Apr 282012
 

by: Sherri Tenpenny, DO

Typhoid fever is an illness caused by the bacterium Salmonella Typhi. In the United States, only about 400 cases occur each year, and 75% of these are acquired while traveling internationally. Typhoid fever is still common in areas of the world where hand washing is less frequent and water is likely to be contaminated with sewage. In the developing world, it affects about 21.5 million persons each year. 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.

Signs and symptoms of typhoid fever include a fever as high as 103° to 104° F (39° to 40° C). Weakness, stomach pain, headache, diarrhea, malaise and loss of appetite are the most common symptoms. In some cases, patients have a rash of flat, rose-colored spots. The only way to know for sure if an illness is typhoid fever is to have samples of stool or blood tested for the presence of S. Typhi. Many other gastrointestinal microbes can cause similar types of traveler’s diarrhea.

The Vaccine

The protective efficacy for the Vi capsular polysaccharide (lyophilized formulation) group for blood culture confirmed cases of typhoid fever was 55%. That is just only slightly better than a coin toss.

Vaccination has been associated with an increase in anti-Vi antibodies. Antibody levels have documented to remained elevated at 6 and 12 months post-vaccination. An increase in serum antibodies is thought to be the basis of protection provided by Typhim Vi vaccine. However, the specific correlation between antibody levels and protection is not known and the level of Vi antibody that will provide protection has not been determined.[1]  In addition, most efficacy studies were done on children on Third World countries. Because of the low incidence of typhoid fever, efficacy studies were not feasible in a US population.

Typhoid vaccination is not required for international travel. It is only recommended for travelers thought to have prolonged exposure to potentially contaminated food and water. The definition of “prolonged exposure” is not given, but is thought to be 4-6 weeks in other literature.

 Vaccine Side Effects

Acute allergic reactions have occurred and the vaccine should not be given to anyone with blood disorders. No studies have been conducted to evaluate interactions or immunological complications when the Typhim Vi vaccine is given concurrently with antibiotics and antimalarial drugs, and other vaccines.  No studies have been done to to evaluate the vaccine for its carcinogenic potential, mutagenic potential or impairment of fertility.[2]

The most common side effects of the vaccine are strikingly similar to the symptoms seen from the disease itself: malaise, headache, myalgias, nausea, vomiting, diarrhea, abdominal pain and fever ≥100°F. Other side effects include:

• Local Reactions: injection site pain, injection site inflammation, injection site induration, injection site erythema, and lymphadenopathy.

• Generalized: Fever, malaise, flu-like episode, abdominal pain.

• Immune system disorders: Allergic-type reactions such as pruritus, rash, urticaria, difficulty breathing, hypotension and Serum sickness.

• Musculoskeletal and connective tissue disorders: Myalgia, arthralgia, neck pain.

• Nervous system disorders: Headache, loss of consciousness, tremor.[3]

Post-marketing reports of glomerulonephritis, neutropenia, bilateral retinitis, and polyarthritis have been reported in patients who had also received the typhoid vaccine along with other vaccines.[4]

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.[5]  Avoiding risky foods will also help protect you from other illnesses, including travelers’ diarrhea, cholera, dysentery, and hepatitis A. A simple rule in very rural areas is “Boil it, cook it, peel it, or forget it.”

Typhoid fever can be treated with antibiotics.[6] Taking antibiotics will not prevent typhoid fever; they only help treat it. Three commonly prescribed antibiotics are ampicillin, trimethoprim-sulfamethoxazole, and ciprofloxacin. Persons given antibiotics usually begin to feel better within 2 to 3 days, and deaths rarely occur. In fact, during the period of 1983 to 1991 in the US, the case fatality rate reported to the CDC was 0.2% (9 cases out of 4010 documented cases).

What should I pack?

A compact travel kit should include:

• diarrhea, upset stomach, or heartburn remedies like Pepto-Bismol. Some frequently travelers have been known to consume 1-2 chewable Pepto-Bismol tablets daily to decrease risk of traveler’s diarrhea. NOTE: This over-the-counter preparation will turn you stools black (due to the bismuth). Don’t be alarmed!

• constipation remedies like FiberCon®

• decongestants or natural antihistamines

• antibacterial soap like Safeguard®

• skin cream/antibiotic ointment (for cuts and scratches)

• first aid supplies (bandaids, gauze, adhesive tape)

• sunscreen/suntan lotion

• natural, non-DEET insect repellant

• soothing, non-alcohol-based lotion (for insect bites and sunburn)

• vitamins. A good daily supplement is Opti-Biotic or Culterelle to keep good bacteria in your intestines.

