No

Vaccine

Parenteral: Promotes active immunity to typhoid fever for patients intimately exposed to a typhoid carrier or foreign travel to a typhoid fever endemic area

Oral: For immunization of children >6 years and adults who expect intimate exposure of or household contact with typhoid fever, travelers to areas of world with risk of exposure to typhoid fever, and workers in microbiology laboratories with expected frequent contact with S. typhi

Typhoid vaccine: Live, attenuated Ty21a typhoid vaccine should not be administered to immunocompromised persons, including those known to be infected with HIV. Parenteral inactivated vaccine is a theoretically safer alternative for this group.

C

Acute respiratory or other active infections, previous sensitivity to typhoid vaccine, congenital or acquired immunodeficient state, acute febrile illness, acute GI illness, other active infection, persistent diarrhea or vomiting

Postpone use in presence of acute infection; use during pregnancy only when clearly needed, immune deficiency conditions; not all recipients of typhoid vaccine will be fully protected against typhoid fever. Travelers should take all necessary precautions to avoid contact or ingestion of potentially contaminated food or water sources. Unless a complete immunization schedule is followed, an optimum immune response may not be achieved.

All serious adverse reactions must be reported to the U.S. Department of Health and Human Services (DHHS) Vaccine Adverse Event Reporting System (VAERS) 1-800-822-7967.

1% to 10%:

Dermatologic: Rash

Gastrointestinal: Abdominal discomfort, stomach cramps, diarrhea, nausea, vomiting

<1%: Anaphylactic reaction

Injection:

>10%:

Central nervous system: Headache (9% to 30%), fever

Dermatologic: Local tenderness, erythema, induration (6% to 40%)

Neuromuscular & skeletal: Myalgia (14% to 29%)

<1%: Hypotension

Simultaneous administration with other vaccines which cause local or systemic adverse effects should be avoided

Refrigerate, do not freeze; potency is not harmed if mistakenly placed in freezer; however, remove from freezer as soon as possible and place in refrigerator; can still be used if exposed to temperature less than or equal to 80°F

Virulent strains of Salmonella typhi cause disease by penetrating the intestinal mucosa and entering the systemic circulation via the lymphatic vasculature. One possible mechanism of conferring immunity may be the provocation of a local immune response in the intestinal tract induced by oral ingesting of a live strain with subsequent aborted infection. The ability of Salmonella typhi to produce clinical disease (and to elicit an immune response) is dependent on the bacteria having a complete lipopolysaccharide. The live attenuate Ty21a strain lacks the enzyme UDP-4-galactose epimerase so that lipopolysaccharide is only synthesized under conditions that induce bacterial autolysis. Thus, the strain remains avirulent despite the production of sufficient lipopolysaccharide to evoke a protective immune response. Despite low levels of lipopolysaccharide synthesis, cells lyse before gaining a virulent phenotype due to the intracellular accumulation of metabolic intermediates.

Oral: Onset of immunity to Salmonella typhi: Within about 1 week; Duration: ~5 years

Parenteral: Duration of immunity: ~3 years

S.C. (AKD and H-P):

Children 6 months to 10 years: 0.25 mL; repeat in greater than or equal to 4 weeks (total immunization is 2 doses)

Children >10 years and Adults: 0.5 mL; repeat dose in greater than or equal to 4 weeks (total immunization is 2 doses)

Booster: 0.25 mL every 3 years for children 6 months to 10 years and 0.5 mL every 3 years for children >10 years and adults

Oral: Adults:

Primary immunization: 1 capsule on alternate days (day 1, 3, 5, and 7)

Booster immunization: Repeat full course of primary immunization every 5 years

No information available to require special precautions

No effects or complications reported

Oral capsule should be taken 1 hour before a meal with cold or lukewarm drink, do not chew, swallow whole; systemic adverse effects may persist for 1-2 days. Take all 4 doses exactly as directed on alternate days to obtain a maximal response.

The doses of vaccine are different between S.C. and intradermal; S.C. injection only should be used

Capsule, enteric coated (Vivotif Berna™): Viable S. typhi Ty21a Colony-forming units 2-6 x 10⁹ and nonviable S. typhi Ty21a Colony-forming units 50 x 10⁹ with sucrose, ascorbic acid, amino acid mixture, lactose and magnesium stearate

Injection, suspension (H-P): Heat- and phenol-inactivated, killed Ty-2 strain of S. typhi organisms; provides 8 units/mL, less than or equal to 1 billion/mL and less than or equal to 35 mcg nitrogen/mL (5 mL, 10 mL)

Injection (Typhim Vi®): Purified Vi capsular polysaccharide 25 mcg/0.5 mL (0.5 mL)

Powder for suspension (AKD): 8 units/mL less than or equal to 1 billion/mL, acetone inactivated dried (50 doses)

Gardner P and Schaffner W, "Immunization of Adults," N Engl J Med, 1993, 328(17):1252-8.