TYPHOID IN INDIA

THE NEED TO TAKE PREVENTIVE MEASURES TO FIGHT TYPHOID – IMPORTANCE OF VACCINATION

VACCINE

MOST AFFECTED AREA – INDIAN SUB-CONTINENT

TYPHOID INFECTION

Typhoid fever is an infection caused by bacteria called Salmonella typhi that can spread throughout the body; without prompt treatment, it can cause serious complications

This infection can cause • Fever, diarrhoea and hypotensive shock• Gastrointestinal hemorrhage in 10-15% of cases

WHO IS AT RISK?

Typhoid fever is most common in parts of the world that have poor levels of sanitation and limited access to clean water

Children and younger adults are at the most risk of developing typhoid fever because of their comparatively weaker immune system

HOW DOES BACTERIA SPREAD!

Fruit flies found in unsanitary conditions like garbage dumps and trashcans carry the bacteria around through food and water

100 different kinds of disease causing germs are carried over by these insects

Most types of salmonella bacteria remain in the gut and cause diarrhoea, often as part of food poisoning; the type called Salmonella typhi can get from the gut into other parts of the body and causes the more serious illness of typhoid fever

TYPHOID – SYMPTOMS & COMPLICATIONS

Symptoms: A fever that gradually rises before settling at around

102-103 F Abdominal pain; a dull headache

Complications: One in 10 people with untreated typhoid fever will

develop one or more serious complications – usually occur in the third week after symptoms start

Internal bleeding; a section of the digestive system or bowel splits open and causes widespread infection

PREVENTION THROUGH VACCINATION

Travelers to pilgrimage places, to hill stations, travelling abroad and to areas where typhoid is a problem because of consistent rains should be immunized

As per a study by Gates Foundation – • antibiotic resistant strains of S. typhi are increasing

rapidly, including multi-drug resistant strains • vaccination against typhoid even more imperative

as other forms of treatment are not as effective

TYPBAR TCV VACCINE

Earlier Technology: • First dose at 2 years and revaccination after three

years – like a booster

• Vaccine wouldn’t be effective after two shots as the antibodies would be inactive

New Technology:• Typbar TCV in infants older than 6 months; protects

against typhoid fever caused by Salmonella typhi and is the only conjugate vaccine available with memory cells for identification of disease

Different types of Typhoid vaccines

1st Generation - Inactivated Whole – Cell Vaccine

2nd Generation - Cell Vaccine (Live Oral) 2nd

Generation - Vi Polysaccharide Vaccine 3rd

“Typbar”

Generation - Vi Polysaccharide Conjugate Vaccine “Typbar-TCV”

STUDY -

Global mortality estimates for typhoid fever (216,000 – 600,000 or more) place typhoid in the range of several priority infectious diseases, including HPV, rotavirus and Hib

The number of typhoid-related deaths each year is comparable to that of cervical cancer caused by HPV and is greater than that of Japanese encephalitis and meningococcal meningitis – all diseases that are top priorities for disease control in the global health community

Typbar-TCV development at BBIL

Source for Typhoid Vi Polysaccharide: Purified Typhoid Vi Polysaccharide The bacterial strain : Salmonella typhi Ty2

given to BBIL by Dr. John Robbins, NIH,USA.

Source for Tetanus Toxoid: P.T. Biofarma (WHO Prequalified) Used as Carrier Protein

Conjugate Vaccine

The covalent attachment of the polysaccharide to a

protein carrier can create a conjugate molecule •

This conjugate molecules can convert the T-independent Polysaccharides (TI) to T-

dependent

Study Design & Study Population

Vi poly saccharide Typbar

B cell dependent immune induce mainly IgM.

No immunological memory for long term

IgM levels drop rapidly with in 3 yrs & and repeat vaccine is required.

Are not effective in infants and un recognized under 2 yrs age children

Conjugated Typbar TCV

T. cell dependent immune response induce mainly

IgG

Antibody response boosted against s.typhy

IgG levels maintain for long term

Are safe effective in infants

Long lived & provides herd immunity

Study investigators and sites

Dr. Monjori Mitra, Institute of Child Health, Kolkata •

Dr. G. Sampath, Institute of Preventive Medicine, Hyderabad. •

Dr. P. Venugopal, King George Hospital, Visakhapatnam. •

Dr. Mukesh Gupta, Soumya Child Clinic, Jaipur •

Dr. Sudhakar, Priya Children’s Hospital, Vijayawada •

Dr. S.N. Mahantashetti, JNMC-WMKS, Belgaum •

Dr. Sri Krishna, Mahavir Hospital, Hyderabad •

Dr. Bhuvaneswar Rao, Sri Srinivasa Children’s Hospital, Vijayawada

Discussion & Conclusion

Typbar TCV need to conjugation is to vaccinate children older then six months. not only to provide early protection and also to give long term immunity to the vaccinee.

The Typbar-TCV vaccine is safe and more effective than Typbar vaccine.

There is statistically significant difference between Typbar-TCV vaccine and Typbar vaccine in terms of GMT and four fold seroconversion

RECOMMENDATIONS OF ( IAP)

As per the schedule of IAP 2014- 2015 Recommendations

TYPBAR TCV Ist Dose at 9 – 12 , months of age,

TCV , Booster Dose at 2 years of age,

THANK Q