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Prevention of Typhoid by Vi Conjugate Vaccine and Achievable Improvements in Household Water, Sanitation, and Hygiene: Evidence From a Cluster-Randomized Trial in Dhaka, Bangladesh.

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cam.depositDate2022-05-26
cam.issuedOnline2022-04-12
cam.orpheus.success2022-06-07 - Embargo set during processing via Fast-track
dc.contributor.authorTadesse, Birkneh Tilahun
dc.contributor.authorKhanam, Farhana
dc.contributor.authorAhmmed, Faisal
dc.contributor.authorIm, Justin
dc.contributor.authorIslam, Md Taufiqul
dc.contributor.authorKim, Deok Ryun
dc.contributor.authorKang, Sophie SY
dc.contributor.authorLiu, Xinxue
dc.contributor.authorChowdhury, Fahima
dc.contributor.authorAhmed, Tasnuva
dc.contributor.authorBinte Aziz, Asma
dc.contributor.authorHoque, Masuma
dc.contributor.authorPark, Juyeon
dc.contributor.authorPak, Gideok
dc.contributor.authorZaman, Khalequ
dc.contributor.authorKhan, Ashraful Islam
dc.contributor.authorPollard, Andrew J
dc.contributor.authorKim, Jerome H
dc.contributor.authorMarks, Florian
dc.contributor.authorQadri, Firdausi
dc.contributor.authorClemens, John D
dc.contributor.orcidTadesse, Birkneh Tilahun [0000-0003-4005-8605]
dc.date.accessioned2022-06-07T08:21:08Z
dc.date.available2022-06-07T08:21:08Z
dc.date.issued2022-11-14
dc.date.updated2022-05-26T16:09:31Z
dc.description.abstractBACKGROUND: Typhoid fever contributes to approximately 135 000 deaths annually. Achievable improvements in household water, sanitation, and hygiene (WASH) combined with vaccination using typhoid conjugate vaccines (TCVs) may be an effective preventive strategy. However, little is known about how improved WASH and vaccination interact to lower the risk of typhoid. METHODS: A total of 61 654 urban Bangladeshi children aged 9 months to <16 years, residing in 150 clusters with a baseline population of 205 760 residents, were randomized 1:1 by cluster to Vi-tetanus toxoid TCV or Japanese encephalitis (JE) vaccine. Surveillance for blood culture-confirmed typhoid fever was conducted over 2 years. Existing household WASH status was assessed at baseline as Better or Not Better using previously validated criteria. The reduction in typhoid risk among all residents associated with living in TCV clusters, Better WASH households, or both was evaluated using mixed-effects Poisson regression models. RESULTS: The adjusted reduced risk of typhoid among all residents living in the clusters assigned to TCV was 55% (95% confidence interval [CI], 43%-65%; P < .001), and that of living in Better WASH households, regardless of cluster, was 37% (95% CI, 24%-48%; P < .001). The highest risk of typhoid was observed in persons living in households with Not Better WASH in the JE clusters. In comparison with these persons, those living in households with Better WASH in the TCV clusters had an adjusted reduced risk of 71% (95% CI, 59%-80%; P < .001). CONCLUSIONS: Implementation of TCV programs combined with achievable and culturally acceptable household WASH practices were independently associated with a significant reduction in typhoid risk. CLINICAL TRIALS REGISTRATION: ISRCTN11643110.
dc.format.mediumPrint-Electronic
dc.identifier.doi10.17863/CAM.85266
dc.identifier.eissn1537-6591
dc.identifier.issn1058-4838
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/337857
dc.language.isoeng
dc.publisherOxford University Press (OUP)
dc.publisher.departmentDepartment of Medicine
dc.publisher.urlhttp://dx.doi.org/10.1093/cid/ciac289
dc.rightsAll Rights Reserved
dc.rights.urihttp://www.rioxx.net/licenses/all-rights-reserved
dc.subjectWASH
dc.subjecttyphoid conjugate vaccine
dc.subjecttyphoid fever
dc.subjectvaccine effectiveness
dc.subjectHumans
dc.subjectChild
dc.subjectTyphoid Fever
dc.subjectVaccines, Conjugate
dc.subjectSanitation
dc.subjectWater
dc.subjectBangladesh
dc.subjectTyphoid-Paratyphoid Vaccines
dc.subjectHygiene
dc.titlePrevention of Typhoid by Vi Conjugate Vaccine and Achievable Improvements in Household Water, Sanitation, and Hygiene: Evidence From a Cluster-Randomized Trial in Dhaka, Bangladesh.
dc.typeArticle
dcterms.dateAccepted2022-04-07
prism.publicationDate2022
prism.publicationNameClin Infect Dis
prism.startingPageciac289
pubs.licence-display-nameApollo Repository Deposit Licence Agreement
pubs.licence-identifierapollo-deposit-licence-2-1
rioxxterms.typeJournal Article/Review
rioxxterms.versionAM
rioxxterms.versionofrecord10.1093/cid/ciac289

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