Factors Influencing Vaccine Receipt During a 2018 Pediatric Typhoid Conjugate Vaccine Campaign in Navi Mumbai, India

Priyanka Borhade World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India;

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Christopher LeBoa Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California;

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Niniya Jayaprasad World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India;

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Kashmira Date Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia;

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Pradeep Haldar Ministry of Health & Family Welfare, Government of India, New Delhi, India;

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Pauline Harvey World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India;

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Rahul Shimpi World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India;

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Qian An Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia;

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Chenhua Zhang Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia;

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Lily Horng Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California;

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Kirsten Fagerli Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia;

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Vijay N. Yewale Dr. Yewale Multispecialty Hospital for Children, Navi Mumbai, India;

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Savita Daruwalla Department of Pediatrics, NMMC General Hospital, Navi Mumbai, India;

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Dhanya Dharmapalan Dr. Yewale Multispecialty Hospital for Children, Navi Mumbai, India;

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Jeetendra Gavhane Department of Pediatrics, MGM New Bombay Hospital, MGM Medical College, Navi Mumbai, India;

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Shrikrishna Joshi Dr. Joshi’s Central Clinical Microbiology Laboratory, Navi Mumbai, India;

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Rajesh Rai Department of Pediatrics & Neonatology, Dr. D. Y. Patil Medical College and Hospital, Navi Mumbai, India;

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Varsha Rathod Rajmata Jijau Hospital, Airoli (NMMC), Navi Mumbai, India;

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Keertana Shetty Department of Microbiology, Dr. D. Y. Patil Medical College and Hospital, Navi Mumbai, India;

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Divyalatha S. Warrier Department of Pediatrics, Mathadi Trust Hospital, Navi Mumbai, India;

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Shalini Yadav Department of Microbiology, MGM New Bombay Hospital, Navi Mumbai, India;

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Debjit Chakraborty National Institute of Cholera and Enteric Diseases, Indian Council of Medical Research, Kolkata, India;

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Sunil Bahl World Health Organization South-East Asia Regional Office, New Delhi, India

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Arun Katkar Ministry of Health & Family Welfare, Government of India, New Delhi, India;

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Abhishek Kunwar Ministry of Health & Family Welfare, Government of India, New Delhi, India;

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Jason R. Andrews Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California;

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Pankaj Bhatnagar Ministry of Health & Family Welfare, Government of India, New Delhi, India;

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Shanta Dutta National Institute of Cholera and Enteric Diseases, Indian Council of Medical Research, Kolkata, India;

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Stephen P. Luby Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California;

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Seth A. Hoffman Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California;

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ABSTRACT.

In 2018, the Navi Mumbai Municipal Corporation implemented phase 1 of a public sector typhoid conjugate vaccine campaign in Navi Mumbai, India, targeting all children aged 9 months to 14 years within its administrative boundaries. To assess associations with receipt of vaccine in phase 1, we used generalized estimating equations to calculate estimates of vaccination by child-, household-, and community-level demographics (child education and age; household head education, income, and occupation; community informal settlement percent). Campaign vaccine receipt was most associated with children enrolled in school (odds ratio [OR] = 3.84, 95% CI: 2.18–6.77), the lowest household income tertile when divided into three equal parts (OR = 1.64, 95% CI: 1.43–1.84), and lower community-level socioeconomic status (OR = 1.06, 95% CI: 1.04–1.08 per 10% informal settlement proportion). The campaign was successful in reaching the most underserved populations of its target communities.

In 2019, Salmonella enterica serotype Typhi, the causative agent of typhoid fever, was the bacterial pathogen associated with the most deaths in children aged 5 to 14 years in the world.1 Globally, S. Typhi remains a substantial cause of morbidity and mortality, with an estimated greater than 11 million cases and 116,000 deaths in 2017.2 Salmonella Typhi had a mortality in the preantibiotic era as high as 12%.3 Although effective antibiotics have decreased mortality to less than 1% in most regions,2 antimicrobial-resistant S. Typhi strains are on the rise48 and these strains are associated with increased severity of disease.911

