title: Formative investigation of acceptability of typhoid vaccine during a typhoid fever outbreak in Neno District, Malawi.
abstract: Typhoid fever affects an estimated 22 million people annually and causes 216,000 deaths worldwide. We conducted an investigation in August and September 2010 to examine the acceptability of typhoid vaccine in Neno District, Malawi where a typhoid outbreak was ongoing. We used qualitative methods, including freelisting exercises, key informant and in-depth interviews, and group discussions. Respondents associated illness with exposure to "bad wind," and transmission was believed to be airborne. Typhoid was considered extremely dangerous because of its rapid spread, the debilitating conditions it produced, the number of related fatalities, and the perception that it was highly contagious. Respondents were skeptical about the effectiveness of water, sanitation, and hygiene (WaSH) interventions. The perceived severity of typhoid and fear of exposure, uncertainty about the effectiveness of WaSH measures, and widespread belief in the efficacy of vaccines in preventing disease resulted in an overwhelming interest in receiving typhoid vaccine during an outbreak.
authors.affiliation: Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia laurensblum@yahoo.com.
authors.forename: Lauren S
authors.initials: LS
authors.lastname: Blum
authors.affiliation: Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia.
authors.forename: Holly
authors.initials: H
authors.lastname: Dentz
authors.affiliation: Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia.
authors.forename: Felix
authors.initials: F
authors.lastname: Chingoli
authors.affiliation: Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia.
authors.forename: Benson
authors.initials: B
authors.lastname: Chilima
authors.affiliation: Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Warne
authors.affiliation: Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia.
authors.forename: Carla
authors.initials: C
authors.lastname: Lee
authors.affiliation: Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia.
authors.forename: Terri
authors.initials: T
authors.lastname: Hyde
authors.affiliation: Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Gindler
authors.affiliation: Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia.
authors.forename: James
authors.initials: J
authors.lastname: Sejvar
authors.affiliation: Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (NCEZID), CDC, Atlanta, Georgia; Strengthening Immunization Systems Branch, Global Immunization Division, Center for Global Health (CGH), CDC, Atlanta, Georgia; Neno District Health Office, Neno, Malawi; Community Health Services Unit, MOH, Lilongwe, Malawi; Global AIDS Program Malawi, Division of Global HIV AIDS, CGH, CDC, Lilongwe, Malawi; Office of the Director, Division of High Consequence Pathogens and Pathology, NCEZID, CDC, Atlanta, Georgia.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Mintz
mesh_terms: D000328:Adult; D004196:Disease Outbreaks / Q000517:prevention & control; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008295:Malawi / Q000453:epidemiology; D008297:Male; D010342:Patient Acceptance of Health Care; D010465:Perception; D012485:Salmonella typhi / Q000276:immunology*; D012499:Sanitation; D012720:Severity of Illness Index; D014435:Typhoid Fever / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control* / Q000523:psychology; D014436:Typhoid-Paratyphoid Vaccines; D014611:Vaccination / Q000523:psychology*; D055815:Young Adult
chemical_list: D014436:Typhoid-Paratyphoid Vaccines