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PubMed1976

Controlled field trials of three different oral killed typhoid vaccines in India.

Three vaccination trials against typhoid fever were carried out in 1968/69, 1970/71 and 1974 in New Dehli. The vaccine was generally administered in tablet form on three consecutive days. Each new trial consisted of a larger number of killed bacteria: 100.10(9), then 300.10(9) and finally 400.10(9) killed S. typhi. The placebo and vaccinated groups were composed of 6,000 to 7,000 persons, sometimes only children from 6 to 17 years. The number of typhoid fever cases which appeared under normal conditions of infection did not show significant difference between the vaccinated and non-vaccinated subjects during the 18 month period of observation.

Administration, Oral↗
PubMed1994

Vaccination against typhoid fever: present status.

Typhoid fever remains an underestimated important health problem in many developing countries, causing more than 600,000 deaths annually in the world. Because of the reactogenicity of the parenteral, killed whole-cell vaccine, research has been oriented towards vaccination orally using live organisms and purified antigen. Live vaccine Ty21a, given by the oral route, has been extensively tested in several studies in developing countries. Its liquid formulation was the most effective, providing more than 60% protection after 7 years of follow-up. A Vi polysaccharide vaccine has been elaborated and provided more than 65% protection; after 3 years of follow-up the Vi antibody level was still at a high level. These two vaccines are therefore candidates for use in public health control programmes. Before such use, however, they need further evaluation for safety and protective efficacy when administered to the EPI-targeted age groups. The question of whether typhoid fever vaccines interfere with the response to simultaneously administered measles vaccine must also be studied. New live vaccines, given by the oral route in one dose, have been constructed through genetic engineering. The first results are promising, but they must be improved before use in a large-scale study. These strains could be used as live vector to deliver foreign antigens to the intestinal mucosa.

Administration, Oral↗
PubMedDate not supplied

[A system for the mass combined vaccination of the adult population against influenza, viral hepatitis, typhoid, meningitis and diphtheria].

A safe, moderately reactogenic and immunologically effective scheme of complex (combined) immunization against meningitis A, diphtheria, typhoid fever, viral hepatitis A and influenza has been developed as the result of experimental and clinico-immunological studies. Depending on the epidemiological situation, the newly developed scheme can be used in two variants. According to the first variant of this scheme, the following preparations are injected subcutaneously into three different sites: a mixture of group A meningococcal vaccine and diphtheria toxoid, typhoid vaccine and influenza vaccine. The second variant of the scheme differs from its first variant in using intramuscular injection of normal human immunoglobulin instead of injection of influenza vaccine. Moreover, in practical realization these variants may be altered by excluding vaccines, unnecessary under present conditions. The newly developed scheme of vaccinal prophylaxis is recommended for practical use.

Adult↗
PubMed1994

[Combined (associated) immunization against typhoid, typhus and plague].

The article substantiates epidemiological expediency of complex (associated) immunization of servicemen and population against typhoid, typhus and plague in polyetiological zones of these infections, and also in cases of simultaneous proliferation of these diseases. For simultaneous preventive vaccination against these infections a complex immunization scheme was experimentally substantiated and clinically approved. It is based on national commercial vaccines and ensures a simultaneous administration of 2-3 vaccine preparations by hypodermic syringe or jet injection. Typhoid and typhus vaccines are injected under one shoulder-blade, and plague vaccine is injected under another shoulder-blade. This complex vaccine is harmless, moderately reactogenic, develops expressing immunity which have the same protective features as monovaccines alone. This scheme is recommended for use in anti-epidemic practice.

Adolescent↗
PubMed1976

Assessment of effectivity of oral killed typhoid and paratyphoid b vaccines and aerosol chemical thyphoid vaccine in controlled field trials.

A total of 3 controlled field trials were carried out. One of them (1963) showed that aerosol chemical typhoid vaccine did not protect vaccinated subjects from the disease. Two other tests (1964 and 1965) assessing the effectivity of killed orally administered typhoid vaccine revealed a short term (up to 3 months) protective effect expressed by an effectivity coefficient of 45%, fiducial limits being 8-70%. In the assessment of oral paratyphoid B vaccine, the difference in morbidity in the experimental and control groups was statistically insignificant due to a small number of cases of disease.

