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Lancet Infect Dis. 2019 Jan;19(1):e26-e30. doi: 10.1016/S1473-3099(18)30350-5. Epub 2018 Aug 28.

Typhoid conjugate vaccines: a new tool in the fight against antimicrobial resistance.

Author information

1
Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: jandr@stanford.edu.
2
Department of Medicine, University of Cambridge, Cambridge, UK.
3
Department of Medicine, University of Cambridge, Cambridge, UK; Epidemiology Unit, International Vaccine Institute, Seoul, South Korea.
4
Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA.
5
Sabin Vaccine Institute, Washington, DC, USA.
6
Department of Microbiology, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh.
7
Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
8
Department of Medicine, University of Toronto, Toronto, Canada.
9
Center for Health Economics Research and Modeling Infectious Diseases, University of Antwerp, Belgium.
10
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA.
11
Epidemiology Unit, International Vaccine Institute, Seoul, South Korea.
12
Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India.
13
Institute for Disease Modeling, Bellevue, WA, USA.
14
Policy and Economic Research Department, Development and Delivery Unit, International Vaccine Institute, Seoul, South Korea.
15
Division of Infectious Diseases, Massachusetts General Hospital, Harvard University, Boston, MA, USA.
16
Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA.

Abstract

Typhoid fever is an acute systemic infectious disease responsible for an estimated 12-20 million illnesses and over 150 000 deaths annually. In March, 2018, a new recommendation was issued by WHO for the programmatic use of typhoid conjugate vaccines in endemic countries. Health economic analyses of typhoid vaccines have informed funding decisions and national policies regarding vaccine rollout. However, by focusing only on averted typhoid cases and their associated costs, traditional cost-effectiveness analyses might underestimate crucial benefits of typhoid vaccination programmes, because the potential effect of typhoid vaccines on the treatment of patients with non-specific acute febrile illnesses is not considered. For every true case of typhoid fever, three to 25 patients without typhoid disease are treated with antimicrobials unnecessarily, conservatively amounting to more than 50 million prescriptions per year. Antimicrobials for suspected typhoid might therefore be an important selective pressure for the emergence and spread of antimicrobial resistance globally. We propose that large-scale, more aggressive typhoid vaccination programmes-including catch-up campaigns in children up to 15 years of age, and vaccination in lower incidence settings-have the potential to reduce the overuse of antimicrobials and thereby reduce antimicrobial resistance in many bacterial pathogens. Funding bodies and national governments must therefore consider the potential for broad reductions in antimicrobial use and resistance in decisions related to the rollout of typhoid conjugate vaccines.

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