Journal Article

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

Ryan, Edward T, Bogoch, Isaac I, Andrews, Jason R, Garrett, Denise, Yousafzai, Mohammad Tahir, Lo, Nathan C, Alsan, Marcella, Gellin, Bruce G, John, Jacob, Luby, Stephen P, Saha, Samir K, Antillon, Marina, Marks, Florian, Qamar, Farah Naz, Gauld, Jillian, Mogasale, Vittal, Kim, Jong-Hoon, Baker, Stephen, Pitzer, Virginia E

2019

Overview

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.

• Publisher: Elsevier Ltd,Elsevier Limited
• Subject: Adolescent / Anti-Bacterial Agents - adverse effects / Anti-Bacterial Agents - therapeutic use / Antiinfectives and antibacterials / Antimicrobial agents / Antimicrobial resistance / Bacterial infections / Child / Child, Preschool / Children / Conjugates / Cost analysis / Cost benefit analysis / Decision analysis / Decisions / Diagnostic tests / Drug resistance / Drug Resistance, Bacterial - immunology / Economic analysis / Fatalities / Female / Fever / Funding / Humans / Illnesses / Immunization / Incidence / Infant / Infectious diseases / Male / Mortality / Patients / Population / Public health / Salmonella / Salmonella typhi - immunology / Typhoid / Typhoid Fever - drug therapy / Typhoid Fever - epidemiology / Typhoid Fever - microbiology / Typhoid Fever - prevention & control / Typhoid-Paratyphoid Vaccines - adverse effects / Typhoid-Paratyphoid Vaccines - economics / Typhoid-Paratyphoid Vaccines - immunology / Vaccination / Vaccines / Vaccines, Conjugate - adverse effects / Vaccines, Conjugate - economics / Vaccines, Conjugate - immunology / Waterborne diseases