Pakistan set to combat typhoid with a campaign beginning in Sindh

Becomes first country in the world to introduce the one-dose typhoid conjugate vaccine

KARACHI: Pakistan is the first country in the world to introduce the typhoid conjugate vaccine (TCV) to its routine immunisation programme. The vaccine is being launched with a campaign beginning in Sindh in response to the outbreak of typhoid in November 2016. The campaign to combat typhoid, equipped with TCV, was set in motion on Friday with a launching ceremony in Karachi, presided by Special Assistant to Prime Minister on Health Dr Zafar Mirza and Sindh Health and Population Welfare Minister Dr Azra Pechuho. The two-week campaign in Sindh will formally begin on November 18.

Speaking on the occasion, Dr Mirza noted that children are disproportionately affected by typhoid and the complications associated with it. "We strongly believe that TCV would protect our children against the potentially fatal disease," he said, adding that the government of Pakistan has planned a national introduction of TCV with support from local and global partners. The campaign begins in Sindh where the need is most urgent, he added.

Securing the most vulnerable

TCV is a one-dose vaccine which is injected intramuscularly and is lower in cost, with higher efficacy.  It is expected to provide long-lasting immunity in adults, children, and infants, children, and infants older than nine months of age.

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In 2017, 63 per cent of typhoid cases and 70 per cent of the deaths related to the disease were among children younger than 15 years of age. To address this, a phased introduction will begin with a two-week campaign targeting 10.1 million children, between the ages of nine months and 15 years, in more than 460 urban union councils of Sindh, with funding support from Gavi, the Vaccine Alliance. Schools will play their part in reaching out to older children. Around 4.7m children from Karachi would be targeted during the two-week campaign and following the campaign, the vaccine would be given to nine-month-old infants as part of routine immunisation at EPI centres in all parts of the province.

Contagious disease

"Typhoid is a highly contagious disease that spreads more quickly and easily when people live in crowded neighbourhoods with weak water and sanitation infrastructure," said Dr Pechuho. "Beginning the vaccination [campaign] in urban areas is critical in preventing the disease among communities most at risk," she added.

According to Dr Pechuho, typhoid is preventable and prevention through vaccination was one of the most effective interventions to reduce typhoid infections. "The TCV campaign will be conducted from November 18 and continue till November 30 in Sindh and will be followed by the TCV as part of the routine immunisation programme in December," she said, adding that the government was also promoting WASH solutions - water, sanitation and hygiene, alongside the introduction of TCV.

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Global support

Meanwhile, UNICEF Representative in Pakistan Aida Girma said that the phased national introduction plan for TCV would ensure that the vaccine reaches the children most at risk first. She appreciated the efforts of the Pakistani government towards prioritising the immunisation of children at risk of typhoid.

"Before the discovery of antibiotics, typhoid would kill as many as one in five people who contracted it," noted Gavi CEO Dr Seth Berkley. He added that the rise of the extremely drug-resistant typhoid was bringing people back to levels of mortality not seen since the 19th century. "It poses a risk to us all. That's why typhoid conjugate vaccine is so important," he said.

Others at the event included officials from the Federal Ministry of National Health Service, Sindh health director-general, officials of the EPI programme and other officials and dignitaries from the relevant provincial and federal departments.

Published in The Express Tribune, November 16^th, 2019.