• sun glasses and possibly a duplicate pair of eyeglasses. Take a copy of your prescription with you.

• any prescription medicine that you are taking

Bottom line: Be cautious about water from unknown sources. Take prescription of antibiotics with you on your trip. Some studies have shown that taking

1. Typhoid fever vaccine package insert: http://www.vaccineshoppe.com/US_PDF/TyphimVi_4928_4929%20_03.05.pdf

2. Ibid. Typhoid fever vaccine package insert:

3. Ibid. Typhoid fever vaccine package insert:

4. Ibid. Typhoid fever vaccine package insert:

5. CDC: Typhoid Fever http://www.cdc.gov/ncidod/dbmd/diseaseinfo/typhoidfever_g.htm

6. Ibid. CDC: Typhoid Fever

  9 Responses to “Typhoid Fever: What It Is, Why to Avoid the Vaccine”

  1. Hi Two weeks ago my GP gave me a typhoid vaccine as I was travelling to Cancun Mexico. Approx a week after the vaccine (my first day of vacation in LA) I got diarrhea and it hasn’t let up. Im due to fly out to Cancun tomorrow. As my GP is in Australia, all I have brought with me are charcoal tablets, gastro stop (which I would prefer not to take as it clogs you up) and gastrolite an electrolyte drink which slows it down. This is ruining my trip, Do you think it may be from the vaccine a week after I was vaccinated? I have brought with me a box of flagyl antibiotics should I start taking them? I have read that they can cause diarrhea. Help Im not in my home country and don’t know what to do. Thank you.

    • I apologize for the delay in answering, but the typhoid vaccine is worthless and can cause many problems, including diarrhea. It could very well be the vaccine. Why in the WORLD would anyone get a typhoid shot to go to Cancun? Sorry, but this is a bad choice on your part…and an ignorant administration of a medicine by the physician.

  2. Thank you for the article on typhoid fever and immunizations. I am going for two weeks to Ecuador for a mission trip. We will be staying in a hotel of sorts and will eat only food that is prepared there. Each day we will take a sack lunch when we go by bus to the back country to work with the people. After this article, I am seriously thinking I don’t need to have the typhoid vaccine and will be extra careful with what I eat and drink.

    • I know if I were going on the trip, I personally would not take the vaccine. Go to – a one-month membership is $9.98….you can investigate travel vaccines there.

  3. Hello,
    im leaving for India in 6 days have have been debating on taking the typhoid vaccine, I’ll be staying in a very nice hotel and working at factories during the day and always eating at the hotel (Hyatt). I don’t feel that the vaccine is necessary, I’ve traveled to China and all areas of south america and have had no trouble what so ever. Could I get your feed back please?
    Thank you.

    • Do you really think that vaccines “work” and that this vaccine will keep you from getting sick? Or, are there other ways to avoid an infection that comes from bad water? Do you have a greater risk of long term disability from the vaccine or a greater risk from a diarrheal disease? ~ Dr Sherri

  4. I traveled to India last fall and ended up getting the vaccine, before I read this article. I developed a rash on my rib cage that lasted almost two weeks while in India. The doctors said this this must have been from “something” else. Even though it looked like a typhoid rash.

    Approximately two weeks after returning I also developed this bizzare symptom where there is an indentation on the right side of my skull. No clue what that is about and of course a doctor will just look puzzled and say if there’s no pain what can they do ?

    I totally regret getting this vaccine and have no clue what it did to my body. I only hope that no other complications arise and no one else gets it in the future.

  5. Hi there,
    I became ill with Typhoid while traveling in North Africa. It was horrible. Painful, high fevers of 40 degrees C and terrible vomiting and bloody diarhea. I had to be hospitalized. It took me 10 days to get better.

    Get the vaccine… A 55% chance of not getting this dreadful disease is worth it!

  6. In 1980, my mother decided to travel to India. I was 8yo. My brother and I were given some vaccinations specifically for the 9 week trip. I am certain one of them was the Typhoid shot. Soon after, both my brother and I became very unwell, and we both spent an entire day at school in the sick bay. I recall being in excruciating pain – headache/muscle and limb soreness/nausea etc. I am surprised we weren’t sent to hospital. I remember it was considered ‘normal’, but it was one of the most horrific days in my life. I came out in a rash (on face/neck) while we were in India, I always thought/was told it was mosquito bites, but now I’m not so sure. I never remembered being bitten by so many mosquitoes! Would you have any idea what the ingredients of the vaccine (in Australia) would have been back in 1980?

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