| TYPHOID FEVER |
The Disease: - This disease is characterised by high fever, abdominal pain with or without diarrhoea, enlarged spleen and rose coloured spots confined to chest & abdomen. It can infect the blood (septicaemia) which has a fatality rate of 10 - 20 % if untreated & 1% in treated persons. The risk of infection is generally low, approximately 1 in 30,000 for travellers to developing countries spending 4 weeks. Risk is 10 times higher in parts of India, Africa & South America. Typhoid is generally a milder illness in children under 5. Risk is increased by failing to observe hygiene ... cook it, peel it or forget it !
Vaccine recommendation: - For anyone travelling to developing countries where the food and water quality is uncertain and persons with impaired gastric acid or immune deficiency. Most travel clinics do not recommend vaccine for travellers spending less than 2 weeks in popular tourist resorts. However, you can request to be vaccinated & the vaccine is well tolerated, (but expensive).
Vaccination: .. CDC Vaccine information statement .. copy (see also CMI pdf)
Capsules: "CSL-Vivotif(R) Oral", on alternate days, 1 hour before food for 3-4 doses. A 4th dose on day 7 has been estimated to increase immunity by an extra 40%. Boosters every 3-5 years depending on regime. Clinical disease is uncommon in children under 2 years of age. Vaccine can be given in children over the age of 6 years. Some medicines and "Vivotif(R) Oral", may interfere with each other. These include: sulphonamides, antibiotics & antimalarials. [ Nb. mefloquine, chloraquine and malarone do not interfere with IgG O immune response BUT it is still recommended that they should be taken at least 1 week after the (final) dose of "Vivotif(R) Oral" (WHO recommends 10 days) ]. Oral typhoid capsules should be stored in the refrigerator (not freezer - as this will inactivate vaccine) until taken. Contrary to NHMRC guidelines, it is argued that other live vaccines, Sabin, MMR, yellow fever and oral cholera vaccine can be given at the same time as oral typhoid. Oral cholera vaccine is actually enhanced by giving it with oral typhoid. ref: page 123 Manual Travel Medicine
Injection - Typhim Vi polysaccharide vaccine (CSL) & Typherix (SKB) is estimated to be as effective as the 4 dose oral typhoid provided the oral typhoid capsules are given with adherence to the above recommendations (approx 70 - 80% effective). A single injection is simple, immune response quicker and can be used in children over 2 years. - booster every 3 years.
Overseas information: www.cdc.gov/ncidod/diseases/Index.htm