Adverse events following immunization with typhoid conjugate vaccine in an outbreak setting in Hyderabad, Pakistan.

Pakistan is facing the world's largest outbreak of extensively drug-resistant (XDR) Typhoid. Vaccination campaign for children aged 6 months to 10 years old with Typhoid Conjugate Vaccine (Typbar-TCV®) was conducted in high-risk areas of Hyderabad during 2018. About 207,000 children were vaccinated. Here we report the adverse events following immunization (AEFI) during the campaign. The campaign was carried out using outreach and fixed centre strategy. Community mobilizers visited each household to perform line listing and mobilize parents with age-eligible children. Children were observed for 30 min post-vaccination. Two-pronged strategy was used for ascertainment of AEFI. A 24/7 hotline number was provided to all parents/caretakers (n = 199,861) to report AEFI during 14 days following immunization. An age-stratified (n = 7139 children) were actively followed at days 7 and 14 for the ascertainment of AEFI. All AEFI were examined by three trained medical officers. A structured questionnaire using Brighton collaboration criteria with level 3 diagnostic certainty was used for the recording of AEFI. Data were analysed using Microsoft Excel Office 365. Overall, 499 AEFI (433 in the subset actively followed and 66 self-reported through hotline) were observed. The rate of AEFI was significantly higher among very young children (age group 6 to 12 months) as compared to 2 to 3 years old children (0.54% vs. 0.33% respectively; p-value < 0.001). Fever was the most common AEFI self-reported through the hotline (38/199,861 = 0.02%) and among the subset followed actively for 14 days (206/7139 = 2.89%). Fever was followed by local reactogenicity 10/199,861(0.01%), and 134/7139 (1.88%) through self-reported hotline and active follow-up, respectively. No serious AEFI was observed. Administration of a single dose of Typbar-TCV among children aged 6 months to 10 years old during an outbreak setting of Hyderabad Pakistan was safe.

A novel approach for development, standardization, and safety testing of enriched alum-precipitated vaccine against hemorrhagic septicemia in different breeds of cattle.

Hemorrhagic septicemia is a fatal disease of cattle and buffalo all over the world including Pakistan and it causes heavy economic losses every year. The poor farmers cannot bear this loss in the form of less milk production and heavy expenditures on the animal treatment. An enriched alum-precipitated vaccine with reduced dose was prepared and standardized and safety testing of enriched vaccine was performed in Swiss albino mice as well as in natural host. In this experiment, a total of 36 cattle both male and female of different age groups ranging from 4 months to 4 years were used. All these animals belong to all major cattle breeds of Pakistan including Sahiwal, Red Sindhi (crossbred and purebred), Dhani (crossbred and purebred), Lohani (crossbred and purebred), and Cholistani, and exotic breeds including Holstein Friesian and Jersey. These animals were examined for current immune titer prior to vaccination. Animals were vaccinated subcutaneously with 2 mL and 4 mL dose of new vaccine and were observed for any untoward reaction for 48 h. All the animals were kept under close observation for the next 30 days and all were found safe. The experiment was designed to reduce the dose of the vaccine to 2 mL by using BHI as a growth medium, as well as to increase the number of doses prepared in the same infrastructure, hence reducing the cost of vaccine production. The study proved that vaccine with increased biomass in reduced dose is safe in local as well as in exotic breeds of cattle.