In the setting of worsening global rates of antimicrobial-resistant S. Typhi, the WHO has prioritized typhoid vaccine delivery in conjunction with water, sanitation, and hygiene interventions.12 In 2018, the WHO prequalified a new typhoid conjugate vaccine (TCV) that offers improved immunogenicity and longer duration of protection and that can be administered to children as young as 6 months old.12 A trial of TCV in Dhaka, Bangladesh demonstrated 85% protective effectiveness in children ≤15 years old.13

Navi Mumbai, India is an urban township adjacent to Mumbai known to have a high burden of typhoid fever.14,15 In 2018, the Navi Mumbai Municipal Corporation (NMMC) implemented a public-sector pediatric TCV campaign (July 14, 2018–August 25, 2018) (for greater detail on campaign decision-making and implementation, please see the study by Date et al.16). The campaign endeavored to vaccinate all 9-month-olds to 14-year-olds within NMMC administrative boundaries. The campaign was planned in two phases: phase 1 communities that received TCV during the 2018 campaign and phase 2 communities that were subsequently planned for a follow-up campaign.16 Phase 1 and 2 communities were based on Navi Mumbai’s 22 urban health posts and stratified on the proportion of the population living in informal settlements.16 The phase 2 communities were planned as an initial comparator for vaccine effectiveness and campaign effectiveness (TCV only privately available at the time).17 The phase 2 campaign was indefinitely delayed secondary to the COVID-19 pandemic.

We evaluated the population vaccinated with TCV in areas with (phase 1) and without (phase 2) the campaign. Eligible participants were NMMC residents aged 9 months to 14 years at the start of the campaign (July 2018) who were enrolled from a population-based community assessment survey. This survey was initiated after the campaign and was ongoing between October 2018 and August 2020 in phase 1 and 2 communities. The survey was designed to allow for a sample of 150 to 160 geographically representative clusters every 15 to 16 weeks via a door-to-door questionnaire in a random subset of households across study communities. The questionnaire included information on demographic and socioeconomic characteristics, receipt of typhoid vaccine, history of other childhood immunizations, household wealth, and potential typhoid risk factors. Surveys were collected on password-protected tablets.

The primary definition of “vaccinated” in phase 1 communities was presentation of a TCV vaccination card (from the campaign) or caregiver recall of TCV receipt during the phase 1 campaign, which we refer to as “TCV Vax.” We conducted an additional analysis of TCV recipients in phase 1 and phase 2 communities using a more lenient definition of vaccine card presentation or caregiver recall of TCV vaccination at any time, which we refer to as “TCV Any.”

We performed a generalized estimating equation using the “gee” package in R (version 4.0.4) to calculate population-level estimates of vaccination by child-, household-, and community-level demographics, including child education, age, and gender; household head education, profession, and income; and the percentage of the community composed of informal settlements. Clustering was performed by household study identification code, and the model was run using an independent correlation structure. Reference categories for the model used the lowest income group, children who did not attend school, unemployed household heads, and household heads that achieved a middle school certificate (odds for reference categories were calculated using the reciprocal modeled odds of the category variable with the most substantial modeled odds compared with the reference). Incomplete cases and those who reported not knowing if they received TCV were not included in the model. All analyses were conducted in R version 4.2.2. The exchange rate for US$ to Indian rupee (INR) was 1 US$ = 69.8 INR (converted on August 25, 2018).

The population included in this analysis consisted of 6,414 households (10,878 children) enrolled in the survey (phase 1 communities: 5,919 children, phase 2 communities: 4,959 children). In the phase 1 “TCV Vax” analysis, 305 (5.1%) children were removed due to not knowing vaccination status. In the “TCV Any” analysis, 391 children (6.1%) were removed from phase 1 communities and 572 (11.5%) were removed from phase 2 communities due to missing or nonresponse data. Among households living in phase 1 communities, 56.5% of children were vaccinated with TCV during the campaign and 61.8% of children reported any history of TCV vaccination (campaign or not) (Table 1). Among households in phase 2 communities, 7.9% of children had any reported history of TCV receipt. Campaign-administered vaccine went predominantly to lower-income households, whereas households from the highest income tertile had smaller odds of children being vaccinated by the campaign (odds ratio [OR] = 0.61, 95% CI: 0.53–0.70) (Table 2). Typhoid conjugate vaccine campaign receipt was associated with a 6% increase in odds per 10% increase in the fraction of the community that was composed of informal settlement.

