Despite being the largest producer of typhoid vaccines and accounting for half the global burden of typhoid, India has yet to include the Typhoid Conjugate Vaccine (TCV) in its Universal Immunisation Programme (UIP).
About Typhoid
- Typhoid fever is a bacterial infection caused by Salmonella enterica serotype Typhi (S. Typhi)
- Transmission: Faeco-oral route —The disease is typically transmitted through contaminated food or water, often due to poor sanitation and hygiene practices.
- Reservoir: Humans (including asymptomatic carriers).
- Symptoms of Typhoid:
- High fever (up to 104°F or 40°C)
- Weakness and fatigue
- Abdominal pain
- Diarrhea or constipation
- Loss of appetite
- Rash (in some cases, small, flat, rose-colored spots on the skin)
- Enlarged spleen and liver in severe cases
- Disproportionate Impact: Children and young adults; high loss of school and work days.
- Treatment: The primary treatment for typhoid fever is antibiotics, which are used to kill the bacteria causing the infection. Some commonly used antibiotics include:
- Ciprofloxacin (for non-pregnant adults)
- Azithromycin (alternative for cases resistant to other drugs)
- Third-generation cephalosporins (like ceftriaxone) for more severe infections or in patients who cannot tolerate oral medications.
The Burden of Typhoid
- Global Impact (WHO): 9–12 million annual cases, Over 100,000 deaths globally
- India’s Share:
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- Estimated 4.5 million cases and 8,930 deaths annually (SEFI Study, 2017–2020)
- Incidence rate: 576–1,173 per 1,00,000 child-years (higher in poor urban areas)
Challenges in Controlling Typhoid in India
- Diagnostic Gaps:
- Blood culture — the gold standard test — is rarely available at peripheral levels.
- Outdated and unreliable tests like Widal are still widely used.
- This leads to misdiagnosis and irrational antibiotic use, fuelling further resistance.
- Confusion with other diseases: Typhoid mimics dengue, malaria, scrub typhus, and COVID-19.
- Rising Antimicrobial Resistance (AMR):
- Strains resistant to chloramphenicol, ampicillin, and co-trimoxazole since 1950s.
- Ceftriaxone and azithromycin are now showing reduced effectiveness.
- XDR (Extensively Drug-Resistant) typhoid strains have already emerged in Pakistan — a serious threat for India.
- Poor Water and Sanitation Quality:
- Despite Swachh Bharat Mission and Jal Jeevan Mission, access to safe drinking water remains limited.
- Only 6% of urban households across 302 districts have safe water supply; rural coverage is even lower.
- Continued faecal contamination of food and water ensures persistent transmission.
- Inadequate Surveillance:
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- National typhoid surveillance remains patchy.
- Lack of reliable, long-term data delays decision-making for vaccine rollout.
About Typhoid Conjugate Vaccine (TCV)
- It is a conjugate vaccine, where the Vi polysaccharide antigen (from the bacteria) is attached to a carrier protein to enhance immune response, especially in young children.
- WHO Recommendation: Strongly endorses TCV for endemic countries (2018).
- Benefits of TCV:
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- Administered as a single-dose injection
- Enhanced protection in young children (aged 6 months and older).
- Long-lasting immunity.
- Prevention of severe cases, such as intestinal perforation and sepsis.
- Effective in both children and adults in high-risk areas.
- Cost-Effective: Navi Mumbai field trial (2018) showed cost at $1.87 per dose, much lower than treatment costs.
- Major Indian Producers: Bharat Biotech (Typbar TCV), Serum Institute of India, Zydus Lifesciences
Why India Should Include TCV in Universal Immunisation Programme (UIP) ?
- Massive Disease Burden: India bears half of the global typhoid load.
- Including TCV in UIP can significantly reduce cases, hospitalisations, and deaths — especially among children and the urban poor.
- To Curb Drug Resistance: Vaccination reduces infection rates and consequently lowers antibiotic misuse, helping contain antimicrobial resistance (AMR).
- To Promote Health Equity: Currently, TCV is available only in the private sector at high cost.
- Inclusion in UIP ensures free access for vulnerable populations and aligns with the National Health Policy (2017) focus on equity.
- Leverage India’s Vaccine Strength: India is a global vaccine manufacturing hub and the main supplier of TCV to other countries.
- Yet, it lags in domestic utilisation — an ironic policy gap that undermines self-reliance in public health.
- Global and Regional Precedents:
- Pakistan, Nepal, and Bangladesh have successfully integrated TCV in their national immunisation schedules with GAVI support.
- India’s GAVI partnership (2023–2026), worth $250 million, explicitly supports TCV introduction — but action has been delayed.
GAVI, The Vaccine Support:
- Established: In the year 2000.
- Type: Public–private global health partnership (involving WHO, UNICEF, World Bank, Gates Foundation).
- Objective: To improve access to life-saving vaccines for children in low- and middle-income countries.
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About Universal Immunisation Programme (UIP)
- Origin:
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- Launched as the Expanded Programme on Immunization (EPI) in 1978.
- Renamed as the Universal Immunization Programme (UIP) in 1985.
- Aim: To provide free vaccination against preventable diseases to all children and pregnant women.
- Access Points: Vaccines available at government/private health facilities and immunization session sites (Anganwadi centres or other local sites) on fixed days.
- Administered by: Ministry of Health & Family Welfare
- Coverage: 12 vaccines currently (including Measles, Polio, Pentavalent, HPV in selected states).
Mission Indradhanush (MI):
- Launched by: Ministry of Health and Family Welfare (MoHFW) in 2014.
- Objective: To ensure full immunization of all unvaccinated and partially vaccinated children under the Universal Immunization Programme (UIP).
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5 Nov 2025
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