Investigator(s)
| WHO Technical Officer |
Ela Singh Rathaur WHO Nepal Ela Singh Rathaur 
|
| Principal Investigator |
Dr. Henry N. Njuguna Cholera and Typhoid Vaccine Team, Global Immunization Division (GID), U.S. Centers for Disease Control and Prevention (CDC) Dr. Henry N. Njuguna
|
| Co-Investigator(s) |
Shrijana Shrestha Dept of Pediatrics, Patan Academy of Health Sciences (PAHS), Lalitpur, Nepal Shrijana Shrestha
|
| Co-Investigator(s) |
Koshal Chandra Subedee Department of Health Services, Epidemiology and Disease Control Division, Teku, Nepal Koshal Chandra Subedee
|
Title(s) and abstract
| Scientific title | Burden and Risk Assessment of Typhoid (BRAT) Tool Pilot Implementation in Nepal |
| Public title | Burden and Risk Assessment of Typhoid (BRAT) Tool Pilot Implementation in Nepal |
| Background | Typhoid fever is a significant public health issue in low- and middle-income countries, with Nepal having one of the highest burdens globally. The disease is endemic in Nepal, with inadequate access to sanitation and safe drinking water. WHO recommends the introduction of specific vaccines (TCVs) in countries with high disease burdens or antimicrobial resistant S. Typhi. However, there is currently no framework or tools to guide systematic review of available data. The CDC and WHO have developed the burden and risk assessment of typhoid (BRAT) framework and tool in partnership with experts. Nepal introduced TCV in routine immunization in May 2022, but the availability of baseline consolidated data regarding the burden and risk of typhoid fever is limited. Country-specific typhoid disease burden data is important to guide TCV roll out in routine immunization, guide other control strategies and to justify the use of limited available resources to prioritize specific vaccine (TCV) in consideration of several vaccine-preventable diseases (VPDs). BRAT framework and tool will prove instrumental to inform interpretations about the burden and risk of typhoid in Nepal. |
| Objectives | 1. General objectives - Test and validate the BRAT tool to enable its finalization and wide dissemination, and - Assess the typhoid fever burden and risk in Nepal 2. Specific objectives • Testing and validation of the BRAT tool - Assess feasibility and usability of the tool - Review validity of scoring of evidence and interpretation of the evidence in countries with known low, medium, and high typhoid burden - Review validity of scoring of data quality and interpretation of the data quality - Determine the level of technical support and additional funding needed for implementation • Review typhoid fever burden and risk in Nepal to inform future decisions on TCV introduction or other typhoid fever prevention and control strategies, and/or to help establish baseline data on typhoid fever burden and risk prior to implementation of vaccination or other control strategies. This objective will be met through the BRAT tool, which focuses on six specific areas of assessment: - Incidence - Prevalence - AMR - Outbreaks - Intestinal perforations - WASH and other risk factors • Identify challenges and areas for improvement of typhoid fever surveillance |
| Study Methods | This study aims to assess the burden and risk of typhoid fever in Nepal, focusing on the use of laboratory on reported blood and stool cultures and intestinal perforation, epidemiological studies, and online platforms. The assessment sites will be identified from IHIMS, stratified into high, medium, and low caseloads, and AMR sentinel sites from NPHL. The study will also review the National Public Health Laboratory AMR Surveillance Newsletter 2022 to understand hospital-wise distribution of AMR isolates. Sampling techniques will be purposeful and convenient, with inclusion of patients with confirmed S. Typhi infection (laboratory confirmed blood and stool culture)), patients with antimicrobial resistant strain of S. Typhi infection, patients who have undergone surgical procedures for intestinal perforations in at least the past 5 years Relevant information identified from the literature review will be entered into the BRAT tool. All potential data-contributing institutions and health facilities identified in iii) will be visited to collect data (at least last five years of data) from clinical and laboratory registers or reports to inform the assessment areas of prevalence, AMR, outbreaks, and intestinal perforationsData from electronic records systems will be summarized by year. AMR data will be collected per isolate to permit classification as multidrug resistant (MDR) or XDR. In the case of paper-based records, assessment teams will collect information per record without inclusion of Personal Identifiable Information (PII). Data quality indicators and scoring will be assessed as the data is collected, with each area of assessment having specific quality indicators. The mean quality score for all data sources represents the overall quality score for that area of asse |
| Expected outcomes and use of results | A Summary Assessment Report will be compiled by the assessment team, which will include the following: • Executive summary • List of partners • Introduction to typhoid fever globally and in country • Study objectives • Background of the survey including its planning, methods, and execution • Results with analytical comments (elaborating on the meaning and limitation of the results) • Overall interpretation of findings • Recommendations The Summary Assessment Report will facilitate interpretation and use of the assessment findings by the decision-making bodies in the country for decision on TCV roll out (and/or other typhoid control strategies). Decision-makers will have local population-based data to justify the use of limited available resources and to prioritize specific vaccine (e.g., TCV) in consideration of several vaccine-preventable diseases (VPDs). Furthermore, local population based integrated data regarding Typhoid will lay foundation to measure the impact of TCV vaccine in Nepal. BRAT framework and tool will prove instrumental to inform interpretations about the burden and risk of typhoid in Nepal. |
| Keywords | Typhoid Disease, Typhoid Conjugate Vaccine, Burden assessment, Risk assessment, Vaccine introduction |
Research Details
| Student research | No |
| Start Date | 01-Jan-2024 |
| End Date | 31-May-2024 |
| Key Implementing Institution | Family Welfare Divison, Department of Health Service, Nepal |
| Multi-country research | No |
| Nationwide research | Yes |
| Research Domain(s) | Communicable Disease Research |
| Research field(s) | Infectious Disease |
| Involves human subjects | No |
| Data Collection | Secondary data |
| Proposal reviewed by other Committee | Under Review |