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Estimating the effect of vaccination on antimicrobial-resistant typhoid fever in 73 countries supported by Gavi: a mathematical modelling study.
Lancet Infect Dis. 2022 05; 22(5):679-691.LI

Abstract

BACKGROUND

Multidrug resistance and fluoroquinolone non-susceptibility (FQNS) are major concerns for the epidemiology and treatment of typhoid fever. The 2018 prequalification of the first typhoid conjugate vaccine (TCV) by WHO provides an opportunity to limit the transmission and burden of antimicrobial-resistant typhoid fever.

METHODS

We combined output from mathematical models of typhoid transmission with estimates of antimicrobial resistance from meta-analyses to predict the burden of antimicrobial-resistant typhoid fever across 73 lower-income countries eligible for support from Gavi, the Vaccine Alliance. We considered FQNS and multidrug resistance separately. The effect of vaccination was predicted on the basis of forecasts of vaccine coverage. We explored how the potential effect of vaccination on the prevalence of antimicrobial resistance varied depending on key model parameters.

FINDINGS

The introduction of routine immunisation with TCV at age 9 months with a catch-up campaign up to age 15 years was predicted to avert 46-74% of all typhoid fever cases in 73 countries eligible for Gavi support. Vaccination was predicted to reduce the relative prevalence of antimicrobial-resistant typhoid fever by 16% (95% prediction interval [PI] 0-49). TCV introduction with a catch-up campaign was predicted to avert 42·5 million (95% PI 24·8-62·8 million) cases and 506 000 (95% PI 187 000-1·9 million) deaths caused by FQNS typhoid fever, and 21·2 million (95% PI 16·4-26·5 million) cases and 342 000 (95% PI 135 000-1·5 million) deaths from multidrug-resistant typhoid fever over 10 years following introduction.

INTERPRETATION

Our results indicate the benefits of prioritising TCV introduction for countries with a high avertable burden of antimicrobial-resistant typhoid fever.

FUNDING

The Bill & Melinda Gates Foundation.

Links

PMC Free PDF

Authors+Show Affiliations

Birger R
Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, CT, USA.
Antillón M
Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
Bilcke J
Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
Dolecek C
Oxford Centre for Global Health Research, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Dougan G
Department of Medicine, University of Cambridge, Cambridge, UK.
Pollard AJ
Oxford Vaccine Group, University of Oxford, Oxford, UK; National Institute for Health Research Oxford Biomedical Research Centre, Oxford, UK.
Neuzil KM
Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
Frost I
Center for Disease Dynamics, Economics & Policy, New Delhi, India; Imperial College London, London, UK.
Laxminarayan R
Center for Disease Dynamics, Economics & Policy, New Delhi, India; High Meadows Environmental Institute, Princeton University, Princeton, NJ, USA.
Pitzer VE
Center for Disease Dynamics, Economics & Policy, New Delhi, India. Electronic address: virginia.pitzer@yale.edu.

MeSH

Anti-Bacterial AgentsAnti-Infective AgentsHumansInfantModels, TheoreticalTyphoid FeverTyphoid-Paratyphoid VaccinesVaccinationVaccines, Conjugate

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

35123673

Citation

Birger, Ruthie, et al. "Estimating the Effect of Vaccination On Antimicrobial-resistant Typhoid Fever in 73 Countries Supported By Gavi: a Mathematical Modelling Study." The Lancet. Infectious Diseases, vol. 22, no. 5, 2022, pp. 679-691.
Birger R, Antillón M, Bilcke J, et al. Estimating the effect of vaccination on antimicrobial-resistant typhoid fever in 73 countries supported by Gavi: a mathematical modelling study. Lancet Infect Dis. 2022;22(5):679-691.
Birger, R., Antillón, M., Bilcke, J., Dolecek, C., Dougan, G., Pollard, A. J., Neuzil, K. M., Frost, I., Laxminarayan, R., & Pitzer, V. E. (2022). Estimating the effect of vaccination on antimicrobial-resistant typhoid fever in 73 countries supported by Gavi: a mathematical modelling study. The Lancet. Infectious Diseases, 22(5), 679-691. https://doi.org/10.1016/S1473-3099(21)00627-7
Birger R, et al. Estimating the Effect of Vaccination On Antimicrobial-resistant Typhoid Fever in 73 Countries Supported By Gavi: a Mathematical Modelling Study. Lancet Infect Dis. 2022;22(5):679-691. PubMed PMID: 35123673.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Estimating the effect of vaccination on antimicrobial-resistant typhoid fever in 73 countries supported by Gavi: a mathematical modelling study. AU - Birger,Ruthie, AU - Antillón,Marina, AU - Bilcke,Joke, AU - Dolecek,Christiane, AU - Dougan,Gordon, AU - Pollard,Andrew J, AU - Neuzil,Kathleen M, AU - Frost,Isabel, AU - Laxminarayan,Ramanan, AU - Pitzer,Virginia E, Y1 - 2022/02/03/ PY - 2021/05/10/received PY - 2021/08/20/revised PY - 2021/09/23/accepted PY - 2022/2/7/pubmed PY - 2022/4/27/medline PY - 2022/2/6/entrez SP - 679 EP - 691 JF - The Lancet. Infectious diseases JO - Lancet Infect Dis VL - 22 IS - 5 N2 - BACKGROUND: Multidrug resistance and fluoroquinolone non-susceptibility (FQNS) are major concerns for the epidemiology and treatment of typhoid fever. The 2018 prequalification of the first typhoid conjugate vaccine (TCV) by WHO provides an opportunity to limit the transmission and burden of antimicrobial-resistant typhoid fever. METHODS: We combined output from mathematical models of typhoid transmission with estimates of antimicrobial resistance from meta-analyses to predict the burden of antimicrobial-resistant typhoid fever across 73 lower-income countries eligible for support from Gavi, the Vaccine Alliance. We considered FQNS and multidrug resistance separately. The effect of vaccination was predicted on the basis of forecasts of vaccine coverage. We explored how the potential effect of vaccination on the prevalence of antimicrobial resistance varied depending on key model parameters. FINDINGS: The introduction of routine immunisation with TCV at age 9 months with a catch-up campaign up to age 15 years was predicted to avert 46-74% of all typhoid fever cases in 73 countries eligible for Gavi support. Vaccination was predicted to reduce the relative prevalence of antimicrobial-resistant typhoid fever by 16% (95% prediction interval [PI] 0-49). TCV introduction with a catch-up campaign was predicted to avert 42·5 million (95% PI 24·8-62·8 million) cases and 506 000 (95% PI 187 000-1·9 million) deaths caused by FQNS typhoid fever, and 21·2 million (95% PI 16·4-26·5 million) cases and 342 000 (95% PI 135 000-1·5 million) deaths from multidrug-resistant typhoid fever over 10 years following introduction. INTERPRETATION: Our results indicate the benefits of prioritising TCV introduction for countries with a high avertable burden of antimicrobial-resistant typhoid fever. FUNDING: The Bill & Melinda Gates Foundation. SN - 1474-4457 UR - https://www.unboundmedicine.com/medline/citation/35123673/Estimating_the_effect_of_vaccination_on_antimicrobial_resistant_typhoid_fever_in_73_countries_supported_by_Gavi:_a_mathematical_modelling_study_ DB - PRIME DP - Unbound Medicine ER -