ArticleThe Lancet. Global health2021
Effectiveness of typhoid conjugate vaccine against culture-confirmed Salmonella enterica serotype Typhi in an extensively drug-resistant outbreak setting of Hyderabad, Pakistan: a cohort study.
Article in The Lancet. Global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 66 papers, 2 of them syntheses that pooled it.
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Who cites it
66 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Efficacy, immunogenicity, and safety of typhoid conjugate vaccines in children and adolescents: a systematic review and meta-analysis.Infection · 2026Pooled it
- Pooled it
- The validity of test-negative design for assessment of typhoid conjugate vaccine protection: comparison of estimates by different study designs using data from a cluster-randomised controlled trial.The Lancet. Global health · 2025Trial
- Single and two-dose typhoid conjugate vaccine safety and immunogenicity in HIV-exposed uninfected and HIV-unexposed uninfected Malawian children.Human vaccines & immunotherapeutics · 2024Trial
- Efficacy of typhoid conjugate vaccine: final analysis of a 4-year, phase 3, randomised controlled trial in Malawian children.Lancet (London, England) · 2024Trial
- Programmatic Effectiveness of a Pediatric Typhoid Conjugate Vaccine Campaign in Navi Mumbai, India.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Trial
- Typhoid conjugate vaccine effectiveness in Malawi: evaluation of a test-negative design using randomised, controlled clinical trial data.The Lancet. Global health · 2023Trial
- Safety, immunogenicity and non-interference of concomitant Typhoid Vi capsular polysaccharide-tetanus toxoid conjugate vaccine (Typbar-TCV®) and measles or measles-mumps-rubella vaccines in 8-9 months-old Indian children.Human vaccines & immunotherapeutics · 2022Trial
- Immunotherapeutic modalities for combating multidrug-resistant bacteria: therapeutic promises of antibodies and next-generation vaccines.Naunyn-Schmiedeberg's archives of pharmacology · 2026Review
- Global vaccine development.Nature medicine · 2026Review
- Genomic analysis ofMicrobial genomics · 2026Article
- Multivalent vaccines for invasiveInfection and immunity · 2026Review
- Exploring barriers to and motivations for vaccine uptake in a typhoid vaccine trial in Vellore, South India: a qualitative study.BMC public health · 2026Article
- Computational Design and Immunoinformatic Analysis of a Broad-Spectrum Edible Multi-Epitope Vaccine Against Salmonella for Poultry.Veterinary sciences · 2026Article
- Phase II multicentre double-blind randomised controlled trial of a Bivalent VaccInation againstBMJ open · 2026Article
- Review
- Measuring vaccine effects on antibiotic use and antimicrobial resistance in low and middle-income countries: A scoping review of methodological approaches, data sources, metrics, and limitations.PLOS global public health · 2026Article
- The 2024 WHO bacterial priority pathogens list: a critical evolution from a global One Health perspective.Science in One Health · 2026Review
- A contemporary genomic snapshot ofMicrobial genomics · 2025Article
- Effective strategies for typhoid conjugate vaccine delivery: Health and economic insights from the 2015 Kampala outbreak.PLoS neglected tropical diseases · 2025Article
6 more citing papers are in PubMed but not listed here.
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Authors and funding
17 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSalmonella enterica serotype Typhi (S Typhi) is a major public health problem in low-income and middle-income countries. We aimed to investigate the effectiveness and impact of the typhoid conjugate vaccine Typbar-TCV against S Typhi among children in an outbreak setting of extensively drug-resistant (XDR) S Typhi in Pakistan.
methodsThis cohort study was done from Feb 21, 2018, to Dec 31, 2019. A census survey of all households located in the Qasimabad and Latifabad subdistricts of Hyderabad, Pakistan, was done at baseline, and 174 005 households were registered in the census. The Typbar-TCV immunisation campaign was initiated at temporary vaccination centres and 207 000 children aged 6 months to 10 years were vaccinated from Feb 21, 2018, to Dec 31, 2018. Social mobilisers informed parents about the vaccination process. Vaccination records were maintained electronically and linked with the household census surveys. Active surveillance for suspected and blood-culture-confirmed S Typhi was established in hospitals, clinics, and laboratories to assess the following outcomes: cases of suspected typhoid fever, culture-confirmed S Typhi, and antimicrobial resistance. An age-stratified cohort of 1100 vaccinated children was randomly selected from the vaccination registry, tested for Vi-IgG antibodies (data not reported), and followed up fortnightly (via telephone calls or household visits) until Dec 31, 2019, for ascertainment of outcomes during the study period. 20 847 vaccinated and unvaccinated children were randomly selected from the census registry as a quality control cohort and followed up from Oct 1 to Dec 31, 2019, for ascertainment of outcomes. Vaccine effectiveness against suspected, culture-confirmed, and XDR S Typhi was calculated.
findings23 407 children from the census registry and surveillance system were included in the vaccine effectiveness analysis. 13 436 (57·4%) children were vaccinated, 12 214 (52·2%) were male, and 10 168 (43·4%) were aged 6-59 months. 5378 (23·0%) of 23 407 children had suspected S Typhi, among whom 775 (14·4%) had culture-confirmed S Typhi and 361 (68·6%) of 526 had XDR S Typhi. Vaccine effectiveness was 55% (95% CI 52-57) against suspected S Typhi (regardless of culture confirmation), 95% (93-96) against culture-confirmed S Typhi, and 97% (95-98) against XDR S Typhi.
interpretationTypbar-TCV is effective in protecting children against S Typhi infection in an outbreak setting, and was able, with moderate deployment, to curtail a major XDR S Typhi outbreak in a densely populated setting. The vaccine shows efficacy against S Typhi irrespective of antimicrobial resistance.
fundingBill & Melinda Gates Foundation.
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