typhoid vaccination

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Different vaccines:

  • whole cell typhoid vaccine - no longer available
  • polysaccharide typhoid vaccine - Typhim Vi antigen
      • non-conjugated polysaccharide vaccines are poorly immunogenic in infants and young children
      • little definitive data on the efficacy of Vi vaccine in children aged less than 18 months -in 2008, the lower age limit for Typhim Vi was increased from 18 months to two years- ineffective in children less than 18 months
      • an inactive vaccine

  • oral typhoid vaccine (Ty21a)
    • oral typhoid vaccine contains a live, attenuated strain of S. typhi (Ty21a) in an enteric-coated capsule
    • a three-dose regimen gives a cumulative three-year efficacy of about 50 to 60%
    • vaccine is indicated for persons from six years of age

  • whole-cell typhoid vaccine
    • injectable, killed, whole-cell typhoid vaccine contains heat-inactivated, phenol-preserved S. typhi organisms
    • this vaccine is highly reactogenic and is no longer used in the UK

Typhoid vaccine is indicated for active immunisation against typhoid fever and is recommended for:

  • travellers visiting typhoid-endemic areas whose planned activities put them at higher risk
  • travellers to endemic areas with frequent and/or prolonged exposure to conditions where sanitation and food hygiene are likely to be poor
  • laboratory personnel who may handle S. typhi in the course of their work

Check uptodate details in the The Green Book before prescribing/administering a vaccination.

Check the Summary of Product Characteristics (SPC) prescribing/administering a vaccine.

Notes:

  • immunisation can be overcome by a large inoculum of S.typhi (1) - protection by vaccination may be less if a large number of infective organisms are ingested (2)
  • Vi vaccines are routinely given intramuscularly into the upper arm or anterolateral thigh. Intradermal injection may cause a severe local reaction and should be avoided. Vaccines should be given by deep subcutaneous injection to individuals with a bleeding disorder. Vaccines must not be given intravenously. Ty21a vaccine capsules are taken orally
  • a South African study found the cumulative three-year efficacy of Vi polysaccharide vaccine against culture-positive typhoid to be 55% in children aged six to 15 years
  • a three-dose regimen of Ty21a oral vaccine gives a cumulative three-year efficacy of about 50 to 60%
  • Primary immunisation
    • the immunisation schedule of Vi vaccine consists of a single dose; for Ty21a vaccine, a three-dose course

Reference:

  1. GP magazine (September 24th 2004): 44.
  2. The Green Book. Chapter 33 - Typhoid (April 2019)

Last edited 05/2022 and last reviewed 06/2022

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