Typhoid fever vaccination
For some travellers vaccination against typhoid fever can be considered.
Currently, Typhim Vi® is the only available vaccine in Belgium.
The oral vaccine Vivotif® is no longer available since 2021. Other Typhoid conjugate vaccines, such as Typbar-TCV® and TYPHIBEV®, are utilized for routine immunization in endemic countries, but they are also not available in Belgium.
Typhim Vi®
- Product: Typhim Vi®, against Salmonella typhi (Salmonella enterica serovar typhi)
- Vaccine type: polysaccharide vaccine based on the capsular antigen
- Schedule: 0.5ml dose, single dose
- Duration of protection: starts 2 after vaccination, lasts up to 3 years.
- Age: from the age of 2 years, before this age it is poorly immunogenic
- Route of administration: intramuscularly or subcutaneously
- Recommendations: vaccination is indicated for:
- Travellers to India, Nepal, Pakistan, or Bangladesh for more than three weeks.
- Travellers visiting other countries with a risk of typhoid fever if:
- it’s their country of origin and they plan to stay with family or friends (VFR)
- they will stay in areas with poor hygiene conditions
- Efficacy: it offers 60 to 70% protection against typhoid fever but does not protect against paratyphoid fever.
- Contra-indications:
- hypersensitivity or anaphylactic reaction to any vaccine component
- it can be safely administered to pregnant women and during breastfeeding
- Side effects: generally well tolerated and typically causing few side effects. The most common reactions include pain at the injection site, myalgia, fatigue, and headache. Most side effects resolve spontaneously within 1 to 3 days after administration.
- Co-administration with other vaccines: it may be given at the same time as other live or non-live vaccines.
Vivotif®
The oral typhoid vaccine Typhoid Vaccine Live Oral Ty21a (Vivotif®) is since 2021 no longer available on the Belgian market.
- Product: VIVOTIF®, against Salmonella typhi (Salmonella enterica serovar typhi)
- Vaccine type: live attenuated bacteria from the Salmonella typhi Ty 21a strain
- Schedule: 3 capsules to be taken every other day (e.g. Monday - Wednesday - Friday), 1 hour before, or 2 hours after a meal
- Duration of protection: starts 1 week after vaccination, up to at least 3 years
- Age: from the age of 5 years
- Route of administration: oral
- Efficacy: it offers 60 to 70% protection against typhoid fever. There is some evidence that the Ty21a offers partial crossprotection against S. Paratyphi B.
- Interactions
- Administration of oral cholera vaccine and VIVOTIF® should be separated by at least 8 hours.
- It may be given concomitantly with or at any time before or after any parenteral vaccine.
- The series should be completed at least 3 days before starting, or begun at least 3 days after finishing, treatment with sulfonamides, other antibiotics effective against S. typhi, or antimalarial medications as these medications can affect vaccine efficacy.
Exceptions are chloroquine, mefloquine, and atovaquone/proguanil (Malarone®), as these antimalarials do not interfere with the immune response to the vaccine.
- Contra-indications:
- individuals with an acute gastrointestinal condition
- immunocompromised persons.
- no safety data for pregnant or breastfeeding women
- children under 5 years of age
- hypersensitivity or anaphylactic reaction to any vaccine component
- Side effects: abdominal pain, nausea, diarrhea, vomiting, fever, headache, or rash occur in 1% to 10% of vaccine recipients.
Additional information
- Wikitropica, background information on Typhoid fever and other salmonellosis for medical professionals
- CDC yellow book, Typhoid & Paratyphoid Fever (CDC, 2024)
- Factsheet Typhoid (WHO, 2023)
References
- Medasso, gezondheidsadviezen voor reizigers, laatste update 2016 – 2017
- Typhoid vaccines: Canadian Immunization Guide (2023)
- Milligan R, Paul M, Richardson M, Neuberger A. Vaccines for preventing typhoid fever. Cochrane Database Syst Rev. 2018;5(5):CD001261. Published 2018 May 31
- Levine MM, Ferreccio C, Black RE, Lagos R, San Martin O, Blackwelder WC. Ty21a live oral typhoid vaccine and prevention of paratyphoid fever caused by Salmonella enterica Serovar Paratyphi B. Clin Infect Dis. 2007;45 Suppl 1:S24-S28