Liberia on Monday April 5, became the first country in Africa to introduce the new typhoid conjugate vaccine (TCV) into its Expanded Program for Immunization. The vaccine will be introduced to children nationwide in April 2021, beginning with a five-day vaccination campaign to reach 1.9 million children from nine-months- to younger than 15 years of age across Liberia's 15 counties. This will be followed by introduction of TCV into Liberia's routine immunization schedule for nine-month-old infants.
"While our country and the globe continue to fight the COVID-19 pandemic, we are glad to be able to protect our children from another disease, typhoid, which takes a tremendous toll especially among young children in Liberia," said Liberia's Honorable Minster of Health, Doctor Wilhelmina Jallah. "Making the TCV available to all children means better health, fewer hospital visits, and greater school productivity. Routine vaccination can relieve pressure on health services and resources at a time when those are being overstretched by our response to COVID-19."
The World Health Organization (WHO) recommends countries continue routine immunization services when possible, despite COVID-19. The campaign in Liberia is being conducted with all COVID-19 precautions in place. Social distancing will be used at vaccination sites, masks are required, and health care workers will have appropriate personal protective equipment.
WHO has prequalified and recommended TCV as a safe and effective one-dose vaccine, injected intramuscularly, that is expected to provide long-lasting immunity in adults, children, and infants six months of age and older. WHO has recommended TCV for use in all typhoid-endemic countries--including Liberia--because of its higher efficacy compared to other typhoid vaccines, suitable for children as young as 6 months of age, and lower cost. The vaccine does not protect against COVID-19.
Typhoid, a serious illness caused by Salmonella Typhi, is spread through contaminated food and water. The disease can cause fever, diarrhea, and vomiting and is sometimes fatal. The latest Global Burden of Disease analysis estimates that in 2019, Liberia had 5,836 typhoid cases, 59% among children younger than 15 years old.
"Typhoid is a highly contagious disease, but it is preventable," said Doctor Wilhelmina Jallah, the Minister of Health. "Prevention of typhoid through vaccination is one of the most effective ways we have to fight this disease. In addition, other measures such as provision of clean water, sanitation, and hygiene (such as frequent hand washing) should be promoted alongside the TCV introduction. These other measures are critically important not only for preventing typhoid, but also preventing the spread of other infectious diseases."
The campaign will make the vaccine available at a number of sites throughout the country, including health facilities, schools, churches, markets, and transportation hubs. Because health officials need to reach older children, schools will play a role as vaccination sites for several days.
Special emphasis will be placed on reaching hard-to-reach populations to ensure equity in immunization access. After the campaign, TCV will be co-administered at nine months with the first dose of measles vaccine and the yellow fever vaccine, through routine vaccination at health centers across all counties.
"Common childhood diseases, including typhoid, have not disappeared during COVID-19. Even as we prioritize this new pandemic, it is critically important that children continue to be immunized against vaccine-preventable diseases to keep them healthy and protected from these threats," said Dr. PhionahAtuhebwe, Regional New Vaccines Introduction Medical Officer, WHO/AFRO.
This is the first Gavi, the Vaccine Alliance-supported TCV introduction into routine immunization in Africa, and the second globally, after Pakistan introduced the vaccine in November 2019.
"This is a great day for the children of Liberia and for the global effort to stop drug-resistant typhoid," said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. "We have already seen the impact this new vaccine can have in Pakistan and Zimbabwe, where it has helped save lives and prevent the spread of this terrible disease. We now need other countries to follow Liberia's lead and introduce this safe, effective vaccine into their routine immunisationprogramme, to ensure no child is forced to suffer the devastating impact of typhoid."
"The Government of Liberia recognizes the importance of equitable immunization as a key factor contributing to the steady progress toward the reduction in infant and under-five mortality rates," said Honorable Minister Jallah. "With TCV introduction, the Liberian Government is taking a strong action to reinforce the routine immunization system and enhance its ability to protect children."
"Though partnerships like these, we can improve public health," said Dr. Kathleen Neuzil, Director of the Center for Vaccine Development and Global Health at the University of Maryland School of Medicine and Director of the Typhoid Vaccine Acceleration Consortium. "TCV introduction is one part of an integrated typhoid prevention and control strategy. Improved access to safe water, improved sanitation, and hygiene is also crucial to a child's healthy growth and development."