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      Typhoid fever vaccination

      Latest update: - Authors: Matilde Hens, Nele Alders

      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

      References 

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