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 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. 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.
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.
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.
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. A simple rule in very rural areas is “Boil it, cook it, peel it, or forget it.”
Typhoid fever can be treated with antibiotics. 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