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Predicting the Impact of Vaccination on the Transmission Dynamics of Typhoid in South Asia: A Mathematical Modeling Study

Author(s): Pitzer, Virginia E.; Bowles, Cayley C.; Baker, Stephen; Kang, Gagandeep; Balaji, Veeraraghavan; et al

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Abstract: Background: Modeling of the transmission dynamics of typhoid allows for an evaluation of the potential direct and indirect effects of vaccination; however, relevant typhoid models rooted in data have rarely been deployed. Methodology/Principal Findings: We developed a parsimonious age-structured model describing the natural history and immunity to typhoid infection. The model was fit to data on culture-confirmed cases of typhoid fever presenting to Christian Medical College hospital in Vellore, India from 2000–2012. The model was then used to evaluate the potential impact of school-based vaccination strategies using live oral, Vi-polysaccharide, and Vi-conjugate vaccines. The model was able to reproduce the incidence and age distribution of typhoid cases in Vellore. The basic reproductive number (R0) of typhoid was estimated to be 2.8 in this setting. Vaccination was predicted to confer substantial indirect protection leading to a decrease in the incidence of typhoid in the short term, but (intuitively) typhoid incidence was predicted to rebound 5– 15 years following a one-time campaign. Conclusions/Significance: We found that model predictions for the overall and indirect effects of vaccination depend strongly on the role of chronic carriers in transmission. Carrier transmissibility was tentatively estimated to be low, consistent with recent studies, but was identified as a pivotal area for future research. It is unlikely that typhoid can be eliminated from endemic settings through vaccination alone.
Publication Date: 9-Jan-2014
Electronic Publication Date: 9-Jan-2014
Citation: Pitzer, Virginia E., Bowles, Cayley C., Baker, Stephen, Kang, Gagandeep, Balaji, Veeraraghavan, Farrar, Jeremy J., Grenfell, Bryan T. (2014). Predicting the Impact of Vaccination on the Transmission Dynamics of Typhoid in South Asia: A Mathematical Modeling Study. PLoS Neglected Tropical Diseases, 8 (1), e2642 - e2642. doi:10.1371/journal.pntd.0002642
DOI: doi:10.1371/journal.pntd.0002642
EISSN: 1935-2735
Pages: e2642 - e2642
Type of Material: Journal Article
Journal/Proceeding Title: PLoS Neglected Tropical Diseases
Version: Final published version. This is an open access article.

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