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!

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