Typhoid fever primary prevention: Difference between revisions
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== Primary Prevention == | |||
Typhoid fever can be prevented and can usually be treated with [[antibiotics]]. If you are planning to travel outside the United States, you should know about typhoid fever and what steps you can take to protect yourself. | Typhoid fever can be prevented and can usually be treated with [[antibiotics]]. If you are planning to travel outside the United States, you should know about typhoid fever and what steps you can take to protect yourself. | ||
===Two basic actions can protect you from typhoid fever=== | |||
*Avoid risky foods and drinks. | *Avoid risky foods and drinks. | ||
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===Boil it, cook it, peel it, or forget it=== | |||
*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. | *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. | ||
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*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. | *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. | ||
===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. | 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. | ||
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[[Image:Typhoid vaccines.jpg|frame|center|Typhoid vaccines]] | [[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 == | ||
Revision as of 19:25, 26 December 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Primary Prevention
Typhoid fever can be prevented and can usually be treated with antibiotics. If you are planning to travel outside the United States, you should know about typhoid fever and what steps you can take to protect yourself.
Two basic actions can protect you from typhoid fever
- Avoid risky foods and drinks.
- Get vaccinated against typhoid fever.
It may surprise you, but watching what you eat and drink when you travel is as important as being vaccinated. This is because the vaccines are not completely effective. Avoiding risky foods will also help protect you from other illnesses, including travelers' diarrhea, cholera, dysentery, and hepatitis A.
Boil it, cook it, peel it, or forget it
- 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.
- 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.
- Eat foods that have been thoroughly cooked and that are still hot and steaming.
- Avoid raw vegetables and fruits that cannot be peeled. Vegetables like lettuce are easily contaminated and are very hard to wash well.
- 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.
- 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.
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:
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.