What is the duration of severe typhoid injection reactions?

Duration of Severe Typhoid Injection Reactions

Severe typhoid injection reactions typically persist for 1-2 days, with symptoms including discomfort at the injection site, fever, malaise, and headache. 1

Types and Duration of Reactions

Parenteral (Injectable) Typhoid Vaccine Reactions

• Local reactions:

  • Severe local pain and/or swelling occurs in 6-40% of vaccinees 1
  • Typically lasts 1-2 days 1
  • May be accompanied by systemic symptoms

• Systemic reactions:

  • Fever occurs in 14-29% of recipients 1
  • Headache affects 9-30% of vaccinees 1
  • Malaise typically resolves within 1-2 days 1
  • 13-24% of vaccinees miss work or school due to adverse reactions 1

• Severe reactions (rare):

  • Hypotension, chest pain, and shock have been sporadically reported 1
  • These more severe reactions typically require medical intervention and may persist longer than standard reactions

Oral Typhoid Vaccine Reactions

For comparison, the oral typhoid vaccine (Ty21a) has significantly fewer reactions:

• Adverse reactions occur at a rate of <1/100,000 doses 1
• Reactions include nausea, abdominal cramps, vomiting, and skin rash/urticaria 1
• These reactions are typically milder and shorter in duration than injectable vaccine reactions

Management of Severe Reactions

For severe typhoid injection site reactions, the Centers for Disease Control and Prevention (CDC) recommends:

1. Immediate management:

   • Cold compresses to reduce swelling
   • Analgesics for pain relief
   • Antihistamines for itching or allergic symptoms 2

2. Monitoring:

   • Watch for systemic symptoms including fever, hypotension, or signs of anaphylaxis
   • Seek medical attention if symptoms worsen or persist beyond the expected 1-2 day timeframe 2

Important Considerations

• Contraindication: The only absolute contraindication to parenteral typhoid vaccination is a history of severe local or systemic reactions following a previous dose 1, 2

• Alternative options: If a severe reaction occurs, consider alternative typhoid vaccine options such as oral live-attenuated Ty21a vaccine for future immunization needs 2

• Risk factors: Administration of acetone-inactivated vaccine by jet-injector gun results in a greater incidence of local reactions and is not recommended 1

• Metabolic response: Research shows that typhoid vaccine can cause a rapid (within 1 hour) and sustained rise in metabolic rate that peaks at 6-8 hours post-injection, with fever typically peaking around 12 hours after injection 3

Clinical Implications

When counseling patients about typhoid vaccination:

• Inform them that severe local reactions typically resolve within 1-2 days
• Advise that systemic symptoms like fever and malaise generally follow the same timeline
• Recommend appropriate symptomatic treatment for expected reactions
• Instruct patients to seek medical attention if symptoms persist beyond 2 days or if they experience signs of severe reactions like difficulty breathing or significant swelling