TYPHOID IN INDIA

THE NEED TO TAKE

PREVENTIVE MEASURES TO
FIGHT TYPHOID
IMPORTANCE OF
VACCINATION

MOST AFFECTED AREA INDIAN SUBCONTINENT

VACCINE

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
calledSalmonella typhican 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 102103 F
Abdominal pain; a dull headache
Complications:
Onein 10 people with untreated typhoid feverwill
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 wouldnt 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 Tdependent

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 Childrens Hospital, Vijayawada
Dr. S.N. Mahantashetti, JNMC-WMKS, Belgaum
Dr. Sri Krishna, Mahavir Hospital, Hyderabad
Dr. Bhuvaneswar Rao, Sri Srinivasa Childrens Hospital,

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 ,
age,

Booster Dose at 2 years of

THANK Q