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Immunizations - travel vaccinations - Management
When is typhoid fever vaccine indicated?

  • Give a typhoid vaccination to:
    • Travellers to countries where typhoid is endemic (e.g. south Asia, parts of south east Asia, the Middle East, Central and South America, and Africa), especially if staying with or visiting the local population.
    • Travellers to endemic areas with frequent and/or prolonged exposure to conditions where sanitation and food hygiene are likely to be poor.
    • Laboratory personnel who may handle Salmonella typhi in the course of their work.
  • Advise the person that not all recipients of typhoid vaccines will be protected against typhoid fever, and they should take all necessary precautions to avoid contact with, or ingestion of, potentially contaminated food or water.
Basis for recommendation
  • These recommendations are based on expert opinion from the published medical literature [DH, 2006c].
  • Typhoid vaccine is not 100% effective, particularly if the traveller is exposed to large doses of typhoid. Therefore scrupulous attention to personal, food, and water hygiene should be maintained at all times when travelling in endemic areas. In addition, children under the age of 18 months may have a suboptimal response to typhoid vaccination.
  • The efficacy of the polysaccharide vaccine was evaluated in field trials in Nepal and in eastern Transvaal, South Africa:
    • In the Nepalese study, vaccine efficacy at 20 months against culture-positive typhoid was 75% (95% CI 49 to 87%) in adults and children aged 5–44 years.
    • The South African study found the cumulative 3-year efficacy of vaccine against culture-positive typhoid to be 55% (95% CI 30 to 71%) in children aged 6–15 years [DH, 2006c].

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