Typhoid vaccines: WHO position paper – March 2018

There is a continuing high burden of typhoid fever in many parts of the world and a rapid increase in the emergence and spread of antimicrobial resistant strains of S. Typhi. Currently available evidence is favourable regarding the safety, efficacy, effectiveness and/or immunogenicity, as well as cost-effectiveness of typhoid vaccines.

WHO recommends programmatic use of typhoid vaccines for the control of typhoid fever. All typhoid vaccination programmes should be implemented in the context of other efforts to control the disease, including health education, water, sanitation and hygiene (WASH) improvements, and training of health professionals in diagnosis and treatment.

Among the available typhoid vaccines, TCV is preferred at all ages in view of its improved immunological properties, suitability for use in younger children and expected longer duration of protection. Countries may also consider the routine use of ViPS vaccine in individuals aged 2 years and older, and Ty21a vaccine for individuals aged more than 6 years. In choosing a typhoid vaccine, the costs, programmatic issues and duration of protection should be considered.

WHO recommends the introduction of TCV to be prioritized in countries with the highest burden of typhoid disease or a high burden of antimicrobial resistant S. Typhi. Decisions on the age of TCV administration, target population and delivery strategy for routine and catch-up vaccination should be based on the local epidemiology of typhoid fever, including antimicrobial resistance patterns, and programmatic considerations of the routine childhood immunization programme.