If your toddler is due for shots around 15 months, you may have noticed a newer one on the card: TCV, the typhoid conjugate vaccine. Nepal added it to the free national immunization schedule in 2022, and a December 2025 WHO evaluation found about 86% of children are now reached. Here is what the shot is for, why Nepal in particular needs it, and why it works alongside hygiene rather than replacing it.
Why typhoid matters so much in Nepal
Typhoid fever, also called enteric fever, is an infection caused by the bacterium *Salmonella* Typhi. It spreads through food and water contaminated with the bacteria, which is why it thrives where water and sanitation systems are under strain. Nepal carries one of the heaviest typhoid burdens in the world, and the illness falls hardest on children. The Global Burden of Disease study estimated more than 82,000 typhoid cases in Nepal in a single recent year, with the highest rates among under-15s.
For families in Kathmandu Valley and other dense urban areas, the risk is shaped by everyday life: shared water sources, monsoon flooding that can mix sewage into drinking water, and meals or *pani puri* eaten outside the home. None of this means a family is doing anything wrong; it reflects how widely the bacteria circulate in the environment. It is also why a vaccine that protects young children has been such a meaningful addition to the schedule.
What the TCV shot at 15 months actually is
TCV stands for typhoid conjugate vaccine. "Conjugate" means the typhoid sugar that the immune system recognises is linked to a carrier protein, which helps even very young children build a strong, longer-lasting response. This is the key advantage over older typhoid vaccines, which did not work well in children under two. Because TCV does protect toddlers, Nepal's National Immunization Program places a single dose at 15 months of age, given at the same visit as other routine vaccines.
Nepal introduced TCV in April 2022 with a nationwide catch-up campaign for children aged 15 months to 15 years, reaching more than 7 million children across over 50,000 sites, including schools. After that campaign, the single 15-month dose became a permanent part of routine immunization. The WHO South-East Asia post-introduction evaluation published in December 2025 reported that routine coverage had settled at roughly 86%, a strong sign the programme is reaching most children.
Symptoms of typhoid in children
Knowing the early signs helps you act calmly and early. Typhoid in a child often builds over several days rather than appearing suddenly. Common features include:
- A fever that rises gradually and stays high, often worse in the evening
- Tiredness, weakness, and loss of appetite
- Stomach pain, and either constipation or loose stools
- Headache and body aches
- Sometimes a coated tongue or, in some children, a faint rash
These symptoms overlap with many ordinary childhood illnesses, so they are not proof of typhoid on their own. What matters is the pattern: a fever lasting more than a few days, especially with poor appetite and stomach upset, is worth a doctor's review. Typhoid is diagnosed with a blood test and is treated with antibiotics, and most children recover well when it is caught and managed early.
Does the vaccine replace hygiene? No, they work together
This is the most common question parents ask, and the answer is reassuring but clear: the vaccine is a powerful layer of protection, not a reason to relax on clean water and food. TCV greatly lowers a child's chance of getting typhoid, but no vaccine is 100%, and it does not protect against the many other germs that cause diarrhoea and stomach infections in the same way. Think of the shot and good hygiene as two halves of the same shield.
- Give your child the TCV dose at 15 months (or catch up if missed)
- Drink only water that has been boiled, filtered, or otherwise treated, especially during monsoon
- Wash hands with soap before eating and after using the toilet
- Be cautious with cut fruit, salads, and street food washed in untreated water
- Keep up other routine vaccines that protect against waterborne and faecal-oral illness
There is a public benefit too. Typhoid in South Asia is increasingly resistant to common antibiotics, which makes infections harder to treat. By preventing cases in the first place, widespread childhood vaccination reduces antibiotic use and helps slow that resistance, protecting the whole community, not only the vaccinated child.
What to expect at the visit
TCV is a single injection, usually in the upper arm, and is given alongside other 15-month vaccines. Like most vaccines, it may cause mild, short-lived effects such as soreness at the injection site, a mild fever, or fussiness for a day or two. These are signs the immune system is responding and typically settle on their own. Serious reactions are very rare. If your child seems unwell beyond a day or two, or you are simply unsure, your health worker or doctor is the right person to ask.
If your child is older than 15 months and never received TCV, it is not too late. The catch-up window through the national programme covered children up to 15 years, so ask your health post whether your child is eligible. Keeping the immunization card updated makes these conversations quick and accurate.
The single typhoid shot at 15 months and clean water habits are not competing choices. Together they give a Nepali child the strongest, most realistic protection against enteric fever.