Information on Typhoid
Typhoid is a bacterial infection of the digestive tract caused by Salmonella typhi. It is spread via food and water contaminated with fecal matter from an infected human carrier. Typhoid is often transmitted by person-to-person contact, especially through food handlers.
Typhoid fever symptoms usually appear over the course of a month, beginning with fatigue, dull headache, intermittent fever, abdominal pain (typically in the lower-right portion), and, at times, constipation. At the end of the first week of infection, dark red "rose spots" appear on the outer portion of the upper abdomen and the lower chest.
As the illness progresses, fever becomes continuous, an unproductive cough may develop, and the infected person experiences lassitude, disorientation, and sometimes delirium. As the person's condition worsens, "pea soup" diarrhea may appear. Coma may occur, as well as intestinal bleeding. Fever and symptoms gradually recede over the fourth week.
Risk to travelers
The risk of typhoid for international travelers is highest for those going to countries with warm climates and underdeveloped sanitary facilities for sewage disposal and water treatment (especially developing countries in Central and South America, Asia, and Africa).
Only use safe drinks such as canned or bottled carbonated drinks, beer, wine, and beverages made with boiled water. In some places the possibility exists that commercial water bottles may have been filled with tap water and recapped; therefore, carbonated bottled water is the safest option (although be aware that some brands may be high in sodium).
Always avoid ice cubes, and remember that alcohol will not make mixed drinks made with plain tap water safe. Consider non-disposable glasses and cups unsafe, too. Use straws.
Use safe water for brushing your teeth, washing near your mouth and so on. You may want to take along an inexpensive immersion coil for boiling.
An alternative is to treat water with Pristine ( Chlorine Dioxide) with or without the use of a good mechanical water purifier. Removing sediment can be made easier with a pinch of alum.
You should avoid leafy and uncooked vegetables and salads. Peel fruits yourself, taking care not to contaminate the inside.
Order meats, fish, and other seafood cooked well done and served piping hot. Bread is safest when served fresh from the oven. Avoid moist grain dishes (like rice) that have been allowed to sit at room temperature for prolonged periods.
Always avoid cold meat platters, mayonnaise, and creamy desserts, as well as buffets and products from street vendors. Don't eat or drink unpasteurized dairy products, including cheese and yogurt. To protect against any attempts by local vendors to "stretch" pasteurized milk by adding water or unpasteurized milk to cartons or bottles, stick to canned milk.
Don't swim or fish in polluted waters, and don't eat fish or shellfish that may have been caught in such waters.
Always wash your hands or use a hand sanitizer such as Purell or Isagel before eating.
Typhoid vaccine is not recommended for all international travelers. You should consider vaccination if you will be visiting developing countries (especially in Central and South America, Asia, and Africa) and staying for a prolonged period of time, eating adventurously, or venturing off the usual tourist routes into small cities, villages, and rural areas. Typhoid can be difficult to diagnose and treatment can be delayed. Also the organism is developing resistance to the traditional antibiotic treatment. Therefore vaccination may be advantageous.
1. Injectable Vaccine – Typhim Vi®
The primary vaccination is given in a single intramuscular injection. You should get this shot at least 1 week before arrival at a high-risk area. The booster dose, recommended every 2 to 3 years under conditions of repeated or continuous exposure, is also a single injection.
It is protective ( up to 75%) after 10 days.
Injectable Vaccine – Typhim Vi® Vaccine should not be given to children less than 2 years of age.
Injectable Vaccine – Typhim Vi®: The most common side effects are redness, hardening, and tenderness at the injection site; these symptoms almost always resolve within 48 hours of vaccination. Occasionally, fever, headache, and flu-like episodes have been reported.
2. Oral Vaccine – Vivotif Berna®
Because it is a live-bacteria vaccine it should be avoided during pregnancy and under the age of 6 years of age.
This vaccine is given in a 3-dose, every-other-day series on days 0, 2, 4, . Each dose consists of a single sachet. Take each dose 1 hour before a meal with cool or lukewarm water (no warmer than body temperature). Do not take milk or alcohol. Keep them refrigerated until you are ready to take them. The series should be completed at least 1 week before arrival at high-risk areas. The booster series is recommended every 5 years under conditions of repeated or continuous exposure.
Oral Vaccine – Vivotif Berna®: The oral vaccine causes fewer side effects than the injectable Typhim Vi®. Side effects from the oral vaccine are rare, but when they do occur, they may include abdominal discomfort, nausea, vomiting, fever, headache, and rash or hives.
If you will be taking mefloquine (Lariam®) to protect against malaria: make sure it is separated by at least 24 hours from any dose of oral typhoid vaccine.
If you will be taking Malarone™ (a drug used to protect against malaria): studies indicate that Malarone™ and oral typhoid vaccine can be given at the same time (even though Malarone™ contains proguanil).
Sulfonamides or antibiotics should not be taken with oral typhoid vaccine; delay vaccination for at least 24 hours after the last dose of medication.