Background Typhoid fever and paratyphoid fever continue to be important causes of illness and death, particularly among children and adolescents in south‐central and southeast Asia. Two typhoid vaccines are widely available, Ty21a (oral) and Vi polysaccharide (parenteral). Newer typhoid conjugate vaccines are at varying stages of development and use. The World Health Organization has recently recommended a Vi tetanus toxoid (Vi‐TT) conjugate vaccine, Typbar‐TCV, as the preferred vaccine for all ages. Objectives To assess the effects of vaccines for preventing typhoid fever. Search methods In February 2018, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, and m RCT. We also searched the reference lists of all included trials. Selection criteria Randomized and quasi‐randomized controlled trials (RCTs) comparing typhoid fever vaccines with other typhoid fever vaccines or with an inactive agent (placebo or vaccine for a different disease) in adults and children. Human challenge studies were not eligible. Data collection and analysis Two review authors independently applied inclusion criteria and extracted data, and assessed the certainty of the evidence using the GRADE approach. We computed vaccine efficacy per year of follow‐up and cumulative three‐year efficacy, stratifying for vaccine type and dose. The outcome addressed was typhoid fever, defined as isolation of Salmonella enterica serovar Typhi in blood. We calculated risk ratios (RRs) and efficacy (1 − RR as a percentage) with 95% confidence intervals (CIs). Main results In total, 18 RCTs contributed to the quantitative analysis in this review: 13 evaluated efficacy (Ty21a: 5 trials; Vi polysaccharide: 6 trials; Vi‐rEPA: 1 trial; Vi‐TT: 1 trial), and 9 reported on adverse events. All trials but one took place in typhoid‐endemic countries. There was no information on vaccination in adults aged over 55 years of age, pregnant women, or travellers. Only one trial included data on children under two years of age. Ty21a vaccine (oral vaccine, three doses) A three‐dose schedule of Ty21a vaccine probably prevents around half of typhoid cases during the first three years after vaccination (cumulative efficacy 2.5 to 3 years: 50%, 95% CI 35% to 61%, 4 trials, 235,239 participants, moderate‐certainty evidence). These data include patients aged 3 to 44 years. Compared with placebo, this vaccine probably does not cause more vomiting, diarrhoea, nausea or abdominal pain (2 trials, 2066 participants; moderate‐certainty evidence), headache, or rash (1 trial, 1190 participants; moderate‐certainty evidence); however, fever (2 trials, 2066 participants; moderate‐certainty evidence) is probably more common following vaccination. Vi polysaccharide vaccine (...

Trusted evidence. Informed decisions. Better health. Cochrane Database of Systematic Reviews Analysis 4.2. Comparison 4: 1.0 mg/kg/day primaquine 7 days versus high-standard 0.5 mg/kg/day 14 days, Outcome 2: Recurrence by 12 months' follow-up subgrouped by geographical region.

Primaquine at alternative dosing schedules for preventing relapse in people with Plasmodium vivax malaria.

ObjectivesThe circumstances of people living in refugee camps means that they have distinct medical care requirements. Our objective is to describe clinical guidance in published WHO guidelines that refer to people living in refugee camps; and how evidence and context are used and reported in making recommendations.DesignSystematic review and analysis of WHO guidelines approved by the organisation’s quality oversight body and published between 2007 and 2018. We sought for key terms related to camps and humanitarian settings, and identified text that included guidance. We compared this to Mèdecins Sans Frontièrs (MSF) guidelines.ResultsNo WHO guideline published in the last 10 years focused exclusively on clinical guidance for healthcare in camp settings. Seven guidelines contained guidance about camps; three made recommendations for camps—but only two used formal evidence summaries. We did not find any structured consideration of the situation in camps used in the decision-making process. We examined seven WHO guidelines and six chapters within guidelines that concerned humanitarian settings: none of these documents contained recommendations based on formal evidence summaries for camp settings. One of the eight MSF guidelines was devoted to clinical care in refugees and the authors had clearly linked the health problems and recommendations to the setting, but this guideline is now >20 years old.ConclusionsThere is an absence of up-to-date, evidence-based medical treatment guidelines from WHO and MSF that comprehensively address the clinical needs for people living in camps; and there is no common framework to help guideline groups formulate recommendations in these settings. WHO may wish to consider context of special populations more formally in the evidence to decision-making approach for clinical guidelines relevant to primary care.

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