Evidence map›Paper›PMID 34678198›Full record

Trial reportThe Lancet. Global health2021

Efficacy of typhoid conjugate vaccine in Nepal: final results of a phase 3, randomised, controlled trial.

Mila Shakya, Merryn Voysey, Katherine Theiss-Nyland, Rachel Colin-Jones, Dikshya Pant, Anup Adhikari, Susan Tonks, Yama F Mujadidi, Peter O'Reilly, Olga Mazur and 25 more

Abstract readClinical Trial, Phase IIIRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report 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 68 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
68citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

68 citing papers in PubMed, 5 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Typhoid conjugate vaccines for preventing typhoid fever (enteric fever).The Cochrane database of systematic reviews · 2025
    Pooled it
  4. Pooled it
  5. Pooled it
  6. Trial
  7. Trial
  8. Trial
  9. Trial
  10. Trial
  11. Trial
  12. Trial
  13. 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 · 2023
    Trial
  14. Trial
  15. Trial
  16. Trial
  17. Review
  18. Article
  19. Genomic analysis ofMicrobial genomics · 2026
    Article
  20. Article

8 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

35 authors.

Mila ShakyaOxford University Clinical Research Unit, Patan Academy of Health Sciences, Lalitpur, Nepal. Electronic address: mshakya@oucru.org.
Merryn VoyseyOxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
Katherine Theiss-NylandOxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
Rachel Colin-JonesOxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
Dikshya PantPatan Academy of Health Sciences, Patan Hospital, Lalitpur, Nepal.
Anup AdhikariNepal Family Development Foundation, Lalitpur, Nepal.
Susan TonksOxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
Yama F MujadidiOxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
Peter O'ReillyOxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
Olga MazurOxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
Sarah KellyOxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
Xinxue LiuOxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
Archana MaharjanOxford University Clinical Research Unit, Patan Academy of Health Sciences, Lalitpur, Nepal.
Ashata DahalOxford University Clinical Research Unit, Patan Academy of Health Sciences, Lalitpur, Nepal.
Naheeda HaqueOxford University Clinical Research Unit, Patan Academy of Health Sciences, Lalitpur, Nepal.
Anisha PradhanOxford University Clinical Research Unit, Patan Academy of Health Sciences, Lalitpur, Nepal.
Suchita ShresthaOxford University Clinical Research Unit, Patan Academy of Health Sciences, Lalitpur, Nepal.
Manij JoshiOxford University Clinical Research Unit, Patan Academy of Health Sciences, Lalitpur, Nepal.
Nicola SmithOxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
Jennifer HillOxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
Jenny ClarkeOxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
Lisa StockdaleOxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
Elizabeth JonesOxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
Timothy LubindaOxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
Binod BajracharyaWasa Pasa Polyclinics Private, Lalitpur, Nepal.
Sabina DongolOxford University Clinical Research Unit, Patan Academy of Health Sciences, Lalitpur, Nepal.
Abhilasha KarkeyOxford University Clinical Research Unit, Patan Academy of Health Sciences, Lalitpur, Nepal.
Stephen BakerCambridge Institute of Therapeutic Immunology & Infectious Disease, University of Cambridge, Cambridge, UK.
Gordan DouganCambridge Institute of Therapeutic Immunology & Infectious Disease, University of Cambridge, Cambridge, UK.
Virginia E PitzerDepartment of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA.
Kathleen M NeuzilSchool of Medicine, University of Maryland, Baltimore, MD, USA.
Shrijana ShresthaPatan Academy of Health Sciences, Patan Hospital, Lalitpur, Nepal.
Buddha BasnyatOxford University Clinical Research Unit, Patan Academy of Health Sciences, Lalitpur, Nepal; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
Andrew J PollardOxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
TyVAC Nepal Team

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTyphoid fever is a major public health problem in low-resource settings. Vaccination can help curb the disease and might reduce transmission. We have previously reported an interim analysis of the efficacy of typhoid conjugate vaccine (TCV) in Nepali children. Here we report the final results after 2 years of follow-up.

methodsWe did a participant-masked and observer-masked individually randomised trial in Lalitpur, Nepal, in which 20 019 children aged 9 months to younger than 16 years were randomly assigned in a 1:1 ratio to receive a single dose of TCV (Typbar TCV, Bharat Biotech International, India) or capsular group A meningococcal conjugate vaccine (MenA). Participants were followed up until April 9, 2020. The primary outcome was blood culture-confirmed typhoid fever. Cases were captured via passive surveillance and active telephone surveillance followed by medical record review. The trial is registered at ISRCTN registry, ISRCTN43385161 and is ongoing.

findingsFrom Nov 20, 2017, to April 9, 2018, of 20 119 children screened, 20 019 participants were randomly assigned to receive TCV or MenA vaccine. There were 75 cases of blood culture-confirmed typhoid fever included in the analysis (13 in the TCV group and 62 in the MenA group) over the 2-year period. The protective efficacy of TCV against blood culture-confirmed typhoid fever at 2 years was 79·0% (95% CI 61·9-88·5; p<0·0001). The incidence of typhoid fever was 72 (95% CI 38-123) cases per 100 000 person-years in the TCV group and 342 (95% CI 262-438) cases per 100 000 person-years in the MenA group. Adverse events occurring within the first 7 days post-vaccination were reported previously.

interpretationThe final results of this randomised, controlled trial are in keeping with the results of our published interim analysis. There is no evidence of waning protection over a 2-year period. These findings add further support for the WHO recommendations on control of enteric fever.

fundingBill & Melinda Gates Foundation.

Indexed as

AdolescentChildChild, PreschoolFemaleHumansInfantMaleNepalTyphoid FeverTyphoid-Paratyphoid VaccinesVaccines, ConjugateTyphoid-Paratyphoid VaccinesVaccines, Conjugate

Identifiers

PMID34678198
PMCPMC8551681

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.