Can the typhoid vaccine cause abdominal pain?

From the Guidelines

The typhoid vaccine can cause abdominal pain as a side effect, with the oral live attenuated vaccine (Ty21a) causing it in about 5-10% of recipients and the injectable typhoid polysaccharide vaccine causing it in approximately 1-5% of people. According to the study published in 2011 1, both types of typhoid vaccines may cause stomach pain in some recipients. The abdominal pain is typically mild to moderate and resolves within 1-2 days without specific treatment. It is essential to note that the benefits of typhoid vaccination generally outweigh the risks, especially for travelers to regions where typhoid fever is common.

The study also mentions that complication rates are low for both types of S. Typhi vaccines, with serious adverse events requiring hospitalization occurring in an estimated 0.47 to 1.3 per 100,000 doses 1. Another study published in 1993 1 reports that systemic side effects, including abdominal pain, have been reported in about 10% of vaccinees. However, since the 2011 study 1 is more recent and provides more specific information about the typhoid vaccine, its findings take precedence.

It is crucial to consult a healthcare provider if severe or persistent abdominal pain occurs after vaccination. Other common side effects include headache, fever, and nausea, which can be managed with acetaminophen or ibuprofen if they occur. The immune system's response to the vaccine components causes the abdominal discomfort as it builds protection against typhoid fever.

Key points to consider:

• The typhoid vaccine can cause abdominal pain as a side effect
• The oral live attenuated vaccine (Ty21a) causes abdominal pain in about 5-10% of recipients
• The injectable typhoid polysaccharide vaccine causes abdominal pain in approximately 1-5% of people
• Abdominal pain is typically mild to moderate and resolves within 1-2 days without specific treatment
• Benefits of typhoid vaccination generally outweigh the risks, especially for travelers to regions where typhoid fever is common.

From the Research

Typhoid Vaccine and Abdominal Pain

• The typhoid vaccine has been studied for its efficacy and adverse effects in several trials 2, 3, 4, 5, 6.
• According to a study published in The Cochrane database of systematic reviews, the Ty21a vaccine (oral vaccine, three doses) was not associated with more participants with abdominal pain compared to placebo (four trials, 2066 participants; moderate quality evidence) 2.
• However, another study published in Clinical infectious diseases reported that abdominal pain after receipt of Vi vaccine, which is a previously recognized event, occasionally required hospitalization 3.
• A case report published in the Journal of travel medicine described a patient who developed anaphylaxis related to Typhoid Vaccine Live Oral Ty21a (Vivotif), which included symptoms such as abdominal discomfort 5.
• Overall, the evidence suggests that while abdominal pain is a possible adverse effect of the typhoid vaccine, it is not a common or severe reaction 2, 3, 4, 5, 6.

Adverse Effects of Typhoid Vaccine

• The typhoid vaccine can cause various adverse effects, including:
  • Fever 2, 3
  • Headache 2, 6
  • Malaise 6
  • Local pain and swelling at the injection site 3, 6
  • Gastroenteritis-like illness 3
  • Anaphylaxis (rare) 5
• However, the oral Ty21a vaccine has been shown to have a lower incidence of adverse reactions compared to the parenteral Vi vaccine 2, 6.

Efficacy of Typhoid Vaccine

• The typhoid vaccine has been shown to be efficacious in preventing typhoid fever, with the Ty21a vaccine preventing around one-third to one-half of typhoid cases in the first two years after vaccination 2.
• The Vi polysaccharide vaccine has been shown to prevent around two-thirds of typhoid cases in the first year after vaccination 2.
• The new and unlicensed Vi-rEPA vaccine has been shown to be as efficacious as the licensed Ty21a and Vi polysaccharide vaccines and may confer longer immunity 2.