More travelers should get typhoid shots, CDC says

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Travelers to high-risk areas should receive typhoid fever vaccinations even if they plan to stay for only a few weeks, according to a report from the Centers for Disease Control and Prevention (CDC).

Vaccination is an important means of preventing typhoid fever, which is spread largely through contaminated food and water, but deciding who needs to be vaccinated remains challenging, according to the report in the journal Clinical Infectious Diseases.

Dr. Ellen Steinberg Stevenson from the CDC in Atlanta, Georgia, and colleagues reviewed US typhoid fever surveillance data from 1994 to 1999 in order to clarify indications for typhoid vaccination and to identify high-priority groups for improved vaccine coverage.

Nearly three-quarters of the reported cases of typhoid fever were associated with travel, the authors report, with only 7 percent occurring as part of regional outbreaks.

Only 4 percent of infected travelers had received a typhoid vaccination at any point during the 5 years preceding their travel, the investigators write, “indicating that failure to vaccinate, not vaccine failure, is the primary problem.”

Seventy-six percent of travel-related cases were among travelers to six countries - India (30 percent), Pakistan (13 percent), Mexico (12 percent), Bangladesh (8 percent), the Philippines (8 percent), and Haiti (5 percent).

Even short-term travel was associated with a risk of typhoid fever, the researchers note. More than a quarter of infected travelers had stayed abroad no more than three weeks, and 60 percent had stayed six weeks or less.

Typhoid fever vaccination appears to be quite safe, according to the authors.

“Although typhoid fever in tourists and business travelers was rare, we still recommend considering vaccination for these groups, particularly if they visit high-risk areas, such as the Indian subcontinent, for two weeks or more,” the authors conclude.

Special care is needed for infants and toddlers.

“Until newer, more effective vaccines against typhoid, which are currently being evaluated, are available for children under 2 years of age,” the researchers advise, “physicians should encourage caregivers to practice strict food and water precautions and to encourage breast feeding, if possible, while the child is outside of the United States.”

SOURCE: Clinical Infectious Diseases, July 15, 2004.

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