Table 1

Characteristics of study population

Characteristics of UHP Phase 1 Phase 2 Informal settlement (% UHP)
TCV Vax TCV Any TCV Any
% (vaccinated/total children) % (vaccinated/total children) % (vaccinated/total children)
Overall 56.5 (3,171/5,614) 61.8 (3,415/5,528) 7.9 (346/4,387)
Phase 1
 Nerul Sector 48 33.5 (67/200) 48.6 (84/173) 0.0
 Nerul 1 39.7 (98/247) 53.4 (264/494) 65.3
 Shiravane 46.4 (238/513) 57.7 (581/1,007) 0.3
 Juhugaon 48.0 (229/477) 58.8 (446/758) 0.0
 Koparkhairane 52.6 (540/1,027) 62.4 (557/892) 0.6
 Ghansoli 55.5 (509/917) 62.6 (129/206) 0.6
 Digha 60.8 (253/416) 64.3 (270/420) 52.4
 Turbhe Store 61.9 (442/714) 67.1 (273/407) 43.5
 Airoli 68.5 (307/448) 68.4 (323/472) 13.2
 Indiranagar 73.0 (259/355) 68.9 (259/376) 100.0
 Chinchpada 76.3 (229/300) 70.9 (229/323) 100.0
Phase 2
 Mahape 2.0 (8/401) 7.9
 Nocilnaka 2.8 (11/386) 58.1
 Sanpada 3.1 (8/259) 3.5
 CBD 4.3 (17/397) 32.2
 Ilthanpada 7.5 (48/643) 100.0
 Vashigaon 9.9 (57/575) 2.0
 Rabada 10.1 (36/356) 0.7
 Karave 10.8 (21/195) 0.7
 Pawanel 11.8 (43/364) 9.4
 Katkaripada 11.9 (58/488) 100.0
 Nerul 2 12.1 (39/323) 1.8
Child age (years)
 0 to 5 47.2 (946/2,004) 55.1 (1,089/1,977) 10.4 (166/1,595)
 6 to 10 58.2 (1,030/1,771) 62.2 (1,066/1,715) 4.6 (64/1,382)
 11 to 16 65.0 (1,195/1,839) 68.6 (1,260/1,836) 8.2 (116/1,410)
Child sex
 Male 55.2 (1,620/2,934) 60.2 (1,747/2,903) 8.2 (186/2,282)
 Female 57.9 (1,551/2,680) 63.5 (1,668/2,625) 7.6 (160/2,105)
Child education
 Never attended school 43.1 (25/58) 41.7 (25/60) 2.9 (2/68)
 Not of school age 41.1 (450/1,094) 46.3 (506/1,092) 7.5 (63/839)
 Goes to school 60.5 (2,696/4,458) 65.9 (2,884/4,374) 8.1 (281/3,474)
Household income group (US$ or INR per month)
 US$ 0.0–272.21 (INR 0.00–19,000.00) 61.5 (705/1,149) 63.8 (1,353/2,120) 3.4 (59/1,813)
  US$ 0.00–85.96 (INR 0.00–6,000.00) 61.5 (16/26) 64.4 (29/45) 0.0 (0/69)
  US$ 85.97–272.21 (INR 6,001.00–19,000.00) 61.4 (689/1,123) 63.8 (1,324/2,075) 3.4 (59/1,744)
 US$ 272.21–673.35 (INR 19,000.00–47,000.00) 58.5 (518/885) 61.2 (889/1,453) 7.6 (80/1,058)
  US$ 272.22–458.45 (INR 19,001.00 to 32,000.00) 59.3 (387/653) 62.8 (695/1,106) 5.6 (45/807)
  US$ 458.47–673.35 (INR 32,001.00 to 47,000.00) 56.5 (131/232) 55.9 (194/347) 13.9 (35/251)
 More than US$ 673.35 (INR 47,000.00) 59.5 (132/222) 53.8 (163/303) 20.7 (67/324)
  US$ 673.37–902.58 (INR 47,001.00–63,000.00) 60.4 (84/139) 54.1 (98/181) 11.7 (23/196)
  US$ 902.59–1,805.16 (INR 63,001.00–126,000.00) 54.4 (31/57) 44.6 (33/74) 26.3 (26/99)
  More than US$ 1,805.16 (INR 126,000.00) 65.4 (17/26) 66.7 (32/48) 62.1 (18/29)
Household head occupation
 Unemployed 56.8 (2,162/3,803) 62.6 (2,324/3,710) 7.8 (216/2,757)
 Trade/unskilled workers 62.3 (314/504) 58.6 (317/541) 2.9 (15/516)
Skilled worker 60.5 (461/762) 61.2 (479/783) 5.3 (36/681)
 Public official/professional/associate professional 35.4 (125/353) 58.4 (180/308) 25.3 (63/249)
Household head education
 No formal education 62.1 (380/612) 56.8 (382/673) 2.2 (16/728)
 Primary school certificate (through grade 4) 62.4 (108/173) 59.6 (109/183) 3.8 (6/157)
 Middle school certificate (grade 5–10) 66.1 (1,582/2,394) 50.0 (45/90) 12.3 (10/81)
 High school certificate (grade 11–12) 58.2 (503/865) 65.5 (1,606/2,452) 4.4 (80/1,823)
 Intermediate or post-high school diploma 39.2 (38/97) 61.7 (534/866) 6.6 (41/619)
 Graduate (Bachelor’s degree) 40.4 (427/1,056) 56.4 (524/929) 17.4 (122/703)
 Postgraduate, professional, or honors 31.9 (128/401) 64.6 (210/325) 26.8 (71/191)

