Typhoid Vaccine Recommendations

Who Should Receive Typhoid Vaccination

The Centers for Disease Control and Prevention recommends typhoid vaccination for travelers to areas with recognized risk of exposure to S. typhi, particularly those visiting developing countries in Latin America, Asia, and Africa who will have prolonged exposure to potentially contaminated food and drink 1, 2
The Centers for Disease Control and Prevention recommends typhoid vaccination for persons with intimate exposure to a documented typhoid fever carrier, such as those with continued household contact 1, 3
The Centers for Disease Control and Prevention recommends typhoid vaccination for workers in microbiology laboratories who frequently work with S. typhi 1, 2

The oral live-attenuated Ty21a vaccine (Vivotif) reduces laboratory-confirmed infection by approximately 67% for at least 4 years, with similar efficacy to parenteral vaccine but with fewer adverse reactions 4, 2
The parenteral heat-phenol-inactivated vaccine is 51%-76% effective in preventing typhoid fever, but has more frequent adverse reactions compared to oral vaccine 4, 5

The Centers for Disease Control and Prevention recommends that adults and children ≥10 years of age receive either the oral live-attenuated Ty21a vaccine (one enteric-coated capsule taken on alternate days to a total of four capsules) or the parenteral inactivated vaccine (0.5 ml subcutaneously, given on two occasions, separated by ≥4 weeks) 1, 4
The Centers for Disease Control and Prevention recommends booster doses of the parenteral vaccine every 3 years under conditions of continued or repeated exposure 1, 5
The manufacturer recommends revaccination with the entire four-dose series of the oral Ty21a vaccine every 5 years, though efficacy has been shown to persist for 5 years with the four-dose regimen 5

Typhoid vaccination is not a substitute for careful selection of food and drink, since the vaccines are not 100% effective and protection can be overwhelmed by large inocula of S. typhi 1, 2
The inactivated typhoid vaccine is contraindicated in individuals with a history of severe local or systemic reaction after a previous dose 5
The oral typhoid vaccine is not recommended for children <6 years of age or immunocompromised persons, including those with asymptomatic HIV infection 5

The Centers for Disease Control and Prevention recommends oral Ty21a vaccine administration as one enteric-coated capsule taken on alternate days to a total of four capsules with cool liquid no warmer than 37°C, approximately 1 hour before meals, for adults and children ≥10 years 6
The Centers for Disease Control and Prevention recommends Vi polysaccharide vaccine administration as 0.5 ml subcutaneously or intramuscularly, as a single dose, for adults and children ≥10 years 6
The Centers for Disease Control and Prevention recommends Vi polysaccharide vaccine administration as 0.25 ml subcutaneously for children 6 months to <10 years, given on two occasions separated by ≥4 weeks 6

The World Health Organization recommends the Vi-TT conjugate vaccine due to its superior efficacy profile, with a four-year efficacy of 78% 7, 8
The Vi polysaccharide vaccine has a three-year cumulative efficacy of approximately 55% 7, 8
The oral Ty21a vaccine has a three-year cumulative efficacy of 50% 9, 10, 11
The Centers for Disease Control and Prevention suggests that the Vi polysaccharide vaccine requires boosters every 3 years for continued protection in persons with ongoing exposure 7, 8
The oral Ty21a vaccine requires revaccination with the full four-dose series every 5 years 9, 10

The World Health Organization states that all typhoid vaccines demonstrate excellent safety profiles with mild, self-limited adverse events 9, 10
The oral Ty21a vaccine has adverse event rates comparable to placebo (<1/100,000 doses) 7
The Vi polysaccharide vaccine causes injection site reactions but rarely systemic effects 7, 8

The Centers for Disease Control and Prevention recommends Vi polysaccharide vaccine boosters every 2 years for continued protection in patients with ongoing risk, highlighting the need for frequent boosting with this vaccine 12
The World Health Organization notes that neither vaccine provides 100% protection, with both offering 50-80% efficacy range, which can be overwhelmed by large inocula, emphasizing the importance of additional preventive measures 12

For patients requiring typhoid vaccination, the American College of Physicians suggests TCV as the first choice, due to its superior long-term protection, effectiveness in infants and young children, and less frequent boosting required 12
The Infectious Diseases Society of America recommends Vi polysaccharide vaccine as an alternative only if TCV is unavailable, for ages ≥2 years, with a plan for boosters every 2 years with continued exposure 12

The National Institute of Allergy and Infectious Diseases advises that vaccination does not replace food and water safety precautions, and hand hygiene and avoiding high-risk foods/beverages remain essential 12
The Centers for Disease Control and Prevention notes that Vi polysaccharide vaccine should not be used in immunocompromised patients or those with HIV, due to its inadequate immune response in these populations 12