Hundreds of children sick with typhoid vaccine in Nepal

Nepal: Hundreds of children throughout the country are suffering from the side effects of the government-administered typhoid vaccine with at least one child developing serious neurological problems. Doctors have yet to confirm if the vaccine was responsible for the neurological problems.

Hospitals providing treatment throughout the country have reported that the number of children seeking care after receiving the typhoid vaccine is large, officials at the Ministry of Health and Population said.

“Many children who developed fever, diarrhoea, headache, abdominal pain, nausea and vomiting after receiving the typhoid vaccine were treated at our hospital,” Dr Yuba Nidhi Basaula, director at the Kanti Children’s Hospital, told the Post. “Some are still hospitalised.”

According to doctors at the hospital, some children have been found to be suffering from muscle weakness, especially in the legs, and neurological problems after vaccination.

The hospital administration has also reported such cases to the Ministry of Health and Population, and has asked whether the child who has developed neurological problems after receiving the typhoid vaccine be treated for free as the treatment is costly.

“Yes, an 11-year-old boy developed paralysis after receiving the vaccine,” Dr Sangita Kaushal Mishra, spokesperson at the Ministry of Health, told the Post. “We have collected the boy’s body fluid samples and sent them to the World Health Organisation’s collaborating centre for tests.”

The boy from Jajarkot district has been admitted to the Capital’s Kanti Children’s Hospital, the national referral center for pediatric care. “The boy’s condition is improving,” said Mishra. “It will be too early to say that typhoid vaccination is responsible for the neurological problems in the boy.” Officials at the ministry said that it will take around a month for the report to come from the WHO’s collaborating centre.

“We suspect that the boy has Guillain Barre Syndrome,” said Mishra. Doctors say Guillain-Barre syndrome is a rare neurological disorder in which the body's immune system mistakenly attacks part of its peripheral nervous system—the network of nerves located outside the brain and the spinal cord. The problems can range from a very mild case with brief weakness to nearly devastating paralysis, leaving the person unable to breathe independently.

“Whether the condition is due to the adverse effects of the typhoid vaccine can be confirmed after receiving the report from the WHO lab,” Mishra added.

The Health Ministry launched a nation-wide vaccination campaign against typhoid from April 8. Around seven million children between the ages of 15 months and 15 years were inoculated during the month-long campaign, according to officials. The vaccine has been included in the regular immunisation list.

Typhoid fever, usually called typhoid, is a highly contagious disease caused by two types of bacteria—salmonella typhi and salmonella paratyphi—which spread through contaminated food or water. Studies have shown that the disease can be fatal in up to 10 percent of the reported cases.

Typhoid fever has been found throughout the world but the problem is acute in the areas with a lack of safe drinking water and poor sanitation. Nepal has also recorded major typhoid outbreaks in the past, but very few cases have been reported in the last few years. There are divided opinions among experts about typhoid vaccination in Nepal.

Some say mass vaccination against typhoid and the jabs’ inclusion in the regular immunisation list is needed, as it lessens the morbidity and mortality rates. Others believe authorities are launching the programme without having convincing scientific evidence on the prevalence of the disease.

Those not very keen on typhoid mass vaccination say the programme should be made more specific by launching it in the hotspots and the areas where the condition of drinking water and sanitation is very poor.

“Of the total typhoid patients in Nepal, over 50 percent have been found suffering from paratyphoid, against which this vaccine doesn't work,” said Dr Shyam Raj Upreti, former director general at the Department of Health Services. “As the vaccine currently being used in Nepal is new, much is yet to be known about its side effects. Authorities should study its impacts, and side effects.”

The Ministry of Health and Population said that data of the last five years show that around 450,000 people get sick with typhoid every year. And typhoid is among the top three diseases that are caused by contaminated food and water, and the fourth cause of hospitalisation in Nepal, according to the data of the last three years maintained by the Health Management Information System.

Experts also questioned the sustainability of the mass vaccination programme after the inclusion of the typhoid vaccine in the regular immunisation list, as aid agencies do not always provide the jabs. On top of that, typhoid is not like any other disease which can be eradicated, as it can occur in areas where sanitation and water conditions are poor.

Doctors the Post talked to say that without improving water and sanitation conditions, problems of other waterborne diseases cannot be addressed. To improve water and sanitation problems, long-term investments and multisectoral approaches are needed, they say.