Typhoid Vaccine - Oral or Injectable?

There are many different places in the world that travelers need to protect themselves from typhoid fever. Salmonella Typhi is bacteria carried the bloodstream and intestinal tract. It is shed by persons with the infection and by carriers in their stools. Typhoid fever is contracted by eating food or drinking fluids that have been handled by a someone who is shedding the bacteria.

It can be spread by sewage contaminating the water used for drinking or washing food. Travelers from the United States to Asia, Africa, and Latin America are at risk.

Light green areas are endemic

Dark green areas are highly endemic

Symptoms range from mild to severe and include fever as high as 103° to 104° F, weakness, abdominal pains, headache, diarrhea and loss of appetite. In some cases, patients have a rash of flat, rose-colored spots. Diagnosis is made by stool culture. Treatment is with antibiotics and prevention and treatment of dehydration.


So how do you decide which vaccine to give to patients who are traveling?

The injectable vaccine is well tolerated but costs more and lasts only 2-3 years. The oral vaccine is a series of four capsules given every other day so it takes a week to complete it and then a week for it to become effective. It needs to be stored properly, refrigerated , or it loses potency. It must be taken on an empty stomach (one hour before or two hours after eating) and can’t be taken concurrently with antibiotics , alcohol or with very hot or cold beverages. To enhance patient compliance Berna, the manufacturer, has a very good informative booklet, reminder cling decals for the bathroom mirror and refrigerator and an animated video http://www.oraltyphoidvaccine.com/.

They have an absent minded patient program where they will replace a vaccine for free if you sent it back when the patient hasn’t taken it properly. So if you have a compliant patient with enough time, it makes sense to offer the oral vaccine and save your patient some money and give patient 5 years worth of protection and one less shot . If time is short, and you or your patient decides the oral regimen is too complicated, you can give the injection.

Food and water precautions are still recommended because of all the other food and water borne pathogens. Remember to counsel your patients to
Boil it. Peel it. Cook it. Or forget it!

Planning Ahead and Being Prepared

Every year in the Fall I stock up on a few essentials in anticipation of another New England winter. This year I am doing it a bit early in anticipation of H1N1 outbreak. It’s not that I am an alarmist or pessimist but I like to be prepared. I am asking my patients to think about what they would need at home if they couldn’t get out to the grocery store or pharmacy for a few weeks and suggesting that then plan ahead. Here's what I think we need to tell our patients.

Have enough nonperishable groceries on hand to last at least 2-3 weeks. Make sure you have enough of the essentials, such as toilet paper, soap, hand sanitizer, laundry detergent, and tooth paste, stocked up.

Check to see if you have enough acetaminophen and cough syrup on hand in proper doses for the entire family.

Evaluate your prescriptions. Is there anything that you couldn’t go without for a month? If so, get an extra month’s supply and set it aside in a safe place.

Keep a small amount of cash on hand in case you can’t get to the bank.

Got pets? Make sure you have enough food, litter, and pet meds for an extra month.

If you are putting off any repairs that if put off could be a big problem, just get them done.

Keep you gas tank full.

It’s easy to live week to week since banks, groceries, gas stations and pharmacies are readily available but what if supplies became scarce? What if you didn’t want to go out in public? If this Fall is uneventful then we will all be prepared for the next weather related event or public health threat. There’s no harm in being prepared.