Is there a preventive medication for typhoid?

Typhoid Prevention: Vaccination is Available and Recommended for High-Risk Groups

Yes, there are effective preventive vaccines for typhoid fever, and the CDC recommends vaccination for travelers to endemic areas, household contacts of typhoid carriers, and laboratory workers who handle S. typhi. 1

Available Vaccine Options

Three main vaccine types are available with varying efficacy profiles:

Vi-TT Conjugate Vaccine (Typbar-TCV) - Preferred Option

• The American College of Physicians recommends the Vi-TT conjugate vaccine (TCV) as the first-choice preventive medication for typhoid, offering superior long-term protection with 78% efficacy over four years. 1
• This vaccine requires less frequent boosting compared to other options and is effective in infants and young children 1
• It demonstrates an excellent safety profile with only mild, self-limited adverse events 1

Vi Polysaccharide Vaccine - Alternative Option

• Provides approximately 55% cumulative efficacy over three years 1, 2
• Administered as a single 0.5 mL dose subcutaneously or intramuscularly for adults and children ≥10 years 1
• Requires booster doses every 2 years for continued protection in patients with ongoing risk 1
• Should only be used if TCV is unavailable 1
• Contraindicated in immunocompromised patients or those with HIV due to inadequate immune response 1

Oral Ty21a Vaccine (Vivotif) - Oral Alternative

• Provides approximately 50-67% efficacy for at least 4 years 1, 2
• Administered as four enteric-coated capsules taken on alternate days with cool liquid no warmer than 37°C, approximately 1 hour before meals 1, 3
• Requires revaccination with the full four-dose series every 5 years 1
• Not recommended for children <6 years of age or immunocompromised persons 1
• Has adverse event rates comparable to placebo (<1/100,000 doses) 1

Who Should Receive Typhoid Vaccination

High-Priority Groups

• Travelers to endemic areas in Latin America, Asia, and Africa with prolonged exposure to potentially contaminated food and drink 1, 4
• Persons with intimate exposure to documented typhoid carriers, including household contacts 1
• Microbiology laboratory workers who frequently handle S. typhi 1

Geographic Risk Considerations

• Risk is highest in the Indian subcontinent, where fluoroquinolone resistance exceeds 70% 4
• South Asia, Southeast Asia, and the African continent represent high-risk endemic zones 3

Critical Limitations and Precautions

Vaccination is NOT a substitute for careful food and water selection, as no vaccine provides 100% protection and can be overwhelmed by large inocula of S. typhi. 1, 4

Essential Non-Vaccine Prevention Measures

• Hand hygiene and avoiding high-risk foods/beverages remain essential even after vaccination 1
• Previous vaccination provides incomplete protection and does not protect against paratyphoid fever 4
• The mainstay of prevention remains hygiene and food/water precautions 5

Common Pitfalls to Avoid

• Do not rely on ciprofloxacin disc testing alone for antibiotic sensitivity—the organism must also be sensitive to nalidixic acid to be considered truly fluoroquinolone-sensitive 4
• Do not use Vi polysaccharide vaccine in immunocompromised patients 1
• Do not administer oral Ty21a vaccine to children under 6 years 1