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{{Typhoid fever}}
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==Overview==
Effective measures for the primary prevention of typhoid fever include vaccination, improving personal hygiene and sanitation,<ref>Ivanoff, Bernard. "Typhoid fever: global situation and WHO recommendations." Southeast Asian Journal of Tropical Medicine and Public Health 26 (1995): 1-6.</ref> ensuring proper sewage disposal, avoiding overcrowding, and avoiding close contact or sharing utensils with people already suffering from typhoid.<ref name="pmidhttp://dx.doi.org/10.1136/bmj.316.7125.110">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=http://dx.doi.org/10.1136/bmj.316.7125.110 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }} </ref><ref>Wahdan, M. H., et al. "A controlled field trial of live Salmonella typhi strain Ty 21a oral vaccine against typhoid: three-year results." Journal of Infectious Diseases 145.3 (1982): 292-295.</ref><ref name="pmid3657877">{{cite journal| author=Acharya IL, Lowe CU, Thapa R, Gurubacharya VL, Shrestha MB, Cadoz M et al.| title=Prevention of typhoid fever in Nepal with the Vi capsular polysaccharide of Salmonella typhi. A preliminary report. | journal=N Engl J Med | year= 1987 | volume= 317 | issue= 18 | pages= 1101-4 | pmid=3657877 | doi=10.1056/NEJM198710293171801 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3657877  }} </ref><ref name="pmid11320385">{{cite journal| author=Lin FY, Ho VA, Khiem HB, Trach DD, Bay PV, Thanh TC et al.| title=The efficacy of a Salmonella typhi Vi conjugate vaccine in two-to-five-year-old children. | journal=N Engl J Med | year= 2001 | volume= 344 | issue= 17 | pages= 1263-9 | pmid=11320385 | doi=10.1056/NEJM200104263441701 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11320385  }} </ref><ref name="pmid12456854">{{cite journal| author=Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ| title=Typhoid fever. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 22 | pages= 1770-82 | pmid=12456854 | doi=10.1056/NEJMra020201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12456854  }} </ref><ref name="pmid27479027">{{cite journal| author=MacFadden DR, Bogoch II, Andrews JR| title=Advances in diagnosis, treatment, and prevention of invasive Salmonella infections. | journal=Curr Opin Infect Dis | year= 2016 | volume=  | issue=  | pages=  | pmid=27479027 | doi=10.1097/QCO.0000000000000302 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27479027  }} </ref><ref>http://wwwnc.cdc.gov/travel/diseases/typhoid</ref><ref name="pmid12168224">{{cite journal| author=Hainsworth T| title=Travel vaccines: a guide to appropriate use. | journal=Nurs Times | year= 2002 | volume= 98 | issue= 25 | pages= 40-2 | pmid=12168224 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12168224  }} </ref><ref name="pmid27479027">{{cite journal| author=MacFadden DR, Bogoch II, Andrews JR| title=Advances in diagnosis, treatment, and prevention of invasive Salmonella infections. | journal=Curr Opin Infect Dis | year= 2016 | volume=  | issue=  | pages=  | pmid=27479027 | doi=10.1097/QCO.0000000000000302 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27479027  }} </ref>