INR = Indian rupees; TCV Any = vaccine card presentation or caregiver recall of typhoid conjugate vaccine (TCV) vaccination at any time; TCV Vax = presentation of a TCV vaccination card (from the campaign) or caregiver recall of TCV receipt during the phase 1 campaign; UHP = urban health post; US$ = U.S. dollars.

Table 2

Predictors of vaccination status

Predictors Phase 1 Phase 2
TCV Vax TCV Any TCV Any
Odds Ratio CI P-Value Odds Ratio CI P-Value Odds Ratio CI P-Value
(Intercept) 0.49 0.23–1.03 0.107 0.60 0.29–1.25 0.245 0.1 0.02–0.45 0.01
Proportion neighborhood is informal settlement (10% interval) 1.06 1.04–1.08 <0.001 1.04 1.02–1.06 0.002 0.93 0.89–0.98 0.036
Child age (1-year interval) 0.98 0.97–1.00 0.065 0.96 0.95–0.98 0.002 0.89 0.86–0.92 <0.001
Sex (female = 1) 1.12 1.00–1.26 0.039 1.13 0.99–1.29 0.073 0.88 0.69–1.11 0.285
Child education Never attended school Reference Reference Reference
Not of school age 1.20 0.67–2.15 0.597 1.03 0.58–1.84 0.922 0.49 0.11–2.16 0.307
Goes to school 3.84 2.18–6.77 <0.001 3.40 1.95–5.95 <0.001 1.16 0.27–4.97 0.828
Household income group (US$ or INR per month) US$ 0.0–272.21 (INR 0.00–19,000.00) Reference Reference Reference
US$ 272.21–673.35 (INR 19,000.00–47,000.00) 0.84 0.73–0.98 0.103 0.89 0.76–1.04 0.261 1.44 0.99–2.09 0.177
More than US$ 673.35 (INR 47,000.00) 0.61 0.53–0.70 <0.001 0.61 0.47–0.81 0.018 2.28 1.63–3.21 0.001
Household head occupation Unemployed Reference Reference Reference
Trade/unskilled worker 0.91 0.74–1.12 0.526 0.76 0.62–0.94 0.081 0.77 0.43–1.35 0.553
Skilled worker 1.05 0.89–1.24 0.68 0.88 0.72–1.06 0.329 0.79 0.54–1.15 0.307
Public official/professional/associate professional 0.80 0.62–1.03 0.18 0.88 0.63–1.24 0.567 1.56 1.08–2.24 0.039
Household head education No formal education 0.81 0.67–0.99 0.16 0.74 0.60–0.91 0.05 0.6 0.34–1.04 0.19
Primary school certificate (through grade 4) 0.85 0.61–1.19 0.49 0.74 0.52–1.04 0.189 1.02 0.43–2.42 0.972
Middle school certificate (grade 5–10) Reference Reference Reference
High school certificate (grade 11–12) 0.80 0.68–0.95 0.047 0.87 0.71–1.06 0.296 1.29 0.87–1.93 0.338
Intermediate or post-high school diploma 0.40 0.26–0.61 <0.001 0.64 0.37–1.10 0.201 2.06 0.99–4.30 0.096
Graduate (bachelor’s degree) 0.43 0.37–0.51 <0.001 0.72 0.58–0.90 0.026 2.89 2.09–3.99 0.001
Postgraduate, professional, or honors 0.33 0.26–0.42 <0.001 1.44 0.99–2.11 0.146 4.08 2.71–6.13 <0.001

