Typhoid

Question 1

What is typhoid?

Answer 1

Typhoid or typhoid fever is an illness caused by Salmonella typhi, not to be confused with Salmonella enteriditis, which causes non-typhoidal salmonella infections (salmonellosis/food poisoning, GI infection)

Question 2

What are the clinical manifestations of typhoid fever? (5)

Answer 2

1. High fever
2. Diarrhea
3. Vomiting
4. Rash characterized by “rose-spots” on the neck and abdomen

1 in 5 cases can be fatal if untreated
With treatment, fewer than 4 in 100 cases are fatal

Question 3

How is typhoid transmitted?

Answer 3

Human to human via fecal-oral route

No animal vectors therefore transmission is always human to human

Question 4

What is the antibiotic of choice for treatment of typhoid fever?

Answer 4

Ciprofloxacin

Question 5

For whom is typhoid immunisation advised? (3)

Answer 5

1. Traveller’s to areas where typhoid is endemic or whose planned activities put them at higher risk
2. Travelers to endemic areas where frequent or prolonged exposure to poor sanitation and poor food hygiene is likely
3. Laboratory personnel who may be exposed to Salmonella typhi

Question 6

What forms of the typhoid vaccine are available? (2)

Answer 6

1. Capsular polysaccharide from S.typhi for injection

2. Live attenuated S.typhi for oral use

Question 7

What is the vaccination schedule for the capsular polysaccharide typhoid vaccine?

Answer 7

• Single dose, given IM
• Children 1-2 years should be immunized if the risk of typhoid fever is considered high (immunisation is not recommended for infants under 12 mo)
• A single booster dose should be given at 3-year intervals in adults and children over 3 yo who remain at risk

Question 8

What is the vaccination schedule for the oral typhoid vaccine?

Answer 8

• Oral (live-attenuated) vaccine recommended in individuals aged 5 years and over
• One capsule taken on alternate days for a total of 3 doses

*provides protection 7-10 days after the last dose; if traveling from a non-endemic area to an area where typhoid is endemic, a booster consisting of 3 doses is recommended every 3 years

Question 9

Can the oral typhoid vaccine be given to immunosuppressed and HIV infected individuals?

Answer 9

No, because it is a live vaccine

Also, should not be administered to pregnant women because of theoretical risk of fetal infection

Question 10

What additional measures should be taken to avoid typhoid infection?

Answer 10

Improving sanitation and water supplies

Scrupulous personal, food, and water hygiene

Question 11

Is typhoid a notifiable disease?

Answer 11

Yes, all suspected cases must be notified to the local health protection unit