== Primary Prevention ==
== Primary Prevention ==
:Effective measures for the primary prevention of typhoid fever include the following
Effective measures for the primary prevention of typhoid fever include:
===Vaccination===
===Vaccination===
There are two types of vaccines for typhoid fever<ref name="pmidhttp://dx.doi.org/10.1136/bmj.316.7125.110">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=http://dx.doi.org/10.1136/bmj.316.7125.110 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }} </ref><ref>Wahdan, M. H., et al. "A controlled field trial of live Salmonella typhi strain Ty 21a oral vaccine against typhoid: three-year results." Journal of Infectious Diseases 145.3 (1982): 292-295.</ref><ref name="pmid3657877">{{cite journal| author=Acharya IL, Lowe CU, Thapa R, Gurubacharya VL, Shrestha MB, Cadoz M et al.| title=Prevention of typhoid fever in Nepal with the Vi capsular polysaccharide of Salmonella typhi. A preliminary report. | journal=N Engl J Med | year= 1987 | volume= 317 | issue= 18 | pages= 1101-4 | pmid=3657877 | doi=10.1056/NEJM198710293171801 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3657877  }} </ref><ref name="pmid11320385">{{cite journal| author=Lin FY, Ho VA, Khiem HB, Trach DD, Bay PV, Thanh TC et al.| title=The efficacy of a Salmonella typhi Vi conjugate vaccine in two-to-five-year-old children. | journal=N Engl J Med | year= 2001 | volume= 344 | issue= 17 | pages= 1263-9 | pmid=11320385 | doi=10.1056/NEJM200104263441701 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11320385  }} </ref><ref name="pmid12456854">{{cite journal| author=Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ| title=Typhoid fever. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 22 | pages= 1770-82 | pmid=12456854 | doi=10.1056/NEJMra020201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12456854  }} </ref>
There are two types of vaccines for typhoid fever:<ref name="pmidhttp://dx.doi.org/10.1136/bmj.316.7125.110">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=http://dx.doi.org/10.1136/bmj.316.7125.110 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }} </ref><ref name="pmid3657877">{{cite journal| author=Acharya IL, Lowe CU, Thapa R, Gurubacharya VL, Shrestha MB, Cadoz M et al.| title=Prevention of typhoid fever in Nepal with the Vi capsular polysaccharide of Salmonella typhi. A preliminary report. | journal=N Engl J Med | year= 1987 | volume= 317 | issue= 18 | pages= 1101-4 | pmid=3657877 | doi=10.1056/NEJM198710293171801 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3657877  }} </ref><ref name="pmid11320385">{{cite journal| author=Lin FY, Ho VA, Khiem HB, Trach DD, Bay PV, Thanh TC et al.| title=The efficacy of a Salmonella typhi Vi conjugate vaccine in two-to-five-year-old children. | journal=N Engl J Med | year= 2001 | volume= 344 | issue= 17 | pages= 1263-9 | pmid=11320385 | doi=10.1056/NEJM200104263441701 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11320385  }} </ref><ref name="pmid12456854">{{cite journal| author=Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ| title=Typhoid fever. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 22 | pages= 1770-82 | pmid=12456854 | doi=10.1056/NEJMra020201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12456854  }} </ref><ref name="pmid12168224">{{cite journal| author=Hainsworth T| title=Travel vaccines: a guide to appropriate use. | journal=Nurs Times | year= 2002 | volume= 98 | issue= 25 | pages= 40-2 | pmid=12168224 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12168224  }} </ref><ref name="pmid27479027">{{cite journal| author=MacFadden DR, Bogoch II, Andrews JR| title=Advances in diagnosis, treatment, and prevention of invasive Salmonella infections. | journal=Curr Opin Infect Dis | year= 2016 | volume=  | issue=  | pages=  | pmid=27479027 | doi=10.1097/QCO.0000000000000302 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27479027  }} </ref><ref>Wahdan, M. H., et al. "A controlled field trial of live Salmonella typhi strain Ty 21a oral vaccine against typhoid: three-year results." Journal of Infectious Diseases 145.3 (1982): 292-295.</ref>
:*Inactivated typhoid vaccine, ViCPS(IM)
:*Inactivated typhoid vaccine, ViCPS (IM)
:*Live typhoid vaccine (oral)
:*Live typhoid vaccine (oral)