INR = Indian rupees; TCV Any = vaccine card presentation or caregiver recall of typhoid conjugate vaccine (TCV) vaccination at any time; TCV Vax = presentation of a TCV vaccination card (from the campaign) or caregiver recall of TCV receipt during the phase 1 campaign; US$ = U.S. dollars.

Phase 1 children enrolled in school were more likely to report TCV receipt than those who were not enrolled in school (OR = 3.84, 95% CI: 2.18–6.77). Children from phase 1 households in which the household head reported increasing education-level attainment, compared with the attainment of a middle school certificate, were less likely to report TCV receipt (Table 2).

Among phase 2 households (did not receive the campaign), child TCV receipt was more likely in educated and higher-income families. Households that made more than US$673.35/month (INR 47,000.00; highest income tertile) had a 2.28-fold (95% CI: 1.63–3.21) greater odds of TCV receipt than households that made less than US$272.21/month (INR 19,000.00; lowest income tertile). Children from phase 2 households in which the household head reported a bachelor’s degree (OR = 2.89, 95% CI: 2.09–3.99) or postgraduate/professional degree (OR = 4.08, 95% CI: 2.71–6.13) were more likely to report TCV receipt.

Childhood school enrollment and lower household- and community-level socioeconomic statuses were most associated with TCV receipt via the phase 1 campaign. Among phase 2 communities, wealthier households were more likely to report TCV receipt. Utilizing phase 2 communities as a real-world counterfactual to the phase 1 public-sector TCV campaign, our data portray lower socioeconomic status households and communities as overwhelmingly benefited by the campaign. The 2018 NMMC pediatric TCV campaign, which targeted children living in phase 1 communities, effectively reached children living in households who were disproportionately at increased risk for typhoid fever secondary to low reported household income.18,19 The campaign demonstrated good protection against typhoid fever at the community level in a separate analysis.17

This analysis is limited by reliance on self-reported TCV receipt. Participants more aware of the campaign or those with better vaccination records may be overrepresented. The systematic, population-based community assessment survey endeavored to enroll a sample population representative of the study population to reduce bias associated with self-reported TCV receipt. Incomplete cases and those who reported not knowing if they received TCV were not included in our analysis, which may bias our results if responses were due to systematic rather than random causes; however, these represented only a small fraction of our response data. Our major findings remain consistent after application of a stricter definition requiring presentation of a TCV vaccination card. This definition increased the percent vaccinated to 71.4% (765/1,071), reduced the number of children included in the “TCV Vax” phase 1 analysis (from 5,614 to 1,071), led to wider odds ratio 95% CIs, and resulted in increases in missing demographic response data. Among participants included in this analysis, the phase 1 campaign’s TCV coverage was nearly 57%, in comparison with the previously reported administrative campaign coverage estimate of 71%.16 This discrepancy could be due to incomplete coverage of the community survey, as well as our study’s reliance on self-reported TCV receipt, as missing data alone cannot account for the 14% difference in coverage estimates. However, because 71% was an administrative estimate, the initial estimate of children in NMMC-administered Navi Mumbai may have been smaller than the true count and may also speak to the effectiveness of the campaign in seeking out all eligible children in Navi Mumbai.

