furthermore, the more washing processes are obtained the purer proteins. Based on the data obtained it can be concluded that the purification of the S. typhi Fim-C recombinant protein was optimum at a four-time binding process, six times washing and a 300 mM imidazole concentration. These results are expected to be the basis for recombinant protein refining on a pilot scale and industry scale in better vaccine preparation.

The Invisible Burden: Diagnosing and Combatting Typhoid Fever in Asia and Africa.

Measuring the burden of typhoid fever and developing effective strategies to reduce it require a surveillance infrastructure that is currently lacking in many endemic countries. Recent efforts and partnerships between local and international researchers have helped to provide new data on the incidence and control of typhoid in parts of Asia and Africa. Here, we highlight examples from India, Nepal, Vietnam, Fiji, Sierra Leone, and Malawi that summarize past and present experiences with the diagnosis, treatment, and prevention of typhoid fever in different locations with endemic disease. While there is no validated road map for the elimination of typhoid, the lessons learned in studying the epidemiology and control of typhoid in these settings can provide insights to guide future disease control efforts.

The Correlation between the Environmental Risk Factors and Typhoid Disease Among Children and their Care Givers, Alqalioubiya Governorate

AbstractBackground: Typhoid disease remains an important pre-ventable public health problem. Typhoid is found all over the world, but the areas of risk include East and Southeast Asia and Africa particularly Egypt, most of typhoid deaths occur in children of school age or younger.Aim of Study: To assess the correlation between the environmental risk factors and typhoid disease among children and their care givers, Alqalioubiya governorate.Material and Methods: A descriptive correlative research design was utilized. Setting; study was conducted in 4 villages at Alqalioubiya governorate. A simple random sample of 313 participants was selected. Two tools were used; 1st tool a structured interviewing questionnaire includes 3 parts demo-graphic data, Knowledge and practices of the caregivers toward typhoid. 2nd tool an observational checklist for the home environment.Results: Reveals that 47.9% of participants were aged 20 to less than 30 years old with mean ± SD=29.76±7.36. All participants had governmental water while 46% found it unsafe for drinking and food preparation. One fifth kept water tanks in bathrooms, moreover; 32% kept it unclean and 9.4% stored it till water turned off. All participants had trenches sewage disposal system. There were a highly statistically significant negative correlation found between the total knowl-edge and the family history toward typhoid (p=0.000). There were a highly statistically significant positive correlation found between the total knowledge and Total practice scores (p=0.000).Conclusion: That risk of typhoid transmission not only affected by sanitation of the environment but also the practices within this environment.Recommendations: Health education program to increase public awareness for typhoid prevention and regular exami-nation of food handlers. Safe water supply program and continuous monitoring to detect any leakage or fecal contam-ination.