Recent developments in typhoidal and non-typhoidal Salmonella vaccines

Typhoidal and invasive non-typhoidal Salmonella (iNTS) serovars remain leading causes of bloodstream infection, mortality and morbidity, particularly in South Asia and sub-Saharan Africa. The rising burden of antimicrobial resistance has strengthened the case for vaccination as a control strategy. This review summarises recent advances in Salmonella vaccine development, highlighting progress, remaining challenges and future directions.

The introduction of typhoid conjugate vaccine (TCV) programmes across some endemic countries represents a major public health milestone. Important questions remain, however. These include the durability of protection, optimal booster strategies and performance in diverse epidemiological settings. Vaccine development for S. Paratyphi A and iNTS has also accelerated, with candidates including conjugate, outer membrane vesicle/GMMA and live-attenuated, platforms advancing through preclinical and early clinical evaluation. Multivalent vaccine strategies have attracted growing interest. However, the divergent epidemiology of typhoidal and non-typhoidal disease, including differences in age-specific risk and geographic distribution, raises important questions about whether a single combination product is suitable for all settings.

The Salmonella vaccine landscape is evolving rapidly from a focus on typhoid alone toward broader protection against multiple clinically important serovars. Although recent progress is encouraging, important scientific, regulatory, and implementation challenges remain. The practical case for integrated Salmonella vaccine strategies will depend on careful matching of vaccine composition to the differing epidemiology, age-specific risks, and delivery contexts of typhoidal and nontyphoidal disease.