Our findings support the importance the NMMC has placed on TCV vaccination campaigns to successfully reach impoverished communities, especially as part of the potential introduction of TCV into regional and national vaccination programs. Without a public program designed to reach low-income households, wealthier populations may be more likely to benefit from the availability of TCV even when their income status is already known to be protective against typhoid incidence.18,19 Despite the achievement of the TCV introduction in Navi Mumbai, a large proportion of the target population was not reached by this public sector pediatric TCV campaign; even this successful program will require additional pathways of access to reach optimal levels of vaccine coverage.

ACKNOWLEDGMENTS

We thank the following organizations and individuals for their contributions to this study: the Navi Mumbai Municipal Corporation leadership and staff, the Government of India Ministry of Health and Family Welfare Universal Immunization Program, State of Maharashtra Department of Public Health and Family Welfare, Indian Academy of Pediatrics Navi Mumbai Chapter, Bharat Biotech International Limited, the Indian Council of Medical Research, WHO India National Public Health Surveillance Project, Grant Government Medical College (Nilma Hirani), and the CDC, Atlanta, Georgia (Kathleen Wannemuehler, Benjamin Nygren, and Matt Mikoleit).

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    Gavhane J , Yewale V , Weekey P , Dhanya , Warrior D , 2010. Enteric fever in children from Navi Mumbai—clinical profile, hematological features, sensitivity patterns and response to antimicrobials. Pediatr Infect Dis 2: 59.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Jayaprasad N , Borhade P , LeBoa C , Date K , Joshi S , Shimpi R , Andrews JR , Luby SP , Hoffman SA , 2023. Retrospective review of blood culture-confirmed cases of enteric fever in Navi Mumbai, India: 2014–2018. Am J Trop Med Hyg 109: 571574.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Date K et al., 2020. Decision making and implementation of the first public sector introduction of typhoid conjugate vaccine—Navi Mumbai, India, 2018. Clin Infect Dis 71: S172S178.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Hoffman SA et al., 2023. Programmatic effectiveness of a pediatric typhoid conjugate vaccine campaign in Navi Mumbai, India. Clin Infect Dis 77: 138144.

  • 18.

    Gasem MH , Dolmans WM , Keuter MM , Djokomoeljanto RR , 2001. Poor food hygiene and housing as risk factors for typhoid fever in Semarang, Indonesia. Trop Med Int Health 6: 484490.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Sharma PK , Ramakrishnan R , Hutin Y , Manickam P , Gupte MD , 2009. Risk factors for typhoid in Darjeeling, West Bengal, India: Evidence for practical action. Trop Med Int Health 14: 696702.

    • PubMed
    • Search Google Scholar
    • Export Citation

Author Notes

Financial support: This work was supported by the Bill & Melinda Gates Foundation (grant no. OPP1169264) (principal investigator, S. P. Luby). C. LeBoa is funded by the Global Health Equity Scholars Program NIH FIC (award no. D43TW010540). S. A. Hoffman is supported in part by the NIH under the National Institute of Allergy and Infectious Diseases grant T32AI007502, as well as by the Stanford Maternal and Child Health Research Institute. K. Date reports CDC employee salary through her employer.

Disclosure: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position, policies, or views of the U.S. CDC or the WHO.

We obtained parental/guardian written informed consent for all study participants. The evaluation protocol was approved by the Institutional Ethics Committee, Indian Council of Medical Research–National Institute of Cholera and Enteric Diseases (no. A-1/2020-IEC), the WHO Research Ethics Review Committee (ERC.0002923), the CDC Institutional Review Board (IRB) (no. 7026), the Stanford University IRB (IRB-39627), and institutional review committees of all evaluation sites.

