Typhoid
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Salmonella enterica Typhi
typhoid

Typhoid fever is an acute, life-threatening febrile illness caused by the bacterium Salmonella typhi. About 21 million cases of typhoid fever occur each year around with world, with more than 200,000 related deaths. About 400 cases of typhoid fever occur each year in the United States, mostly among travelers. Travel to certain areas of the world puts people at increased risk of exposure to S. typhi. These areas include South Asia, East Asia, Southeast Asia, Africa, Caribbean, Central America, and South America.

People infected with S. typhi shed the bacteria in their urine and feces. S. typhi can also be found in an infected person's blood. Most people become infected through consumption of water or food that has been contaminated by the feces of a person who is shedding S. typhi. About 10% of people infected with typhoid remain infectious for up to 3 months, if not treated. In addition, up to 4% of people become chronic carriers. Carriers no longer have symptoms, but are capable of infecting others.

Symptoms of typhoid fever begin about 1 to 3 weeks after exposure. Common symptoms include sudden onset of a sustained fever as high as 39.4°C to 40°C (103°F to 104°F), myalgia (muscle pain), severe headache, fatigue, weakness, nausea, abdominal pain, severe anorexia, and constipation. Some people with typhoid fever also may have a characteristic flat, rose-colored rash on the abdomen and chest during the second week of fever. Severe typhoid fever can progress to swelling of the liver and spleen, intestinal hemorrhage and/or perforation, pericarditis, and sometimes meningitis or inflammation of the joints. Without treatment, people can continue to have fever for weeks or months. The death rate from complications can be as high as 30%.

Treatment for typhoid fever includes supportive care, usually in a hospital, and antibiotics. In addition, people who handle food or care for small children may be required to stay away from work until lab tests show that they no longer carry the bacteria.

About the Vaccine

There are two typhoid vaccines. One is an oral, live attenuated vaccine (Vivotif®). The other is an injected, inactivated vaccine (Typhim Vi®).

Typhoid Vaccines Licensed for use in the US

Product: Typhim Vi® (Inactivated Typhoid Vaccine)
Manufacturer: Sanofi Pasteur
Year licensed: 1994
Product Insert

Product Name: Vivotif® (Live Typhoid Vaccine)
Manufacturer: Berna
Year licensed: 1989
Product Insert

Indications Contraindications and precautions
  • Travelers to areas where there is a recognized risk of exposure.
  • People with intimate exposure to a carrier.
  • Microbiology laboratory workers who work frequently with S. typhi.
  • Alert military forces during deployment or travel to typhoid-endemic areas and other areas with poor sanitation systems.
  • People who have had a severe allergic reaction to a previous dose of typhoid vaccine or a typhoid vaccine component.
  • People who are moderately or severely ill should wait until recovery before receiving any vaccine. Minor illnesses, such as a cold, are not a contraindication. Do not give Vivotif to persons with gastrointestinal illnesses.
  • Children younger than 2 years of age should not receive Typhim Vi and children younger than 6 years of age should not receive Vivotif.
  • People who are immune compromised should not receive Vivotif. Typhim Vi may be given instead.
  • Pregnant women should not receive Vivotif. Typhim Vi may be given instead after consultation with a healthcare provider.
  • People who are taking oral antibiotics should not receive Vivotif within 3 days because the antibiotics can kill the vaccine bacteria. Typhim Vi may be given instead.
  • People taking an antimalarial medication that contains proquanil should not receive Vivotif. Typhim Vi may be given instead.
Vaccine Ages Dose/Route Routine Administration Schedule
Typhim Vi® 2 years and older Dose: 0.5 mL
Route: Intramuscular (IM)
Single dose
Booster dose of 1 injection every 2 years if still at risk for exposure
Vivotif® 6 years and older Dose: 4 capsules
Route: Oral
1 capsule every 48 hours before meals and with cool or luke warm fluids only
Booster dose of 4 capsules every 5 years if still at risk for exposure     
Inactivated Typhoid Vaccine (Typhim Vi) Side Effects
  • Redness or swelling where the shot was given (up to 7 people per 100).
  • Headache (up to 3 people per 100).
  • Fever (up to 1 person per 100).
  • Severe allergic reaction (very rare).
Live Typhoid Vaccine (Vivotif) Side Effects
  • Fever or headache (up to 5 people per 100).
  • Abdominal discomfort, nausea, vomiting, or rash (rare).
  • Severe allergic reaction (very rare).
Product Name Supplied Storage and Handling
Typhim Vi
Sanofi Pasteur
0.5 mL single dose prefilled syringes (1 per package) and 20-dose multidose vial (1 per package). Store refrigerated between 2° to 8°C (35° to 46°F). Do not freeze. Discard if vaccine has been frozen.

Typhim Vi is a clear, colorless solution.
Vivotif
Berna
Single blister pack of 4 capsules (1 pack per package). Store refrigerated between 2° to 8°C (35° to 46°F). Do not freeze.

Vivotif is a blister pack of four enteric-coated, salmon/white capsules.
GENADMIN PDF 21 Jun 13
III MEF FORCE HEALTH PROTECTION (FHP) REQUIREMENTS 2014
BUMED PDF 05 Sep 12
YELLOW FEVER (YF) AND TYPHOID FEVER (TF) VACCINATION GUIDANCE
BUMED PDF 30 Oct 08
ADDITIONAL CLARIFICATION ON TYPHOID (TF) AND YELLOW FEVER (YF) VACCINATION FOR PERSONNEL ASSIGNED TO OPERATIONAL UNITS UNCLASSIFIED
Recommendations of the Advisory Committee on Immunization Practices (ACIP)
World Health Organization
National Advisory Committee on Immunization (NACI) Canada
Typhoid Vaccine 09 Jan 98
Author: http://www.ha.osd.mil/afeb/1998/1998-05.pdf
Recommendations of the Armed Forces Epidemiological Board (AFEB)
Package Insert - Vaccine
Package Insert - Vaccine
MMQC-12-1673 13 Nov 12
SANOFI PASTEUR / TYPHOID VACCINE / PRODUCT INFORMATION
MMQC-12-1575 28 Sep 12
SANOFI PASTEUR / TYPHOID VACCINE / PRODUCT INFORMATION
MMQC-12-1577 28 Sep 12
BERNA BIOTECH / TYPHOID VACCINE / PRODUCT INFORMATION / CORRECTION
MMQC-12-1573 27 Sep 12
SANOFI PASTEUR / TYPHIM VI (TYPHOID VI POLYSACCHARIDE VACCINE) / URGENT VACCINE RECALL / DLA 12-354
VIS
Vaccine Information Statement