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