Current contact information: Priyanka Borhade, Rahul Shimpi, World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India, E-mails: dm.tcvwho@gmail.com, shimpir@who.int. Christopher LeBoa, Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, E-mail: cleboa@berkeley.edu. Niniya Jayaprasad, World Health Organization, India Hypertension Control Initiative, New Delhi, India, E-mail: niniya.jayaprasad@yahoo.com. Kashmira Date, Johnson & Johnson Global Public Health, New Brunswick, NJ, E-mail: kashmira.date@gmail.com. Pradeep Haldar, Arun Katkar, Abhishek Kunwar, and Pankaj Bhatnagar, Ministry of Health & Family Welfare, Government of India, New Delhi, India, E-mail: pradeephaldar@yahoo.co.in, katkara@who.int, abhishekk@who.int, and bhatnagarp@who.int. Pauline Harvey, U.S. Centers for Disease Control and Prevention, Atlanta, GA, E-mail: pdh7@cdc.gov. Qian An, Chenhua Zhang, and Kirsten Fagerli, Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia E-mails: fei8@cdc.gov, noi7@cdc.gov, and kirsten.fagerli@mcri.edu.au. Lily Horng, Jason R. Andrews, Stephen P. Luby, and Seth A. Hoffman, Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, E-mails: lily.horng@gmail.com, jandr@stanford.edu, sluby@stanford.edu, and sethhoffman@stanford.edu. Vijay N. Yewale and Dhanya Dharmapalan, Dr. Yewale Multispecialty Hospital for Children, Navi Mumbai, India, E-mail: vnyewale@gmail.com. Savita Daruwalla, E-mails: childoc62@gmail.com and drdhanyaroshan@gmail.com. Jeetendra Gavhane, Department of Pediatrics, MGM New Bombay Hospital, MGM Medical College, Navi Mumbai, India, E-mail: drjeetendra@gmail.com. Shrikrishna Joshi, Dr. Joshi’s Central Clinical Microbiology Laboratory, Navi Mumbai, India. E-mail: skajoshi@yahoo.co.in. Rajesh Rai, Department of Pediatrics & Neonatology, Dr. D. Y. Patil Medical College and Hospital, Navi Mumbai, India, E-mail: drrajeshrai@yahoo.com. Varsha Rathod, Rajmata Jijau Hospital, Airoli (NMMC), Navi Mumbai, India, E-mail: vrmsrjhairoli@gmail.com. Keertana Shetty, Department of Microbiology, Dr. D. Y. Patil Medical College and Hospital, Navi Mumbai, India, E-mail: keertana.shetty@gmail.com. Divyalatha S. Warrier, Department of Pediatrics, Mathadi Trust Hospital, Navi Mumbai, India, E-mail: divyawarrier60@gmail.com. Shalini Yadav, Department of Microbiology, MGM New Bombay Hospital, Navi Mumbai, India, E-mail: doc_shalini@rediffmail.com. Debjit Chakraborty and Shanta Dutta, National Institute of Cholera and Enteric Diseases, Indian Council of Medical Research, Kolkata, India, E-mails: drdebjitepi@gmail.com and drshantadutta@gmail.com. Sunil Bahl, World Health Organization South-East Asia Regional Office, New Delhi, India, E-mail: bahls@who.int.

Address correspondence to Seth A. Hoffman, Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, 300 Pasteur Dr., Lane Bldg. 134, Stanford, CA 94305. E-mail: shoff@stanford.edu
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    • PubMed
    • Search Google Scholar
    • Export Citation
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    Jayaprasad N , Borhade P , LeBoa C , Date K , Joshi S , Shimpi R , Andrews JR , Luby SP , Hoffman SA , 2023. Retrospective review of blood culture-confirmed cases of enteric fever in Navi Mumbai, India: 2014–2018. Am J Trop Med Hyg 109: 571574.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Date K et al., 2020. Decision making and implementation of the first public sector introduction of typhoid conjugate vaccine—Navi Mumbai, India, 2018. Clin Infect Dis 71: S172S178.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Hoffman SA et al., 2023. Programmatic effectiveness of a pediatric typhoid conjugate vaccine campaign in Navi Mumbai, India. Clin Infect Dis 77: 138144.

  • 18.

    Gasem MH , Dolmans WM , Keuter MM , Djokomoeljanto RR , 2001. Poor food hygiene and housing as risk factors for typhoid fever in Semarang, Indonesia. Trop Med Int Health 6: 484490.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Sharma PK , Ramakrishnan R , Hutin Y , Manickam P , Gupte MD , 2009. Risk factors for typhoid in Darjeeling, West Bengal, India: Evidence for practical action. Trop Med Int Health 14: 696702.

    • PubMed
    • Search Google Scholar
    • Export Citation
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