Typhoid

Transmission 

Typhoid infection is caused by the bacteria Salmonella enterica typhi and Salmonella enterica paratyphi and it is transmitted by contaminated food or water, faecal-oral route or uncooked vegetables contaminated with human waste.

Vaccination schedule – Typhoid only

Brand  Vaccine information Primary course Booster
Typherix
  • Inactivated
  • Licensed from two years of age
  • Single dose
  • Effective after at least two weeks
  • Lasts up to three years
Single dose — must be administered within three years for those who remain at risk

Typhim Vi

  • Purified Vi capsular polysaccharide from S. typhi
  • Licensed from two years of age
  • Single dose
  • Effective within two-to-three weeks
  • Lasts up to three years
Single dose — every three years for those who remain at risk

Vivotif

  • Live, oral, attenuated
  • Licensed from six years of age

Concomitant anti-malarial use:

  • Can be taken with atovaquone and proguanil combination
  • Mefloquine — separate dose 12 hours apart
  • All others — dose at least three days after Vivotif
  • Three capsules orally over five days
  • Effective seven-to-ten days after last capsule
  • Lasts for at least three years — under conditions of continuous/repeated exposure
  • Every 12 months for those travelling to endemic areas from non-endemic areas
  • Every three years for continuous/ repeated exposure 

 

Vaccination schedule – Typhoid and Hepatitis A

Brand  Vaccine information Primary course Booster

Hepatyrix

  • Inactivated, adsorbed
  • Licensed from 15 years of age
  • Single dose
  • Effective after two weeks
  • Hepatitis A protection lasts up to 12 months 

For hepatitis A:

  • Dose of an inactivated hepatitis A vaccine between 6–12 months
  • Lasts for at least 10 years

For typhoid:

Dose of Vi polysaccharide vaccine every three years, or, Hepatyrix if hepatitis A revaccination required

ViATIM

  • Inactivated, adsorbed
  • Licensed from 16 years of age
  • Single dose
  • Effective after two weeks

For hepatitis A:

  • Dose of monovalent hepatitis A vaccine between 6–12 months but can be within 36 months, or, ViATIM if typhoid revaccination required

For typhoid:              

  • Dose of ViATIM at 36 months
  • Lasts for at least ten years

* See National Travel Health Network and Centre clinical update 10 May 2013 “Vaccine supply: typhoid and hepatitis A/typhoid (combined) vaccines“.

The information below is based on Public Health England recommendations; individual Summaries of Product Characteristics should be referred to for manufacturer recommendations regarding individual brands.

Acute illness

If a patient is suffering from an acute illness, immunisation should be postponed until they have recovered. Patients with minor infections without fever or systemic upset do not need to postpone their vaccination schedule.

The live oral vaccine should not be administered to patients who have a gastrointestinal illness. It should also not be administered to a patient within three days of them starting or completing a course of antibiotics.

Administration with certain antimalarials

The live oral vaccine reacts with certain antimalarials and doses should be separated as follows:

  • Mefloquine: doses of mefloquine and live oral vaccine should be separated by 12 hours
  • Atovaquone/proguanil: can be taken concomitantly
  • Doxycycline: separate the last dose of oral typhoid vaccine and first dose of doxycycline by three days minimum
  • Proguanil: separate the last dose of oral typhoid vaccine and first dose of proguanil by three days minimum
  • Chloroquine: separate the last dose of oral typhoid vaccine and first dose of chloroquine by three days minimum

Administration with other vaccines

Injectable typhoid vaccines (inactivated) can be given at the same time as other travel vaccines as long as they are administered at different sites. The oral vaccine can be given at the same time as other travel vaccines.

Immunocompromised patients

Injectable typhoid vaccines (inactivated) can be given to patients who are immunocompromised if they are at risk of infection, however, it may not be as effective. Specialist advice may be required and the importance of good personal, food and water hygiene measures while in risk areas should be emphasised. The live oral vaccine is contraindicated in those patients who are immunocompromised.

Pregnancy and breast-feeding

No harmful effects due to Injectable typhoid vaccination (inactivated) during pregnancy or breastfeeding have been reported so it may be given when clinically indicated.

The live oral vaccine should only be administered during pregnancy if it is clearly needed as it is not known whether it causes harm to the fetus. There is no data regarding its use during breastfeeding.