From the Guidelines
Typhoid vaccination is recommended as an adjunct to hand hygiene and the avoidance of high-risk foods and beverages for travelers to areas where there is moderate to high risk for exposure to Salmonella enterica subspecies enterica serovar Typhi, people with intimate exposure to a documented Salmonella Typhi chronic carrier, and microbiologists and other laboratory personnel routinely exposed to cultures of Salmonella Typhi. This recommendation is based on the most recent and highest quality study available, which suggests that typhoid vaccination is not recommended routinely, but rather for specific groups at risk 1. The typhoid vaccine is available as an oral live attenuated vaccine (Ty21a) given as 4 doses over 7 days, or as an injectable Vi capsular polysaccharide vaccine given as a single dose.
Some key points to consider when recommending typhoid vaccination include:
- Travelers to areas with moderate to high risk of exposure to Salmonella Typhi should be vaccinated, especially if they will have prolonged exposure to potentially contaminated food and water in smaller villages or rural areas off the usual tourist routes 1.
- Persons with intimate exposure to a documented typhoid carrier, such as household contact, should also be vaccinated 1.
- Microbiologists and other laboratory personnel who frequently work with Salmonella Typhi should be vaccinated as well 1.
- Booster doses are recommended for people who remain at risk, with the optimal booster schedule depending on the type of vaccine used 1.
It's also important to note that typhoid vaccination is not a substitute for careful selection of food and drink, as the vaccine is not 100% effective and can be overwhelmed by large inocula of S. typhi 1. Therefore, practicing good hygiene, consuming only safe food and water, and vaccination for those traveling to endemic areas are all important measures for preventing typhoid fever.
From the Research
Treatment Options for Typhoid
- The treatment of typhoid fever is complicated by the emergence of antimicrobial resistant Salmonella Typhi 2.
- Azithromycin is commonly used for first-line treatment of uncomplicated enteric fever, but the response to treatment may be sub-optimal in some patient groups when compared with fluoroquinolones 2.
- A study compared different antimicrobial regimens for the treatment of uncomplicated typhoid fever, including ciprofloxacin, azithromycin, and Cefixime, and found that azithromycin had a higher clinical cure rate and shorter fever clearance time 3.
Comparison of Azithromycin and Ciprofloxacin
- A study compared the treatment responses to Azithromycin and Ciprofloxacin in uncomplicated Salmonella Typhi infection and found that azithromycin was associated with prolonged bacteraemia and prolonged fever clearance times 2.
- Another study found that azithromycin and ciprofloxacin were similarly effective, both clinically and bacteriologically, against typhoid fever caused by both sensitive organisms and MDR S. typhi 4.
- A review of 20 prospective clinical trials found that azithromycin meets the criteria for ideal treatment of typhoid fever better than other drugs, including ciprofloxacin 5.
Other Treatment Options
- Ceftriaxone continues to be useful as a back-up choice for the treatment of typhoid fever 5.
- Chloramphenicol, despite its toxicity, is making a comeback in developing countries where the bacteria are susceptible to it 5.
- Gatifloxacin appears to be more effective than ciprofloxacin and ofloxacin for patients infected with bacteria showing decreased ciprofloxacin susceptibility 5.