"Rising Typhoid Cases Highlight India's Vaccine and AMR Policy Gap"
Typhoid-Conjugate Vaccine (TCV)
vaccine linking Vi polysaccharide antigen to a carrier protein, effective in children under two years
Antimicrobial Resistance (AMR)
reduced effectiveness of antibiotics due to bacterial adaptation from selection pressure
Typhoid fever is caused by Salmonella typhi, a bacterium transmitted through contaminated food and water. It remains a significant public health burden in South Asia, where inadequate sanitation and dense populations sustain transmission. India is classified as a high-burden country for typhoid, with millions of suspected cases diagnosed annually. The disease is entirely vaccine-preventable, yet it continues to be managed primarily through antibiotics, a pattern that is now generating a serious antimicrobial resistance (AMR) crisis.
India's public health response to typhoid has historically relied on two pillars: clinical diagnosis and antibiotic treatment. The Widal test, a serological test developed in the 19th century, remains widely used in routine practice despite well-documented limitations. Blood culture is the laboratory gold standard but is resource-intensive and sensitive to prior antibiotic use. Neither tool is well-suited to India's primary-care setting, where most patients first seek treatment. This diagnostic gap has perpetuated empirical prescribing, treating suspected typhoid with antibiotics without confirmed microbiological evidence, which in turn accelerates resistance in Salmonella typhi populations.
The National Action Plan on AMR (NAP-AMR), launched in alignment with the WHO Global Action Plan, commits India to reducing unnecessary antibiotic use across human health, animal husbandry, and agriculture. Typhoid represents a direct test case for this commitment: a disease where a proven vaccine exists, yet antibiotic overuse continues unchecked.
The typhoid-conjugate vaccine (TCV) is a newer generation of typhoid vaccine that links the Salmonella typhi Vi polysaccharide antigen to a carrier protein, producing a stronger and more durable immune response than older Vi polysaccharide vaccines. Crucially, TCVs are effective in children under two years of age, a group that older polysaccharide vaccines could not adequately protect. The WHO has prioritised TCV introduction in countries with high typhoid burden or high AMR levels, and has prequalified several products for global procurement.
India holds a significant position in this landscape. Typbar-TCV, manufactured by Bharat Biotech, became the world's first WHO-prequalified TCV in 2017. Additional Indian TCV products have since achieved WHO prequalification, demonstrating India's manufacturing capability in this space. Despite this, TCV has not been introduced into India's Universal Immunisation Programme (UIP), which currently covers diseases such as diphtheria, tetanus, pertussis, hepatitis B, Hib, and polio. …
What is the basic principle behind vaccine development? How do vaccines work? What approaches were adopted by Indian vaccine manufacturers to produce COVID-19 vaccines?
What is the importance of using Pneumococcal Conjugate Vaccine in India?
1.These vaccines are effective against pneumonia as well as meningitis and sepsis.
2.Dependence on antibiotics that are not effective against drug-resistant bacteria can be reduced.
3.These vaccines have no side effects and cause no allergic reactions.
Select the correct answer using the code given below:
Which one of the following statements is not correct?
Consider the following statements regarding the Typhoid-Conjugate Vaccine (TCV):
1.India produced the world's first WHO-prequalified TCV.
2.TCVs are effective in children under two years of age, unlike older Vi polysaccharide vaccines.
3.The WHO recommends TCV introduction only in countries with high disease burden, not in countries with high AMR levels.
Which of the statements given above are correct?
Consider the following statements regarding typhoid diagnosis in India:
1.A single Widal test is sufficient to confirm acute typhoid in endemic countries.
2.Blood culture has a sensitivity of approximately 55–60% for a single sample, per WHO guidance.
3.Prior antibiotic use before blood culture reduces the diagnostic yield further.
Which of the statements given above are correct?
Match the following vaccine types with their defining characteristics:
List I (Vaccine Type) — List II (Characteristic)
A.Typhoid-Conjugate Vaccine (TCV) — 1. Polysaccharide antigen linked to carrier protein; effective under two years
B.Inactivated whole-virus vaccine — 2. Chemically killed pathogen combined with adjuvant
C.Viral vector vaccine — 3. Modified virus carries gene for target antigen's spike protein
D.Vi polysaccharide vaccine — 4. Polysaccharide antigen alone; not effective under two years
Select the correct match:
Consider the following statements regarding antimicrobial resistance (AMR) and typhoid in India:
1.Extensively drug-resistant (XDR) typhoid strains are resistant to chloramphenicol, ampicillin, fluoroquinolones, and third-generation cephalosporins.
2.India's National Action Plan on AMR (NAP-AMR) aligns with the WHO Global Action Plan on AMR.
3.Vaccination against typhoid is considered a substitute for improvements in water, sanitation, and hygiene (WASH).
How many of the above statements are correct?
With reference to India's approach to typhoid control, consider the following:
1.Typhoid-conjugate vaccine (TCV) has been included in India's Universal Immunisation Programme (UIP).
2.India has produced WHO-prequalified TCV products.
3.The WHO prioritises TCV introduction in countries with high typhoid burden or high AMR levels.
Which of the statements given above are correct?
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