Oral typhoid vaccine

Typhoid is relatively uncommon in the United States, but is endemic in parts of Mexico, Central and South America, the Caribbean, Africa, Portugal, Spain, Italy , Eastern Europe, India, the Far East, and the Philippines. Typhoid is transmitted through food and water contaminated with feces or urine from patients or caregivers with typhoid. Patients with typhoid can experience fever, myalgia, anorexia, abdominal discomfort, headache, constipation (adults), or diarrhea (children). Complications may include intestinal perforation and hemorrhage, and 2-4% of patients will develop the chronic carrier state. There is a 10-20% fatality rate for those unable to acquire and take proper antibiotics. In the US oral vaccination is the preferred route for patients planning to travel to endemic areas. This route is preferred because it has fewer side effects than the parenteral route and reduces disease rate by 60-77%. Since it is a live, attenuated bacteria, the typhoid vaccine is best stored in the refrigerator, and alcohol should be avoided within 2 hours of administration. The efficacy of this vaccine will be reduced if combined with certain antibiotics, therefore, it is advised to separate the two by 72 hours. Patients are to take 4 capsules total given in 1 capsule doses on days 0,2,4, and 6. These capsules should be swallowed whole an hour prior to meals. It is best to finish the 4th capsule at least 1 week prior to travel. Side effects reported occur in 5% or fewer patients and include nausea, abdominal pain, headache, fever, diarrhea, vomiting, or rash.

References:

1. Grabenstein J. ImmunoFacts: Vaccines and Immunologic Drugs 2012. 37th rev. ed. St. Louis, MO: Wolters Kluwer Health; 2011. 188-192.
2. Crucell healthcare representative telephone call.