The typhoid vaccine is not required for international travel. The typhoid vaccine should be used only by people traveling to high-risk areas who will be:
- Staying for more than six weeks
- Staying in rural areas or small towns
- Choosing to eat uncooked foods and unpeeled fruits, and drink unbottled water
There are two forms of the typhoid vaccine that are available in the United States; each one is most effective when given at a particular age. Although the vaccines are both fairly effective in preventing typhoid (ranging from 50-80 percent), you should still heed the warning "boil it, peel it or forget it."
- The disease
What is typhoid?
Typhoid is caused by a bacterium (Salmonella typhi) that attacks the intestines, causing fever, stomach pain and rash. Typhoid infection can result in shock, and possibly even death. Typhoid is common in developing countries where many sewage systems are substandard.
Where can you catch typhoid?
Typhoid infections are common in Mexico, East and South Asia (including India and Pakistan), South America and Africa. An estimated 22 million cases and 200,000 to 600,000 deaths occur worldwide each year.
Typhoid bacteria are ingested in contaminated food or water. They can be avoided by drinking only bottled water, and avoiding ice, unpeeled fruits, undercooked meats, shellfish, salads and food from street vendors.
- The vaccine
What is the typhoid vaccine?
The typhoid vaccine comes in two forms:
- "Ty21a" is a weakened form of the live bacteria and is given by mouth to people 6 years of age and older. A total of four capsules are taken one every other day.
- The "polysaccharide" vaccine is made from the sugar that coats the surface of the bacteria. The "polysaccharide" vaccine is given as a single shot to children between 2 years and 6 years of age.
Who should get the typhoid vaccine?
The typhoid vaccine is not required for international travel. And the vaccine is not generally recommended for people traveling to areas where the infection is common. However, the typhoid vaccine is recommended for people who travel to high-risk areas if they plan on any of the following:
- Travel "off the beaten path" in small towns and rural areas.
- Travel for more than six weeks in countries where typhoid is common.
- Travel and eat in areas without standard tourist accommodations.
Who shouldn't get the typhoid vaccine?
The typhoid vaccine should not be given to anyone less than 2 years of age.
Does the typhoid vaccine have side effects?
Both the "Ty21a" and "polysaccharide" vaccines can cause headache and fever, but do not cause serious side effects.
- Relative risks and benefits
Do the benefits of the typhoid vaccine outweigh the risks?
The risk of catching typhoid fever is like the risk of catching cholera — it can be virtually eliminated by paying attention to the foods that you eat and the water that you drink. Although the disease is highly prevalent and occasionally deadly, it can be prevented by avoiding non-bottled water, ice, uncooked meats, salads, unpeeled fruits, shellfish and foods from street vendors. So, for most people, the typhoid vaccine is not necessary.
However, for people who travel in small towns or rural areas, are staying in areas without standard tourist accommodations, or who choose to eat foods likely to be contaminated with the bacteria, the benefits of the vaccine do outweigh the risks.
- Fever, stomach pain and rash
- Disease can cause shock and death
- Headache and fever in some people
Plotkin SA, Orenstein W, and Offit PA. Typhoid fever vaccines in Vaccines, 6th Edition, 2012, 812-836.