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Typhoid is a major public health concern in India, particularly among those dwelling in urban slums with poor sanitation. The disease caused by Salmonella enterica serovar Typhi spread majorly through contaminated food and water. The economic burden of the disease is catastrophic and affects both families and the government making a strong case for including typhoid vaccines in the national immunization schedule. The World Health Organization has prequalified several vaccines and has recommended their use in endemic areas. While there is robust evidence for vaccination of children from India and other LMICs, the case for adult vaccination remains less clear. The Indian Association of Preventive and Social Medicine acknowledges the necessity to adopt a widespread typhoid immunization program, along with other preventive strategies, especially in the vulnerable pockets. IAPSM recommends focusing on newer-generation Typhoid Conjugate Vaccines (TCVs), which provide long-lasting and superior immunological benefits, and are effective across all ages including adults. IAPSM suggests routine use of Typbar-TCV™ for adults up to 45 years old in India. The organization also highlights the necessity for post-marketing surveillance of these vaccines, to monitor the long-term safety and effectiveness of various vaccines in different communities. IAPSM encourages members to take front-line efforts in their community health service areas, and finally appeals for the development of vaccines to cover a more extensive range of Salmonella infections so that control over typhoid can be strengthened. [ABSTRACT FROM AUTHOR]

Background & objectives Burden estimates of enteric fever are required to make policy decisions on introducing typhoid vaccine in India. Incidence, antimicrobial susceptibility, and out-of-pocket expenditure (OOPE) of enteric fever are estimated in Chandigarh, India. Methods A hybrid (facility and community-based) surveillance system was set up at a secondary care hospital to enrol patients above six months of age, hospitalized with fever, from a defined catchment population from May 2018 to March 2020. Blood samples were collected and cultured using an automated system (BD BACTECTM blood culture system). The Salmonella Typhi and S. Paratyphi isolates were characterized for antimicrobial susceptibility. OOPE was recorded after 14 and 28 days of discharge. Results Blood samples were collected from 97 per cent of the 1650 study participants enrolled. The incidence of enteric fever was 226.8 per 1,00,000 person-years (PY), severe typhoid fever 156.9 per 1,00,000 PY, and severe paratyphoid fever 69.9 per 1,00,000 PY. Salmonella was highly susceptible to ampicillin, azithromycin, and ceftriaxone (99.25%) and least susceptible to ciprofloxacin (11.3%). The OOPE due to hospitalization of individuals infected with S. Paratyphi [INR 8696.6 (USD 116)] was significantly higher than the individuals infected with S. Typhi [INR 7309 (USD 97.5), P =0.01], and among cases who were hospitalized for more than seven days [INR 12,251 (USD 163.3)] as compared with those with a stay of 3-7 days [INR 8038.2 (USD 107.2)] or less than three days [INR 5327.8 (USD 71), P <0.001]. Interpretation & conclusions There was a high incidence of enteric fever, high OOPE, and resistance to ciprofloxacin. [ABSTRACT FROM AUTHOR]