{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:32:52Z","timestamp":1787031172466,"version":"build-2736575974"},"reference-count":0,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","license":[{"start":{"date-parts":[[2022,4,6]],"date-time":"2022-04-06T00:00:00Z","timestamp":1649203200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,4,6]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Modest improvements in household water, sanitation, and hygiene (WASH) and typhoid vaccination can reduce typhoid risk in endemic settings. However, empiric evaluation of their combined impact is lacking. A total of 62,756 persons residing in 80 clusters in a Kolkata slum were allocated randomly 1:1 to either the typhoid Vi polysaccharide (ViPS) vaccine or hepatitis A (Hep A) vaccine. Surveillance was conducted for 2 years before and 2 years after vaccination. We classified households as having \u201cbetter\u201d or \u201cnot better\u201d WASH, and calculated the prevalence of better WASH households in clusters using previously validated criteria. We evaluated the protection by better household WASH, better household WASH prevalence, and ViPS vaccination against typhoid in all cluster members present at baseline using Cox proportional hazard models. Overall, ViPS vaccination was associated with a 55% (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001; 95% CI, 35\u201369) reduction of typhoid risk and was similar regardless of better WASH in the residence. Living in a better WASH household was associated with a typhoid risk reduction of 31% (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.16; 95% CI, \u201316 to 59) overall. The reduction was 48% (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.05; 95% CI, \u20131 to 73) in Hep A clusters, 6% (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.85; 95% CI, \u201382 to 51) in ViPS clusters, and 57% (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.05; 95% CI, 15\u201378) in the population during the 2 years preceding the trial. These findings demonstrate a preventive association of better household WASH in the non-ViPS population, but, unexpectedly, an absence of additional protection from ViPS by better WASH in the ViPS population. This analysis highlights the importance of assessing the combination of WASH in conjunction with typhoid vaccines, and has implications for the evaluation of new-generation typhoid conjugate vaccines.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.21-1034","type":"journal-article","created":{"date-parts":[[2022,3,7]],"date-time":"2022-03-07T09:25:35Z","timestamp":1646645135000},"page":"1149-1155","source":"Crossref","is-referenced-by-count":9,"title":["Prevention of Typhoid Fever by Existing Improvements in Household Water, Sanitation, and Hygiene, and the Use of the Vi Polysaccharide Typhoid Vaccine in Poor Urban Slums: Results from a Cluster-Randomized Trial"],"prefix":"10.4269","volume":"106","author":[{"given":"Justin","family":"Im","sequence":"first","affiliation":[{"name":"1International Vaccine Institute, Seoul, Republic of Korea;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farhana","family":"Khanam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faisal","family":"Ahmmed","sequence":"additional","affiliation":[{"name":"2International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deok Ryun","family":"Kim","sequence":"additional","affiliation":[{"name":"1International Vaccine Institute, Seoul, Republic of Korea;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Kang","sequence":"additional","affiliation":[{"name":"1International Vaccine Institute, Seoul, Republic of Korea;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birkneh Tilahun","family":"Tadesse","sequence":"additional","affiliation":[{"name":"1International Vaccine Institute, Seoul, Republic of Korea;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahima","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"2International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tasnuva","family":"Ahmed","sequence":"additional","affiliation":[{"name":"2International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asma Binte","family":"Aziz","sequence":"additional","affiliation":[{"name":"1International Vaccine Institute, Seoul, Republic of Korea;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masuma","family":"Hoque","sequence":"additional","affiliation":[{"name":"2International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. Taufiqul","family":"Islam","sequence":"additional","affiliation":[{"name":"2International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juyeon","family":"Park","sequence":"additional","affiliation":[{"name":"1International Vaccine Institute, Seoul, Republic of Korea;"},{"name":"3Department of Medicine, University of Cambridge, Cambridge, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinxue","family":"Liu","sequence":"additional","affiliation":[{"name":"4Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dipika","family":"Sur","sequence":"additional","affiliation":[{"name":"5National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gideok","family":"Pak","sequence":"additional","affiliation":[{"name":"1International Vaccine Institute, Seoul, Republic of Korea;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyon Jin","family":"Jeon","sequence":"additional","affiliation":[{"name":"1International Vaccine Institute, Seoul, Republic of Korea;"},{"name":"3Department of Medicine, University of Cambridge, Cambridge, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalequ","family":"Zaman","sequence":"additional","affiliation":[{"name":"2International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashraful Islam","family":"Khan","sequence":"additional","affiliation":[{"name":"2International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Firdausi","family":"Qadri","sequence":"additional","affiliation":[{"name":"2International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Marks","sequence":"additional","affiliation":[{"name":"1International Vaccine Institute, Seoul, Republic of Korea;"},{"name":"3Department of Medicine, University of Cambridge, Cambridge, United Kingdom;"},{"name":"6University of Antananarivo, Antananarivo, Madagascar;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerome H.","family":"Kim","sequence":"additional","affiliation":[{"name":"1International Vaccine Institute, Seoul, Republic of Korea;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D.","family":"Clemens","sequence":"additional","affiliation":[{"name":"1International Vaccine Institute, Seoul, Republic of Korea;"},{"name":"2International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh;"},{"name":"7University of California Los Angeles Fielding School of Public Health, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/106\/4\/article-p1149.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/106\/4\/article-p1149.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,6]],"date-time":"2022-04-06T08:38:50Z","timestamp":1649234330000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/106\/4\/article-p1149.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,6]]},"references-count":0,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.21-1034","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,6]]}}}