Do you need to be vaccinated against typhoid fever?

Staten Island Advance By Staten Island Advance Staten Island Advance
on August 23, 2010 at 7:47 AM, updated August 23, 2010 at 7:50 AM

STATEN ISLAND, N.Y. — Are you traveling out of the United States this summer? Before you go, it is important that you find out whether or not typhoid is common in the part of the world that you are traveling to. Some areas at risk are South Asia, East and Southeast Asia, Africa, the Caribbean, and Central and South America.

Typhoid fever is an acute, life-threatening illness caused by bacteria called Salmonella Typhi. It causes a high fever, weakness, stomach pains, headache, loss of appetite, and sometimes a rash. Unfortunately, there is no definitive test for typhoid fever, so the diagnosis often has to be made clinically. Typhoid strikes about 21 million people each year worldwide and kills about 200,000. If you do contract typhoid fever, and it is untreated, the disease can last for a month.

What can you do to prevent contracting typhoid?

There are two vaccines to prevent typhoid. One is an inactivated (killed) vaccine given as a shot, and the other is live, attenuated (weakened) vaccine which is taken by mouth.

The inactivated typhoid vaccine should not be given to children younger than age 2. One dose provides protection. It should be given at least two weeks before travel to allow the vaccine time to work. A booster does is needed every two years for people who remain at risk.

The live typhoid vaccine should not be given to those younger than age 6. Four doses, given two days apart, are needed for protection. The last dose should be given at least one week before travel to allow the vaccine time to work. A booster dose is needed every five years for people who remain at risk.

It is important to be aware that the typhoid vaccine is not 100 percent effective and typhoid fever could still occur. Therefore, in addition to the vaccine you must be careful about what you eat or drink.

Not everyone can receive the vaccine. For example, anyone who has had a severe reaction to a previous dose of the vaccine should not receive the shot or the oral vaccine again.

In addition, you should not receive the live oral vaccine if you have a weakened immune system or are on certain antibiotics for 24 hours. Some examples of persons with a weakened immune system are those who are HIV/AIDS positive, being treated with drugs that affect the immune system, such as steroids for two weeks or longer, have any kind of cancer, or are taking cancer treatment with X-rays or drugs.

As with any medication, allergic reactions may occur in individuals who receive the shot or oral medication. Serious problems are very rare and the risk of serious harm or death is extremely small. However, you should look for the following signs: a very high fever, behavior changes, difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness. If you show any of these signs, you must get to a doctor immediately.
Mild reactions are more common. For instance, the inactivated typhoid vaccine may cause fever, headache or redness and swelling at the sige of injection. The live typhoid vaccine may cause fever, headache, abdominal discomfort, nausea, vomiting or, on rare occasions, a rash.

If you exhibit any of these mild signs, you should still contact your doctor. Notably, when contacting your doctor because of a reaction, make sure you are prepared to explain what occurred and when, together with when the vaccine was given.

In sum, when traveling, you must know what medication or vaccines you need to take before you leave. Also, you must consider the benefits of taking that medication or vaccines against the possible risks. In most cases, it is more advisable to receive the medication or vaccine than to risk going without it.

This column is provided by the Richmond County Medical Society. Dr. Scafuri, is a member of the Society. He specializes in infectious disease and maintains a practice in West Brighton and Eltingville.