'''Indications'''
'''Indications'''<ref name="pmid8613306">{{cite journal| author=John TJ| title=Typhoid vaccine. | journal=Indian Pediatr | year= 1995 | volume= 32 | issue= 3 | pages= 391-3 | pmid=8613306 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8613306  }} </ref><ref>http://www.cdc.gov/vaccines/hcp/vis/vis-statements/typhoid.html</ref><ref name="pmid25811680">{{cite journal| author=Jackson BR, Iqbal S, Mahon B, Centers for Disease Control and Prevention (CDC)| title=Updated recommendations for the use of typhoid vaccine--Advisory Committee on Immunization Practices, United States, 2015. | journal=MMWR Morb Mortal Wkly Rep | year= 2015 | volume= 64 | issue= 11 | pages= 305-8 | pmid=25811680 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25811680  }} </ref><ref name="pmid15307027">{{cite journal| author=Steinberg EB, Bishop R, Haber P, Dempsey AF, Hoekstra RM, Nelson JM et al.| title=Typhoid fever in travelers: who should be targeted for prevention? | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 2 | pages= 186-91 | pmid=15307027 | doi=10.1086/421945 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15307027 }} </ref><ref name="pmid12456854">{{cite journal| author=Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ| title=Typhoid fever. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 22 | pages= 1770-82 | pmid=12456854 | doi=10.1056/NEJMra020201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12456854  }} </ref><ref name="pmid10432074">{{cite journal| author=Tarr PE, Kuppens L, Jones TC, Ivanoff B, Aparin PG, Heymann DL| title=Considerations regarding mass vaccination against typhoid fever as an adjunct to sanitation and public health measures: potential use in an epidemic in Tajikistan. | journal=Am J Trop Med Hyg | year= 1999 | volume= 61 | issue= 1 | pages= 163-70 | pmid=10432074 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10432074 }} </ref>
*Travelers visiting endemic areas.<ref name="pmid8613306">{{cite journal| author=John TJ| title=Typhoid vaccine. | journal=Indian Pediatr | year= 1995 | volume= 32 | issue= 3 | pages= 391-3 | pmid=8613306 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8613306  }} </ref>
*Travel to [[endemic]] areas
*Health care workers dealing typhoid patients or handling salmonella typhi.
*Health care workers or researchers dealing typhoid patients or handling [[Salmonella typhi]]
*Individuals at increased risk of acquiring infection such as household contact<ref name="pmid25811680">{{cite journal| author=Jackson BR, Iqbal S, Mahon B, Centers for Disease Control and Prevention (CDC)| title=Updated recommendations for the use of typhoid vaccine--Advisory Committee on Immunization Practices, United States, 2015. | journal=MMWR Morb Mortal Wkly Rep | year= 2015 | volume= 64 | issue= 11 | pages= 305-8 | pmid=25811680 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25811680  }} </ref><ref name="pmid15307027">{{cite journal| author=Steinberg EB, Bishop R, Haber P, Dempsey AF, Hoekstra RM, Nelson JM et al.| title=Typhoid fever in travelers: who should be targeted for prevention? | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 2 | pages= 186-91 | pmid=15307027 | doi=10.1086/421945 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15307027  }} </ref>
*Individuals at increased risk of acquiring infection (e.g., household contacts of a patient with typhoid fever)
*Pregnancy( travel to endemic areas)<ref name="pmid4286306">{{cite journal| author=Spence JT| title=The biological function of molybdenum. | journal=Z Naturwiss Med Grundlagenforsch | year= 1965 | volume= 2 | issue= 3 | pages= 267-83 | pmid=4286306 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4286306 }} </ref>
*To prevent typhoid epidemic in case of natural disasters or the presence of a refugee camp in an endemic area
The table below provides basic information on typhoid vaccines that are available in the United States:
 
'''Contraindications'''<ref name="pmid24919344">{{cite journal| author=Galev A, Nacheva A| title=[Pregnancy and vaccinoprevention]. | journal=Akush Ginekol (Sofiia) | year= 2014 | volume= 53 | issue= 1 | pages= 51-6 | pmid=24919344 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24919344  }} </ref><ref name="pmid12456854">{{cite journal| author=Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ| title=Typhoid fever. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 22 | pages= 1770-82 | pmid=12456854 | doi=10.1056/NEJMra020201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12456854 }} </ref><ref>http://www.cdc.gov/vaccines/hcp/vis/vis-statements/typhoid.html</ref>
*Severe [[allergic]] reaction to the vaccine component
*Severely ill or [[immunocompromised]] patients
*Severe reaction to previous dose
*Children younger than 2 years of age for inactivated vaccine
*Children younger than 6 years of age for live attenuated vaccine
*Pregnancy


The table below provides basic information about the typhoid vaccines that are available in the United States:
[[Image:Typhoid vaccines.jpg|frame|center|Typhoid vaccines]]
[[Image:Typhoid vaccines.jpg|frame|center|Typhoid vaccines]]


