Typhoid immunization of children urged at workshop in Bali

Typhoid fever continues to exact a significant toll on the population of Indonesia, especially children living in large urban areas. A disease surveillance study was carried out in 2002 and 2003 in two sub-districts of North Jakarta by the National Institute of Health Research and Development (NIHRD) and the IVI – through the Diseases of the Most Impoverished (DOMI) Program, funded by the Bill & Melinda Gates Foundation & Swedish International Development Cooperation Agency.

 

Children 6-14 years old living in these slum areas were found to be at high risk of getting the disease – having annual incidence rates, adjusted for the 50 percent sensitivity of blood cultures, of nearly 500/100,000 (Figure 1). The annual rate for all ages combined was 200/100,000. These already high rates are likely to be considerably under-estimated, since not all public health facilities and no private facilities were included in the surveillance.

 

 

Typhoid not only causes suffering and pain among its victims, it can lead to extreme financial hardship for their families. Economic studies by the DOMI Program found that the ¡°private¡± costs of illness – paid largely by families for medical care and lost wages of patients or their caretakers – averaged US$249 for hospitalized patients. This is the equivalent of 3.5 months average household income in the area.

 

These results, as well as a successful vaccine demonstration project by DOMI, in which 4,800 North Jakarta school children received Vi polysaccharide typhoid vaccine, prompted the NIHRD to organize a national workshop on ¡°Typhoid Fever Vaccination in Endemic Areas of Indonesia: Challenge for the Future.¡± The one and a half day workshop co-sponsored by the IVI, was held in Bali, Indonesia April 26-27, and was attended by over 40 participants from the Centers for Disease Control (of the Ministry of Health), NIHRD, UNICEF, the Jakarta local government, the U.S. Naval Medical Research Unit (NAMRU-2), BioFarma (the local vaccine producer), and other health practitioners and researchers.

 


A consensus was reached among participants that typhoid fever is a serious problem in large cities of Indonesia and that vaccination targeted towards high-risk areas should be further explored to control this disease. Participants also agreed that the introduction of typhoid vaccination should be phased in, beginning with a pilot introduction project to demonstrate the impact of vaccination on disease burden, and to estimate the cost-effectiveness of vaccination.

 

Participants agreed that the pilot vaccination should take place in all districts of North Jakarta for children in primary school and the first three grades of secondary school (around ages 6-14 years), and that the vaccine to be used will be will be the Vi polysaccharide vaccine, which was has been found to confer around 70% protection and which is under development by the country¡¯s vaccine producer, BioFarma.

 

A Task Force is now being formed in Indonesia to develop a proposal for this pilot introduction project, to be presented to both the local and national governments and to donor agencies.

 

For more information on DOMI¡¯s typhoid program or the project in Indonesia, please contact Leon Ochiai at: rlochaia@ivi.int.