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Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Typhoid Fever Vaccine

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Typhoid fever is caused by the bacteria Salmonella typhi, which are transmitted among humans through ingestion of contaminated food or water. Most cases are acquired abroad under conditions of poor hygiene.

After an incubation period of 10 to 14 days, victims suffer fever with or without diarrhea and abdominal pain. Most victims also complain of headache, fatigue, and loss of appetite. “Rose spots,” which are 2 to 4 mm red spots on the trunk that blanch (lose their color) when pressed, are seen in some cases. The liver may become inflamed.

Most cases resolve in 3 to 4 weeks. The seriously stricken individual may suffer a severely inflamed bowel, bleeding from the gastrointestinal tract, pneumonia, heart failure, severe fever, and death.

A physician who diagnoses typhoid fever will treat the victim with an intravenous antibiotic. The layperson can use trimethoprim-sulfamethoxazole; administer one double-strength tablet twice a day for 2 to 3 weeks. You can also use ampicillin 100 mg per kg (2.2 lb) of body weight in four divided doses for 2 to 3 weeks. It is important to keep the victim from becoming dehydrated.

Injectable and oral vaccines to prevent typhoid fever are available to people traveling to areas of high risk. Typhim Vi polysaccharide vaccine is available for immunization against typhoid fever caused by Salmonella typhi. Immunization is recommended only for travelers who visit regions (e.g., Nepal, South Africa, Indonesia) known to harbor the disease. A single intramuscular injection is required, followed by booster injection at 2-year intervals, depending on the local disease risk. An oral vaccine (Vivotif Typhoid Vaccine Live Oral Ty21a [Berna]) is given as one capsule every other day for four doses in people age 6 years or older. A booster series is necessary every 5 years. Side effects, which include fever, headache, and flu-like symptoms, are more commonly associated with the injections than with the oral capsules.

According to Berna Products, here are some recommendations on how to take typhoid vaccine capsules:

DO's:

1. DO complete taking the capsules at least one week before traveling.
2. DO take each capsule on an empty stomach (1 hour before eating or 2 hours after eating).
3. DO take each capsule with a full glass of cool or lukewarm water.
4. DO keep capsules in the refrigerator.

DON'T's:


1. DON'T take the vaccine if you are taking antibiotics (consult your doctor).
2. DON'T take the vaccine with alcohol (wait at least 2 hours before drinking alcohol).
3. DON'T open or chew the capsules.
4. DON'T forget to skip a day between capsules.
5. DON'T forget to take all 4 capsules.

The capsules are designed to stay intact and only dissolve then they reach the small intestine. The capsules should be taken at approximately the same time each day. If a person has had an adverse reaction to the oral typhoid vaccine or any other enteric coated capsule in the past, the oral vaccine should not be taken. If the person has a fever, continued vomiting, or diarrhea/stomach illness, the oral vaccine should not be taken.

It is very important to remember that this vaccine is not foolproof, so even if a person is vaccinated, he or she should avoid potentially contaminated food and water.

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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