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A recent study showed typhoid conjugate vaccine to be very effective in Bangladeshi children (NEJM JW Infect Dis Oct 2021 and Lancet 2021 Aug 21; 398:675 [e-pub]). Is such protection achievable in sub-Saharan Africa? In a trial in Malawi, investigators randomly assigned 28,130 children (age range, 9 months–12 years) to receive a single dose of tetanus-toxoid conjugated vaccine (Vi-TCV) or meningococcal capsular group A conjugate vaccine (MenA).
In the intention-to-treat analysis, incidence of blood culture–confirmed typhoid fever per 100,000 person-years was 47 (Vi-TCV group) vs. 243 (MenA group), for an efficacy of 80.7% that was similar in boys and girls younger or older than 5 years, and that persisted throughout 18–24 months' follow up. …