BLANTYRE-(MaraviPost)-Malawi is going to hold the first African typhoid vaccine trial next year, officials have confirmed.
This comes after research for over 15 years, mainly done in Blantyre, according to Dr. James Meiring, another researcher working with the Malawi Liverpool Wellcome Trust.
“The next stage for the work is to test the new vaccine for typhoid which we think has a protective effect of about 90%. It’s never been tested in Africa before neither has it been given to African children so we want to see whether it works in Malawi and what impact it could have on reducing the rates of typhoid fever,” said Dr. Meiring.
The trial will be done in Ndirande and Zingwangwa townships in Blantyre, targeting at least 24, 000 children aged between nine months and 12 years in a TyVAC study which will run for six months.
There will be a period of surveillance for between two and three years, according to Dr. Meiring who said the vaccine is being produced in India where it was also tested.
“It also has just undergone efficacy studies (human challenge study) in Europe where it had an effectiveness of 87%. Parallel studies are being conducted in Kathmandu, Nepal and Dhaka, Bangladesh with funding from the Bill and Melinda Gates Foundation at a grand total of US$36 million,” said Dr. Meiring.
Dr Medson Matchaya, Blantyre District Health Officer urges parents and guardians to enroll their children in the study. “I would encourage whoever is approached to participate; there’s no danger otherwise there would be an advantage in that if it works it means there will be no need to get vaccinated again.
“On the other hand, medicine relies on people of good will in order to come up with scientific evidence to help the whole world in dealing with diseases.”
Ministry of Health Expanded Programmes on Immunization (EPI) Manager Geoffrey Chirwa said in a separate interview that the study will help Malawi gather data on typhoid.
Chirwa said the government could not fully commit to run the programme countrywide before knowing the magnitude of the disease.
“At the moment we don’t have statistics on Typhoid so it is very hard for us to justify the introduction of the vaccine; we need figures to know how big the problem is in Malawi. We however appreciate the work being done by the Malawi Liverpool Wellcome Trust; they have helped us before with the pneumonia and Rota vaccines,” said Chirwa.
In November the World Health Organization recommended the typhoid vaccine for use in countries with high incidence.
Gavi, an international organization which funds vaccines in low and middle income, has also announced it they will put US$85 million in funding vaccine campaigns in countries which want to adopt them.
The disease symptoms are very familiar; fever, headache, shivering and stomachache. But unlike the usual suspect malaria, these symptoms point to another condition – Typhoid fever.
Caused by Salmonella bacteria, Typhoid fever is a disease that affects over 100 in every 100, 000 people a year in Malawi’s commercial capital Blantyre.
This is according to a strata study which started in 2016 and is currently ongoing in Ndirande Township by the Malawi Liverpool Wellcome Trust in conjunction with the Blantyre District Health Office.
“Anything 100 and above is considered high, while between 50 or 100 is medium, and below 50 is lower incidence. So in this case, is it concerning,” explained one of the researchers, Dr. Melita Gordon, one of the researchers at the Malawi Liverpool Wellcome Trust.
Typhoid fever is slowly becoming more prevalent among the population of Malawi, with outbreaks reported in Zomba, Blantyre, Mangochi, Thyolo and Mulanje districts.
“Typhoid became a serious problem in Blantyre from 2010 and persistently the age group that is predominantly affected is those from five to about 14 years which is school-age children. However we’ve also found the disease in the very young like children from around 12 months of age” said Dr. James Meiring, another researcher working with the trust.
Typhoid fever affects an estimated 20.6 million people globally each year, causing an estimated 223,000 deaths.
In Malawi, the prevalence of typhoid fever is mainly being attributed to lack of good sanitation, poverty and overpopulation. There is also a new strain of typhoid resistant to the common antibiotics.
Eighty percent of the population has access to improved sources of drinking water, but about 4 million people still lack access to safe water, according to a report by the United Nations Childrens Fund (Unicef) WASH project.
The report says only six percent of the population has access to an improved sanitation facility. These populations are at risk of Typhoid.
“The way we pass on Salmonella from human to human is through compromised hygienic standards and obviously when people are poor this reduction is very noticeable.
And in highly populated areas such as Ndirande, this reduction of hygienic practices is there and if you have challenges of water you are not washing your food correctly and adequately it’s easier to contract the virus,” said Dr Medson Matchaya, Blantyre District Health Officer.
According to a World Factbook, the highest risk of infectious diseases in Malawi is from food and water borne illnesses emanating from contaminated water.
“Water pollution in Malawi is mainly from agricultural runoff, sewage, and industrial waste,” it says.
The major challenge in Malawi in the fight against typhoid is diagnosis.
To carry out a test for typhoid, blood samples are collected and what is called blood culture is carried out to find the salmonella bacteria. But this process is currently being done in major hospitals only.
“In the past six months, we have had some five suspected cases; we may not say they were confirmed typhoid cases but we treated them on suspicion because of limitations in terms of tests that we carry out.
So we prescribed antibiotics to which they responded and were discharged,” disclosed Rex Khukulu, a pediatrics and child health clinician at Thyolo District Hospital.
This prescription of antibiotics on suspicion of typhoid is leading to an increase in a condition called anti-microbial resistance (increasing inability for an antibiotic to work against a bacterial infection).
“In Malawi, particularly with children, if they go to a health facility with fever the first thing that happens is they have a rapid test for malaria and if it’s negative they are generally given an antibiotic that might be for a respiratory infection or diarrhea but listed in there is typhoid.
“It is difficult as a clinician just on symptoms alone to reliably diagnose Typhoid because unlike Malaria, there’s no good reliable rapid Typhoid test,” Dr. Meiring said.
Dr. Meiring said as a result children end up being given antibiotics which is resulting in anti-microbial resistance.
“So if we can prevent typhoid through a vaccine, you would eliminate that cause of febrile illness; eliminate that possible diagnosis from health centers, reduce the amount of antibiotic that gets used and eventually have a positive impact of this problem of antibiotic resistance. Of course what would be good is if we develop a quick and reliable test like that of Malaria,” he said.