===Other measures===
===Other measures===
The following preventive measures help decrease incidence of typhoid in endemic areas:<ref name="pmid12456854">{{cite journal| author=Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ| title=Typhoid fever. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 22 | pages= 1770-82 | pmid=12456854 | doi=10.1056/NEJMra020201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12456854  }} </ref><ref>Ivanoff, Bernard. "Typhoid fever: global situation and WHO recommendations." Southeast Asian Journal of Tropical Medicine and Public Health 26 (1995): 1-6.</ref>
*Improving personal hygiene and sanitation
*Implementing proper sewage disposal
*Avoiding overcrowding
*Avoiding close contact or sharing utensils with people already suffering from typhoid


===Boil it, cook it, peel it, or forget it===
The following preventive measures help prevent disease in people traveling to endemic areas:<ref name="pmid12456854">{{cite journal| author=Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ| title=Typhoid fever. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 22 | pages= 1770-82 | pmid=12456854 | doi=10.1056/NEJMra020201 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12456854  }} </ref><ref>http://wwwnc.cdc.gov/travel/diseases/typhoid</ref><ref name="pmid27523510">{{cite journal| author=Ahmad Hatib NA, Chong CY, Thoon KC, Tee NW, Krishnamoorthy SS, Tan NW| title=Enteric Fever in a Tertiary Paediatric Hospital: A Retrospective Six-Year Review. | journal=Ann Acad Med Singapore | year= 2016 | volume= 45 | issue= 7 | pages= 297-302 | pmid=27523510 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27523510  }} </ref>
 
*Avoiding consumption of foods and beverages purchased from street vendors
*If you drink water, buy it bottled or bring it to a rolling boil for 1 minute before you drink it. Bottled carbonated water is safer than uncarbonated water. 
*Avoiding consumption of raw fruits and vegetables that cannot be peeled
*Ask for drinks without ice unless the ice is made from bottled or boiled water. Avoid popsicles and flavored ices that may have been made with contaminated water. 
*Avoiding consumption of ice cream
*Eat foods that have been thoroughly cooked and that are still hot and steaming. 
*Eating food which is properly cooked and served hot
*Avoid raw vegetables and fruits that cannot be peeled. Vegetables like lettuce are easily contaminated and are very hard to wash well. 
*Using hard cooked eggs
*When you eat raw fruit or vegetables that can be peeled, peel them yourself. (Wash your hands with soap first.) Do not eat the peelings. 
*Using pasteurized milk products
*Avoid foods and beverages from street vendors. It is difficult for food to be kept clean on the street, and many travelers get sick from food bought from street vendors. 
*Using boiled or bottled water
 
===Getting vaccinated===
 
If you are traveling to a country where typhoid is common, you should consider being [[vaccinated]] against typhoid. Visit a doctor or travel clinic to discuss your vaccination options.
 
Remember that you will need to complete your vaccination at least 1 week before you travel so that the vaccine has time to take effect. Typhoid vaccines lose effectiveness after several years; if you were vaccinated in the past, check with your doctor to see if it is time for a booster vaccination. Taking [[antibiotics]] will not prevent typhoid fever; they only help treat it.  
 
The chart below provides basic information on typhoid vaccines that are available in the United States:
 
[[Image:Typhoid vaccines.jpg|frame|center|Typhoid vaccines]]
 
Typhoid vaccine is recommended for travelers to areas where there is an increased risk of exposure to S.Typhi.
===Indications===
The typhoid vaccines do not protect against S. Paratyphi infection. Both typhoid vaccines protect 50%–80% of recipients; travelers should be reminded that typhoid immunization is not 100% effective, and typhoid fever could still occur. Two typhoid vaccines are available in the United States:
 
*Oral live, [[attenuated]] [[vaccine]].
*Vi capsular polysaccharide (ViCPS) vaccine for [[intramuscular]] use.
===Vaccine Administration===
The time required for primary vaccination differs for the 2 vaccines, as do the lower age limits.
 
Primary vaccination with oral Ty21a vaccine consists of 4 capsules, 1 taken every other day. The capsules should be kept refrigerated (not frozen), and all 4 doses must be taken to achieve maximum efficacy. Each capsule should be taken with cool liquid no warmer than 98.6°F (37°C), approximately 1 hour before a meal. This regimen should be completed 1 week before potential exposure. The vaccine manufacturer recommends that Ty21a not be administered to infants or children aged <6 years.
 
