Batool Rabab, Tahir Yousafzai Mohammad, Qureshi Sonia, Ali Miqdad, Sadaf Tahira, Mehmood Junaid, Ashorn Per, Naz Qamar Farah
Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan; Adolescent, and Maternal Health, Faculty of Medicine and Health Technology, Tampere University, Kalevantie 4, 33100 Tampere, Finland.
Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan; Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, High Street, Kensington, NSW 2052, Australia.
Vaccine. 2021 Sep 24;39(40):5858-5865. doi: 10.1016/j.vaccine.2021.08.051. Epub 2021 Aug 28.
Enteric fever, caused by Salmonella Typhi and S. Paratyphi, is a cause of high morbidity and mortality among children in South Asia. Rising antimicrobial resistance presents an additional challenge. Typhoid Conjugate Vaccines (TCV) are recommended by the World Health Organization for use among people 6 months to 45 years old living in endemic settings. This study aimed to assess the effectiveness of TCV against culture-confirmed S. Typhi in Lyari Town, Karachi, Pakistan. This peri-urban town was one of the worst affected by the outbreak of extensively drug resistant (XDR) typhoid that started in November 2016.
A matched case-control study was conducted following a mass immunization campaign with TCV at three key hospitals in Lyari Town Karachi, Pakistan. Children aged 6 months to 15 years presenting with culture-confirmed S. Typhi were enrolled as cases. For each case, at least 1 age-matched hospital control and two age-matched community controls were enrolled. Adjusted odds ratios with 95% confidence intervals (CIs) were calculated using conditional logistic regression.
Of 82 typhoid fever patients enrolled from August 2019 through December 2019, 8 (9·8%) had received vaccine for typhoid. Of the 164 community controls and 82 hospital controls enrolled, 38 (23·2%) community controls and 27 (32·9%) hospital controls were vaccinated for typhoid. The age and sex-adjusted vaccine effectiveness was found to be 72% (95% CI: 34% - 88%). The consumption of meals prepared outside home more than once per month (adjusted odds ratio: 3·72, 95% CI: 1·55- 8·94; p-value: 0·003) was associated with the development of culture-confirmed typhoid.
A single dose of TCV is effective against culture confirmed typhoid among children aged 6 months to 15 years old in an XDR typhoid outbreak setting of a peri-urban community in Karachi, Pakistan.
由伤寒沙门氏菌和副伤寒沙门氏菌引起的肠热病是南亚儿童高发病率和高死亡率的一个原因。日益增加的抗菌药物耐药性带来了额外挑战。世界卫生组织建议在生活在流行地区的6个月至45岁人群中使用伤寒结合疫苗（TCV）。本研究旨在评估TCV在巴基斯坦卡拉奇利亚里镇针对培养确诊的伤寒沙门氏菌的有效性。这个城郊镇是2016年11月开始的广泛耐药（XDR）伤寒疫情受影响最严重的地区之一。
在巴基斯坦卡拉奇利亚里镇的三家主要医院开展了一次TCV大规模免疫接种活动后，进行了一项匹配病例对照研究。将出现培养确诊的伤寒沙门氏菌的6个月至15岁儿童纳入病例组。对于每个病例，至少纳入1名年龄匹配的医院对照和2名年龄匹配的社区对照。使用条件逻辑回归计算调整后的比值比及95%置信区间（CI）。
在2019年8月至2019年12月登记的82例伤寒热患者中，8例（9.8%）接种过伤寒疫苗。在纳入的164名社区对照和82名医院对照中，38名（23.2%）社区对照和27名（32.9%）医院对照接种过伤寒疫苗。年龄和性别调整后的疫苗有效性为72%（95%CI：34% - 88%）。每月不止一次食用家庭外准备的食物（调整后的比值比：3.72，95%CI：1.55 - 8.94；p值：0.003）与培养确诊伤寒的发生有关。
在巴基斯坦卡拉奇一个城郊社区的XDR伤寒疫情环境中，单剂量TCV对6个月至15岁儿童培养确诊的伤寒有效。
