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      Typhoid Conjugate Vaccine: A Boon for Endemic Regions

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          Abstract

          Typhoid fever has the highest disease burden in countries in low- and middle-income countries, primarily located in Asia and Sub-Saharan Africa. Previous typhoid vaccines such as the live attenuated typhoid (Ty21a) vaccine and Vi (virulence) capsular polysaccharide vaccine had the limitation that they could not be administered with other standard childhood immunizations and were ineffective in children under two years of age. To address these shortcomings of the previous vaccines, typhoid conjugate vaccines (TCVs) were developed and prequalified by the World Health Organization. Cross-reacting material and tetanus toxoid are widely used as carrier proteins in TCVs. According to various studies, TCV has higher efficacy, has a more extended protection period, and is safe and immunogenic in infants as young as six months. This review article aims to comprehensively appraise the data available on TCVs’ efficacy, duration of protection, safety, and immunogenicity in endemic regions.

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          History of vaccination.

          Stanley Plotkin (2014)
          Vaccines have a history that started late in the 18th century. From the late 19th century, vaccines could be developed in the laboratory. However, in the 20th century, it became possible to develop vaccines based on immunologic markers. In the 21st century, molecular biology permits vaccine development that was not possible before.
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            Typhoid and paratyphoid fever.

            M K Bhan, Rajiv Bahl, Shinjini Bhatnagar (2005)
            Typhoid fever is estimated to have caused 21.6 million illnesses and 216,500 deaths globally in 2000, affecting all ages. There is also one case of paratyphoid fever for every four of typhoid. The global emergence of multidrug-resistant strains and of strains with reduced susceptibility to fluoroquinolones is of great concern. We discuss the occurrence of poor clinical response to fluoroquinolones despite disc sensitivity. Developments are being made in our understanding of the molecular pathogenesis, and genomic and proteomic studies reveal the possibility of new targets for diagnosis and treatment. Further, we review guidelines for use of diagnostic tests and for selection of antimicrobials in varying clinical situations. The importance of safe water, sanitation, and immunisation in the presence of increasing antibiotic resistance is paramount. Routine immunisation of school-age children with Vi or Ty21a vaccine is recommended for countries endemic for typhoid. Vi vaccine should be used for 2-5 year-old children in highly endemic settings.
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              Salmonella enterica serovar Typhi and the pathogenesis of typhoid fever.

              Gordon Dougan, Stephen Baker (2014)
              Salmonella enterica serovar Typhi, the cause of typhoid, is host restricted to humans. S. Typhi has a monophyletic population structure, indicating that typhoid in humans is a relatively new disease. Antimicrobial usage is reshaping the current S. Typhi global population and may be driving the emergence of a specific haplotype, H58, that is well adapted to transmission in modern settings and is able to resist antimicrobial killing more efficiently than other S. Typhi. Evidence gathered through genomics and functional studies using the mouse and in vitro cell systems, together with clinical investigations, has provided insight into the mechanisms that underpin the pathogenesis of human typhoid and host restriction. Here we review the latest scientific advances in typhoid research and discuss how these novel approaches are changing our understanding of the disease.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 19 March 2024
                Publication date (Electronic, collection): March 2024
                Volume: 16
                Issue: 3
                Electronic Location Identifier: e56454
                Affiliations
                [1 ] Department of Pediatrics, Southern Gem Hospital, Hyderabad, IND
                [2 ] Department of Pediatrics, Happy Family Hospital, Karnal, IND
                [3 ] Department of Pediatrics, Nihan Medical Children Hospital, Patna, IND
                [4 ] Department of Pediatrics, Natus Women and Children Hospital, Bengaluru, IND
                [5 ] Department of Infectious Disease, Zydus Lifesciences, Ahmedabad, IND
                [6 ] Medical Affairs, Zydus Lifesciences, Ahmedabad, IND
                Author notes
                Article
                DOI: 10.7759/cureus.56454
                PMC ID: 11034893
                PubMed ID: 38650789
                SO-VID: b17669f3-4231-4cad-9bf4-e5c7e74a0220
                Copyright © Copyright © 2024, Agarwal et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date accepted : 12 March 2024
                Categories
                Subject: Public Health
                Subject: Pediatrics
                Subject: Allergy/Immunology

                Keywords: tetanus toxoid (tt),salmonella paratyphi,salmonella typhii,typhoid conjugate vaccine,crm197,vips,endemic regions,vaccine,typhoid,tcv
                Data availability:
                Keywords: tetanus toxoid (tt), salmonella paratyphi, salmonella typhii, typhoid conjugate vaccine, crm197, vips, endemic regions, vaccine, typhoid, tcv

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