Prophylaxis & Treatment Of Typhoid Fever

Prophylaxis & Treatment Of Typhoid Fever


PROPHYLAXIS:

  • Two types of vaccines are available
  • Oral and Injectable
  • Oral – A live oral vaccine ( typhoral ) is a stable mutant of S.typhi strain Ty 21a lacking the enzyme UDP Galactose -4-epimerase.
  • One capsule given orally taken before food, with glass of water or milk, on 1, 3, 5 days ( three doses )
  • No antibiotics should be taken during the period of administration of vaccine
  • Both vaccines are given to only > 5 years of age.
  • Immunity lasts for 3 years Need a booster

 Vi capsular polysaccharide vaccine (or ViCPS) 

  • It is one of two vaccines recommended by the World Health Organisation for the prevention of typhoid (the other is Ty21a).
  • It was first licensed in the US in 1994 and is made from the purified Vi capsular polysaccharide from the Ty2 Salmonella Typhi strain; it is a subunit vaccine.

Indications: 

  • The vaccine may be used in endemic areas in order to prevent typhoid. It is also commonly used to protect people who are traveling to parts of the world where typhoid is endemic.

Dosing: 

  • The vaccine is injected either under the skin or into a muscle at least seven days before traveling to the typhoid-affected area. 
  • It is given to children 2 years or older, ideally one month before travel, as a single dose (0.5 ml) with a booster every year.

Oral vaccine, Ty21 a,

  • It is given to children 6 years of age or older. 
  • It is a live vaccine
  • It is given as 3 doses over 1 week,1, 3, 5 days with repeat every 5 years
  • For a typhoid endemic country like India, the immunization of choice is Typhoral 21 A oral vaccine
Characteristics Killed vaccine Live vaccine
Doses  Multiple  Single
Adjuvant  Needed  Not needed
Duration of immunity  Short  Long
Effectiveness of protection   Lower  Greater
Reversion of virulence  No   Possible
Stability at room temperature  High  Low

Immunity

Mucosal immunity

Cell mediated immunity

 Poor

 Poor

 High

 High

 Contain major and minor antigens.

 Booster doses not required.

 Immunoglobulin’s can be given 2 weeks after live vaccine. 

 
 
TREATMENT:
  1. Bed rest :Hospitalization for low classes of people because of bad hygienic measures.     
  2. Full nutrition : Soft diet is recommended
  3. Antibiotics 
  4.  Vitamins : specially water soluble (B&C)   

DRUGS USED :

Drug sensitive S.typhi:

  • Chloramphenicol:3g -2g after becoming afebrile
  • Ampicillin 9-12g/d
  • Trimethoprim-sulfamethoxazole 320-640/3200mg divided into 2 doses

Drug resistant S.typhi:

  • Fluoroquinolones( adult)
  • Ciprofloxacin 200mg IV every 12 hrs
  • Ciprofloxacin resistance cases ceftriaxone 3-4g/day for 7-10 days or
  • Azithromycin 1g/day followed by 500mg/day for 6 days

Shock cases 

  • Dexamethasone 3mg/kg followed by 1mg/kg every 6hr for 48hrs

Intestinal perforation cases:

  • Gentamycin/clindamycin
  • Metronidazole

Chronic carrier :

  • Ciprofloxacin(750 mg BD for 28 days)
  • Amoxicillin (100mg/kg/d)+ Probenecid (30mg/kg/d) for 4-6weeksor ampicillin
  • TMP-SMX + cholecystectomy
Exam Question
 
  • Carrier are treated by β-lactamase inhibitors
  • The number of doses recommended for oral Ty21a typhoid vaccine is 3
  • Vi polysaccharide vaccine for typhoid is administered subcutaneously or intramuscularly
  • Ty21a is an oral vaccine in typhoid
  • Vi polysaccharide of bacterial cell used for vaccination
  • Typhoid Vi polysaccharide vaccine is usually administered in children above the age of 2 years
  • Treatment of choice for salmonella typhi is Ciprofloxacin
  • Vi polysaccharide is a subunit vaccine
  • Chemoprophylaxis is not required in Typhoid 
  • Ty21a is the live attenuated vaccine in typhoid
  • Typhoid oral vaccine is given on 1, 3, 5 days
  • Immunity lasts for 3 years Need a booster
  • For a typhoid endemic country like India, the immunization of choice is Typhoral 21 A oral vaccine
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