NEW DELHI: Nearly 5 million typhoid cases were estimated in India in 2023, with children bearing much of the burden. Amid rising antibiotic resistance, the World Health Organization (WHO) has updated its guidance on typhoid conjugate vaccine (TCV), recommending the first dose at 9-24 months in settings with high or very high typhoid incidence.A Lancet Regional Health – Southeast Asia study estimated 4.9 million cases, 7.3 lakh hospitalisations and 7,850 deaths from typhoid in India in 2023. About 6 lakh, or 82%, of hospitalisations were linked to fluoroquinolone-resistant typhoid.Children accounted for most estimated treated cases, with those aged 5-9 years accounting for 36%, followed by 10-14 years at 27% and 6 months to 4 years at 25%.“Given India’s very high typhoid burden and the emergence of drug-resistant Salmonella Typhi, including reports of carbapenem-resistant strains, routine introduction of TCV is justified and urgent. NTAGI’s 2022 recommendations and repeated cost-effectiveness analyses already support this,” said Dr Kamini Walia, senior scientist at ICMR.She said India could consider giving TCV at the existing 18-month vaccination visit, alongside the second measles-containing vaccine dose. “Even as a single dose without a booster, TCV is expected to have a significant impact on disease burden. A school-entry booster, particularly in high-burden urban areas, may be considered if surveillance shows waning protection,” she said.WHO recommends TCV in settings with high or very high typhoid incidence, high case-fatality rates or a high burden of antimicrobial-resistant Salmonella Typhi. It also recommends catch-up vaccination when TCV is introduced, with children below 15 years potentially targeted depending on local disease burden and programme feasibility.On booster doses, WHO says countries with very high typhoid incidence should consider a booster around five years after the first dose given at 9-24 months. In high-incidence settings, a booster may be considered if there is evidence that protection is waning. Decisions should take into account disease burden, antimicrobial resistance, cost-effectiveness and feasibility.The updated advice comes amid growing concern over antibiotic-resistant typhoid, which can limit treatment options and increase reliance on more expensive injectable or last-resort drugs.
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TCV is not a new WHO recommendation. The agency recommended its routine use in children in typhoid-endemic countries in 2017 and prequalified the first vaccine in 2018. The latest guidance updates recommendations based on newer evidence, including vaccination age, catch-up programmes and booster use.For India, the issue is particularly relevant. The study notes that the National Technical Advisory Group on Immunisation (NTAGI) recommended including TCV in the Universal Immunisation Programme in 2022.WHO also stresses that vaccination cannot replace basic measures such as safe water, sanitation, hygiene, food safety and timely diagnosis and treatment, which remain essential to controlling typhoid.
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