Typhoid fever, locally known by the Malaysians as Demam Kepialu, is a bacterial infection caused by the bacterium Salmonella Typhi, which is related to the bacteria that cause salmonella food poisoning. It is a potentially serious illness that primarily affects the digestive system and can spread to other parts of the body. The symptoms of typhoid fever can be enfeebling including:
- High fever
- Headache
- Abdominal pain
- Constipation (more commonly manifest as diarrhoea in children)
- Rash
Without prompt treatment, it can lead to severe complications and even be deadly!
The transmission of Typhoid
Typhoid typically happens when people consume food or water that has been contaminated by the faeces or urine of an infected person. It can also be spread through the use of a contaminated bathroom and touching your mouth before washing your hands, or by eating seafood caught from a contaminated water source.
In regions where proper disposal of human waste is lacking, contaminated water sources are the primary means of transmission. On the other hand, in regions with improved sanitation practices, the transmission of typhoid fever is more commonly associated with the consumption of contaminated food.
There are currently three Typhoid vaccines available in Malaysia:
|
Typhim Vi® By Sanofi Aventis (M) Sdn Bhd |
Vivotif Oral® By Propharm (M) Sdn Bhd |
Typherix® By GlaxoSmithKline Pharmaceutical Sdn Bhd |
|
|
Content |
Polysaccharide vaccine. 0.5mL of syringe contains 0.025mg purified Vi capsular polysaccharide of Salmonella typhi strain Ty2. |
Live attenuated vaccine. |
Polysaccharide vaccine. 0.5mL of syringe contains 0.025mg purified Vi capsular polysaccharide of Salmonella typhi strain Ty2. |
|
Administration Route |
Injections deep into muscles |
Oral |
Injections deep into muscles |
|
Minimum age for vaccination |
≥2 years old |
≥6 years old |
≥2 years old |
|
Dose Schedule |
Single injection |
Take one capsule on days 1, 3, and 5. It is important to swallow whole the capsule one hour before eating with lukewarm water (not more than 37°C) |
Single injection |
|
Booster |
Every 2 years |
Every 3-5 years |
Every 2 years |
|
Co-administration with other vaccines/ medications |
Able to receive the vaccine before or after, or with, other vaccines |
Able to receive oral at the same time as any other live parenteral vaccines. However, the final vaccine dose should be at least three days prior to beginning antibiotics or anti-malarial prophylaxis, as these medications can disrupt the effectiveness of the vaccines. |
Able to receive the vaccine before or after, or with, other vaccines |
|
Contraindications |
Severe allergic reaction (anaphylaxis) after a previous dose of any typhoid vaccine or after any component of a typhoid vaccine |
Pregnant woman People who are immunocompromised, including people with HIV
|
Severe allergic reaction (anaphylaxis) after a previous dose of any typhoid vaccine or after any component of a typhoid vaccine |
|
Potential Adverse Effects |
Generally safe
|
Generally safe, potential adverse effects are:
|
Generally safe
|
Like any medication, the typhoid vaccines have the potential to cause side effects. The most common side effects of the typhoid vaccine are soreness at the injection site, fever, headache, muscle aches, nausea, vomiting and abdominal pain. Talk to your doctor before getting a typhoid vaccine if you have any medical conditions.
Who should take the Typhoid vaccines?
Food handlers, especially restaurant owners, hawkers, canteen/stall owners and all their employees who handle food are required to get the Typhoid vaccine in Malaysia.
Image source: AOEMM
Other than food handlers, it is also recommended for individuals travelling to places where typhoid fever is endemic. The injectable vaccine should be taken at least two weeks before travelling and the oral vaccine one week before the journey.
As a food handler, what else can I do to prevent the transmission of Typhoid?
- Practise good hygiene: Wash your hands thoroughly with soap and water before handling food, after using the bathroom, and after any potential contact with contaminated surfaces or objects.
- Maintain a clean working environment: Keep your food preparation area clean and sanitised. Regularly disinfect surfaces, utensils, and equipment to prevent cross-contamination.
- Cook food thoroughly: Ensure that all foods, especially meat and poultry, are cooked thoroughly to kill any potential bacteria, including Salmonella Typhi.
- Avoid cross-contamination: Keep raw and cooked foods separate to prevent the transfer of bacteria. Use different cutting boards and utensils for raw and cooked foods.
- Use safe water: Make sure the water you use for cooking and drinking is safe. If you're unsure about the water source, boil it before use or drink bottled water.
- Follow proper food storage practices: Store food at appropriate temperatures to prevent bacterial growth. Refrigerate perishable items promptly and discard any expired or spoiled food.
As a consumer, choose not to eat at places that are unclean and practise good hygiene by washing hands and eating with clean utensils too. Be on the lookout for the appearance, smell and taste of the food that you are eating, throw it out if you sense that the meal has gone stale.
This article is written by Ke Feng, Bpharm(Hons) DOC2US,
reviewed by Dr. Lee Siew Ling, MD (DOC2US).
References
- World Health Organization (WHO). Typhoid vaccines: WHO position paper – March 2018. Weekly Epidemiological Record 2018;93:153-72.
- Begier EM, Burwen DR, Haber P, Ball R, Vaccine Adverse Event Reporting System Working Group. Postmarketing safety surveillance for typhoid fever vaccines from the Vaccine Adverse Event Reporting System, July 1990 through June 2002. Clinical Infectious Diseases 2004;38:771-9.
- Levine MM. Typhoid fever vaccines. In: Plotkin SA, Orenstein WA, Offit PA, Edwards KM, eds. Plotkin's vaccines. 7th ed. Philadelphia, PA: Elsevier; 2018.
- Australian Government Department of Health and Aged Care. (2018). Typhoid fever. Autralian Immunisation Handbook. Retrieved June 1, 2023, from https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/typhoid-fever#
- Centers for Disease Control and Prevention. (2015). Advisory Committee on Immunization Practices. Updated Recommendations for the Use of Typhoid Vaccine.
