Typhoid is an infectious disease caused by the bacteria Salmonella typhi which causes severe symptoms in the digestive system. It can be life-threatening, but if treated early antibiotics are effective.
Typhoid is found in countries with inadequate sanitation and is endemic in Indian subcontinent, South East Asia, parts of the Middle East, Central and South America and Africa. Around 22 million cases of typhoid fever and 220,000 deaths occur annually (WHO 2014).
The disease is transmitted from human to human via ingesting contaminated food or drinking water or through poor personal hygiene, such as lack of hand washing. The bacteria is found in the faeces of infected individuals and 2-5% of those infected become long term carriers and excrete the bacteria in their faeces.
The incubation period is 10 to 20 days and depends on, among other things, how large a dose of bacteria has been taken in.
In the mild disease, the bacterium is eliminated very early in the course of the disease and there are perhaps only mild symptoms.
Symptoms can include high fever, diarrhoea or constipation, headache, rash and in severe disease multi-organ failure can occur. If untreated, the death rate is 20%, whereas prompt antibiotic treatment reduces this to less than 1%.
Typhoid is treatable with antibiotics administered early on. Supportive treatment, such as rehydration are also important.
Food and water hygiene measures while travelling are important as is maintaining personal hygiene.
Vaccination is available to those at risk of typhoid fever.
The typhoid vaccine is made from inactivated protein from the bacteria. It cannot cause infection in the vaccinated individual and nor is the vaccinated individual infectious to others. The inactivated vaccine is effective form 7 days and provides around 75% protection against the illness. There is a live vaccine that is taken orally, which is 50-60% effective. However, this is rarely indicated as it requires 3 doses, can only be given from 6 years of age and is not as effective as the inactivated injection.
Adults and children from 2 years of age travelling to countries endemic for or with a high risk of typhoid infection.
|Age range||Vaccine Brands||Method of Administration||Number of doses|
|From 2 years of age||Typhim Vi|
|Intramuscular injection to the deltoid muscle||1 dose|
Single dose given every 3 years for ongoing risk.
Combined Hepatitis A and Typhoid Vaccine
The combined vaccine contains inactivated Hepatitis A virus and Typhoid protein and can be given to travellers requiring protection against both diseases. The combined vaccines cannot be used in children under 15 years of age.
|Vaccine Brand||Age||Method of Administration||Number of doses|
|Viatim||From 16 years||Intramuscular injection to the deltoid muscle||1|
|Hepatyrix||From 15 years||Intramuscular injection to the deltoid muscle||1|
Booster doses Following receipt of combined Hepatitis A and Typhoid Vaccine
Hepatitis A-a single dose of Hepatitis A vaccine 6-12 months after administration of the combined vaccine provides protection for 25 years.
Typhoid-a single dose of Typhoid vaccine 3 years after administration of the combined vaccine.
The inactivated vaccine should not be given if:
- There is a history of severe allergic reaction to previous dose of typhoid vaccine or any of the components of the vaccine.
- In illnesses with fever above 38.5 degrees Celsius.
There is no specific data on the safety of the inactivated typhoid vaccine during pregnancy. However, inactivated vaccines have not been shown to cause harm during pregnancy. Therefore, the vaccine can be administered to pregnant women who are at significant risk of exposure to Typhoid during travel following a careful risk assessment.
There is no specific data on the safety of the inactivated typhoid vaccine when given to breast feeding mothers. However, inactivated vaccines have not been shown to cause harm when given to breast feeding mothers. Therefore, the vaccine can be admisnieterd to pregnant women who are at significant risk of exposure to Typhoid during travel following a careful risk assessment.
Common Side Effects
Local reactions at injection site-pain, redness, swelling.
Fever, nausea and vomiting, abdominal pain, headache and muscle ache can occur after vaccination and are normally short lived.
Interactions with Other Vaccines
The inactivated typhoid vaccien doe snot interact with other vaccines and can be given at the same time as other vaccines, including hepatitis A, hepatitis B, rabies and yellow fever.
Frequently Asked Questions
1) What are the contents of the inactivated Typhoid vaccines?
Typhim Vi contains the following ingredients
- Phenol (preservative)
- Sodium Chloride
- Disodium phosphate dihydrate
- Sodium dihydrogen phosphate dihydrate
- Water for Injections
The vaccine does not contain
- Egg products
2) Why can the vaccine not be given to children under 2 years?
The reason for this is that the typhoid vaccine is a polysaccharide vaccines and children under 2 years do not mount a good immune response to the vaccine. Therefore, they are not as effective.
3) Why is a booster required at 3 years for this vaccine?
The immunity from the typhoid vaccine wanes over this period of time. Therefore, if there is further risk of exposure due to travel, a booster dose is required to increase the protection levels.
4) How effective is the Typhoid vaccine?
The inactivated vaccine is around 75% effective. This may be less if a large number of bacteria is ingested. Therefore, it is important that in addition to vaccination, you are scrupulous with food and water and hand hygiene while travelling.
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