A type of vaccine against the Salmonella organism that causes typhoid fever was over 90 percent effective in children two to five years of age, according to a new report in the April 26 issue of the New England Journal of Medicine. The vaccine is called Vi-rEPA.

Typhoid fever is a common illness in developing countries, where water and food supplies are often contaminated with the Salmonella typhi bacteria. There are at least 16 million cases of typhoid fever every year, resulting in more than 600,000 deaths. S. typhi has become increasingly resistant to antibiotics, and the current vaccines available confer only 70 percent protection in adults and older children and do not protect young children at all. A new and more effective vaccine, especially one that protects children and adults alike, could offer major public health gains.

Researchers from the National Institute of Child Health and Human Development, led by Feng Ying C. Lin, M.D., M.P.H., evaluated the efficacy of the Vi-rEPA vaccine in more than 11,000 children aged two to five years in Vietnam. Each child received two injections of either Vi-rEPA or an inactive saline placebo, given six weeks apart. The study was double-blind and randomized, thus neither the researchers nor the children knew which injection had been given. Cases of typhoid were diagnosed by identifying the S. Typhi in blood cultures, after a child had experienced 3 or more days of fever.

In the 27 months that followed, S. typhi was identified in 4 of the 5525 children who had received two injections of the Vi-rEPA vaccine and in 47 of the 5566 children who had received two injections of placebo. Thus the vaccine was 91.5 percent effective in protecting against the disease. An additional 771 children received only one injection of either Vi-rEPA or placebo. In this group, 1 child was diagnosed with typhoid fever in the vaccinated group and 8 children were diagnosed in the placebo group (vaccine efficacy, 87.7 percent). No serious adverse reactions occurred due to the vaccination.

Further, among the total number of children with typhoid fever who required hospitalization, none were from the vaccine group.

The results show the efficacy of a typhoid vaccine in young children, for whom no effective vaccine was previously available,” state the authors.

They add, “It is likely that Vi-rEPA will be at least 92 percent protective for persons older than five years of age, including military personnel and travelers to areas in which typhoid is endemic.”

In an accompanying editorial, Richard L. Guerrant, M.D., and Margaret Kosek, M.D., of the University of Virginia comment on the potential uses for an effective typhoid vaccine. They state that if the vaccine is effective in infants “it could play an important part in controlling typhoid fever in areas of endemic disease.”

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