A Turning Point in Typhoid Control

OBJECTIVE:
The highest burden of morbidity and mortality associated with Salmonella enterica serovar Typhi and S. enterica serovar Paratyphi A occurs in South and Southeast Asia and in sub-Saharan Africa. In the last 2 decades, significant contributions to our overall understanding of typhoid fever and paratyphoid fever (collectively enteric fever) have been achieved through key population-based disease burden studies. Of particular note, the landmark Diseases of the Most Impoverished (DOMI) project, conducted between 2000 and 2008, documented the high incidence of blood culture–confirmed typhoid and several epidemiological aspects of the disease in 7 Asian countries. Similarly, the Typhoid Surveillance in Africa Program, conducted in 13 countries in sub-Saharan Africa between 2010 and 2014, generated significant data to fill the knowledge gaps on typhoid fever and nontyphoidal Salmonella disease in that geographic region. Despite these large multicountry studies, and other single-country studies published in recent decades, several epidemiological gaps remain. Several current population studies are anticipated to add to the growing body of knowledge on all 3 invasive Salmonella diseases that will make major contributions to their effective control.
RESULTS:
The long-awaited realization of opportunities for routine vaccination with TCV could ensure rapid reductions in typhoid burden, leading to elimination of typhoid fever in critical geographic areas if the vaccine performs as expected. Today, with these new vaccines, we are on the cusp of the turning point in typhoid history, but we must ensure that the time bought by vaccination leads to long-term investments in sustainable WASH improvements so that typhoid becomes of only historical interest.

Click here to view the article, published in The Journal of Infectious Diseases.