Primary vaccination with ViCPS consists of one 0.5-mL (25-mg) dose administered intramuscularly. One dose of this vaccine should be given ≥2 weeks before expected exposure. The manufacturer does not recommend the vaccine for infants and children aged <2 years.
===Vaccine Safety and Adverse Reactions===
Adverse reactions to Ty21a vaccine are rare and mainly consist of abdominal discomfort, [[nausea]], [[vomiting]], and [[rash]]. ViCPS vaccine is most often associated with [[headache]] (16%–20%) and injection-site reactions (7%). No information is available on the safety of these vaccines in [[pregnancy]]; it is prudent on theoretical grounds to avoid vaccinating pregnant women. Live, attenuated Ty21a vaccine should not be given to [[immunocompromised]] travelers, including those infected with [[HIV]]. The intramuscular vaccine presents a theoretically safer alternative for this group. The only contraindication to vaccination with ViCPS vaccine is a history of severe local or systemic reactions after a previous dose. Neither of the available vaccines should be given to people with an acute febrile illness.
===Precautions and Contraindications===
Theoretical concerns have been raised about the immunogenicity of live, attenuated Ty21a vaccine in people concurrently receiving [[antimicrobials]] (including [[antimalarial]] [[chemoprophylaxis]]), viral vaccines, or [[immune]] [[globulin]]. The growth of the live Ty21a strain is inhibited [[in vitro]] by various [[antibacterial]] agents, and [[vaccination]] with Ty21a should be delayed for >72 hours after the administration of any antibacterial agent. Available data do not suggest that simultaneous administration of oral polio or yellow fever vaccine decreases the immunogenicity of Ty21a. If typhoid vaccination is warranted, it should not be delayed because of administration of viral vaccines. Simultaneous administration of Ty21a and immune globulin does not appear to pose a problem.


== References ==
== References ==
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Aslam, M.B.B.S[2]

Overview

Effective measures for the primary prevention of typhoid fever include vaccination, improving personal hygiene and sanitation,[1] ensuring proper sewage disposal, avoiding overcrowding, and avoiding close contact or sharing utensils with people already suffering from typhoid.[2][3][4][5][6][7][8][9][7]

Primary Prevention

Effective measures for the primary prevention of typhoid fever include:

Vaccination

There are two types of vaccines for typhoid fever:[2][4][5][6][9][7][10]

  • Inactivated typhoid vaccine, ViCPS (IM)
  • Live typhoid vaccine (oral)

Indications[11][12][13][14][6][15]

  • Travel to endemic areas
  • Health care workers or researchers dealing typhoid patients or handling Salmonella typhi
  • Individuals at increased risk of acquiring infection (e.g., household contacts of a patient with typhoid fever)
  • To prevent typhoid epidemic in case of natural disasters or the presence of a refugee camp in an endemic area

Contraindications[16][6][17]

  • Severe allergic reaction to the vaccine component
  • Severely ill or immunocompromised patients
  • Severe reaction to previous dose
  • Children younger than 2 years of age for inactivated vaccine
  • Children younger than 6 years of age for live attenuated vaccine
  • Pregnancy

The table below provides basic information about the typhoid vaccines that are available in the United States:

Typhoid vaccines

Other measures

The following preventive measures help decrease incidence of typhoid in endemic areas:[6][18]

  • Improving personal hygiene and sanitation
  • Implementing proper sewage disposal
  • Avoiding overcrowding
  • Avoiding close contact or sharing utensils with people already suffering from typhoid

The following preventive measures help prevent disease in people traveling to endemic areas:[6][19][20]

  • Avoiding consumption of foods and beverages purchased from street vendors
  • Avoiding consumption of raw fruits and vegetables that cannot be peeled
  • Avoiding consumption of ice cream
  • Eating food which is properly cooked and served hot
  • Using hard cooked eggs
  • Using pasteurized milk products
  • Using boiled or bottled water

