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Information for the Practicing Physician

Bradley A. Woodruff, MD, MPH; Andrew T. Pavia, MD; Paul A. Blake, MD, MPH

JAMA. 1991;265(6):756-759.

Abstract
Most cases of typhoid fever in the United States occur in international travelers, with the greatest risk associated with travel to Peru, India, Pakistan, and Chile. Laboratory workers and household contacts of long-term carriers are also at greater risk than the general population. Decisions to the use typhoid vaccine involve weighing the risk of illness against the risk of vaccine reactions. Until recently, the only typhoid vaccine commercially available to US civilians was a heat-phenol—inactivated parenteral product that is 51% to 77% effective in preventing typhoid fever but frequently produces local pain and swelling, fever, headache, and malaise. A new orally administered, live-attenuated vaccine, made from the Ty21 a strain of Salmonella typhi, has been recently licensed in the United States. This vaccine provides equivalent protection with a much lower incidence of adverse reactions. It is administered in a four-dose series given over 7 days. Since neither vaccine offers total protection, the most important elements in prevention of typhoid fever remain sound biosafety precautions in laboratory workers and care in selecting food and beverages by those traveling to areas where typhoid fever is endemic.

(JAMA. 1991;265:756-759)

Author Affiliations
From the US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Division of Bacterial Diseases, Enteric Diseases Branch, Atlanta, Ga. Dr Pavia is now with the Division of Infectious Disease, Department of Medicine, University of Utah Medical Center, Salt Lake City.

Footnotes
Use of trade names is for identification only and does not imply endorsement by the Public Health Service or by the US Department of Health and Human Services.

Reprint requests to Division of Bacterial Diseases, Centers for Disease Control, 1600 Clifton Rd NE, Mailstop C-09, Atlanta, GA 30333 (Dr Woodruff..

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