References

  1. ↑ Ivanoff, Bernard. "Typhoid fever: global situation and WHO recommendations." Southeast Asian Journal of Tropical Medicine and Public Health 26 (1995): 1-6.
  2. ↑ 2.0 2.1 Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID http://dx.doi.org/10.1136/bmj.316.7125.110 Check |pmid= value (help).
  3. ↑ Wahdan, M. H., et al. "A controlled field trial of live Salmonella typhi strain Ty 21a oral vaccine against typhoid: three-year results." Journal of Infectious Diseases 145.3 (1982): 292-295.
  4. ↑ 4.0 4.1 Acharya IL, Lowe CU, Thapa R, Gurubacharya VL, Shrestha MB, Cadoz M; et al. (1987). "Prevention of typhoid fever in Nepal with the Vi capsular polysaccharide of Salmonella typhi. A preliminary report". N Engl J Med. 317 (18): 1101–4. doi:10.1056/NEJM198710293171801. PMID 3657877.
  5. ↑ 5.0 5.1 Lin FY, Ho VA, Khiem HB, Trach DD, Bay PV, Thanh TC; et al. (2001). "The efficacy of a Salmonella typhi Vi conjugate vaccine in two-to-five-year-old children". N Engl J Med. 344 (17): 1263–9. doi:10.1056/NEJM200104263441701. PMID 11320385.
  6. ↑ 6.0 6.1 6.2 6.3 6.4 6.5 Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ (2002). "Typhoid fever". N Engl J Med. 347 (22): 1770–82. doi:10.1056/NEJMra020201. PMID 12456854.
  7. ↑ 7.0 7.1 7.2 MacFadden DR, Bogoch II, Andrews JR (2016). "Advances in diagnosis, treatment, and prevention of invasive Salmonella infections". Curr Opin Infect Dis. doi:10.1097/QCO.0000000000000302. PMID 27479027.
  8. ↑ http://wwwnc.cdc.gov/travel/diseases/typhoid
  9. ↑ 9.0 9.1 Hainsworth T (2002). "Travel vaccines: a guide to appropriate use". Nurs Times. 98 (25): 40–2. PMID 12168224.
  10. ↑ Wahdan, M. H., et al. "A controlled field trial of live Salmonella typhi strain Ty 21a oral vaccine against typhoid: three-year results." Journal of Infectious Diseases 145.3 (1982): 292-295.
  11. ↑ John TJ (1995). "Typhoid vaccine". Indian Pediatr. 32 (3): 391–3. PMID 8613306.
  12. ↑ http://www.cdc.gov/vaccines/hcp/vis/vis-statements/typhoid.html
  13. ↑ Jackson BR, Iqbal S, Mahon B, Centers for Disease Control and Prevention (CDC) (2015). "Updated recommendations for the use of typhoid vaccine--Advisory Committee on Immunization Practices, United States, 2015". MMWR Morb Mortal Wkly Rep. 64 (11): 305–8. PMID 25811680.
  14. ↑ Steinberg EB, Bishop R, Haber P, Dempsey AF, Hoekstra RM, Nelson JM; et al. (2004). "Typhoid fever in travelers: who should be targeted for prevention?". Clin Infect Dis. 39 (2): 186–91. doi:10.1086/421945. PMID 15307027.
  15. ↑ Tarr PE, Kuppens L, Jones TC, Ivanoff B, Aparin PG, Heymann DL (1999). "Considerations regarding mass vaccination against typhoid fever as an adjunct to sanitation and public health measures: potential use in an epidemic in Tajikistan". Am J Trop Med Hyg. 61 (1): 163–70. PMID 10432074.
  16. ↑ Galev A, Nacheva A (2014). "[Pregnancy and vaccinoprevention]". Akush Ginekol (Sofiia). 53 (1): 51–6. PMID 24919344.
  17. ↑ http://www.cdc.gov/vaccines/hcp/vis/vis-statements/typhoid.html
  18. ↑ Ivanoff, Bernard. "Typhoid fever: global situation and WHO recommendations." Southeast Asian Journal of Tropical Medicine and Public Health 26 (1995): 1-6.
  19. ↑ http://wwwnc.cdc.gov/travel/diseases/typhoid
  20. ↑ Ahmad Hatib NA, Chong CY, Thoon KC, Tee NW, Krishnamoorthy SS, Tan NW (2016). "Enteric Fever in a Tertiary Paediatric Hospital: A Retrospective Six-Year Review". Ann Acad Med Singapore. 45 (7): 297–302. PMID 27523510.

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