Administration, Oral↗
PubMed1995

The new problem of typhoid fever in Papua New Guinea: how do we deal with it?

This paper reviews some of the issues relating to typhoid fever in Papua New Guinea. Before the mid-1980s only sporadic cases of typhoid were reported but it is now one of the greatest public health problems in the highlands and some urban areas. In one study near Goroka an annual incidence rate of 1208 per 100,000 people was found, with settlers from other areas at greater risk than the local landowners. Problems relating to management included differentiation from other diseases, the limitations of the Widal test and poor compliance among outpatients. In Papua New Guinea it appears that transmission is largely from person to person, with little evidence for water-borne transmission. The prolonged convalescent excretion of Salmonella typhi and the difficulties this poses for control of the disease are discussed. Prevention will only be achieved in the long term by improvements in hygiene and sanitation, though more immediate control could be achieved by vaccination with an appropriate vaccine.

Adult↗
PubMed1998

[Vaccination against diarrheal diseases and typhoid fever. Current status and prospects].

Diarrheal diseases and typhoid fever are still common in developing countries and there is still a search for effective control measures able to prevent the epidemics they cause from time to time. There are recommended preventive measures based on health education and improvement of sewage and water facilities; however these recommendations given for many years have not reached the expected results for different reasons. Antibiotherapy was very effective for many years; unfortunately increasing antibiotic resistance has been reported, particularly in Shigella and typhoid fever treatment. This explains the re-kindled interest currently taking place in vaccines development against infections due to V. cholerae, Shigella, E.coli ETEC, S. typhi and rotavirus. The new available vaccines are very effective and provide greater protection than that given by the old killed injectable vaccines. They paved the way for development of new candidate vaccines easier to deliver (oral vaccines or one dose parenteral vaccine), which already give promising results. Some of these candidate vaccines like those related to Shigella infections are considered as a future promising tool for controlling diarrhea due to Shigella.

Adult↗
PubMed1984

Typhoid fever. An epidemic with remarkably few clinical signs and symptoms.

A major common-source, foodborne epidemic of typhoid fever occurred in San Antonio, Tex, in the fall of 1981, involving 80 verified cases. We summarize the clinical course of our 34 patients who had a nonspecific symptom complex that included at the initial examination fever (32 patients, 93%), headache (19 patients, 57%), diarrhea (11 patients, 33%), and anorexia (ten patients, 30%). The most common initial diagnoses were urinary tract and upper respiratory tract infections. The subsequent isolation of Salmonella typhi from blood cultures was usually unexpected. Physical findings were different from two previous series originating in the United States. Hepatomegaly was noted in only 7% (two patients), splenomegaly was noted in 13% (four patients), and rose spots were noted in 5% (two patients) of the patients. Liver function test results, however, were abnormal in 32 (95%) of the 34 patients (mean SGOT, 155 IU/mL). Typhoid fever, as seen in this outbreak, was notable for its nonspecific and mild manifestation and uniformly favorable outcome.

Adolescent↗
PubMed2004

An outbreak of domestically acquired typhoid fever in Queens, NY.

In the summer of 2000, an outbreak of endemic typhoid fever involved 6 people in Queens, NY, and a seventh person in Manhattan, NY. An investigation by the New York City Department of Health traced the likely source to an immigrant employee working at a local restaurant. The clinical presentations of 4 cases seen at New York Hospital Queens, Flushing, a 500-bed hospital, mimicked viral hepatitis or gastroenteritis. We report the clinical features of these 4 cases and review endemic typhoid fever, a diagnosis not likely to be considered in the United States absent a history of recent international travel.

Adult↗
PubMed1983

Typhoid perforation of the intestine.

We reviewed 91 cases of intestinal perforation complicating typhoid fever treated at a rural hospital in Haiti over a ten-year period. Surgical management involved simple primary closure of the perforation (80 patients), small-bowel resection with anastomosis (two patients), simple drainage of the peritoneal cavity (two patients), and serosal patching of the perforation (one patient). Six patients died before surgery. The mortality was 30.8% for all 91 cases but 21.2% for those treated with primary closure of the perforation. We also reviewed the literature pertaining to the management of intestinal perforation complicating typhoid fever.

Adolescent↗
PubMed1981

Typhoid perforation: choice of operation.

Over a 17-year period 93 patients have been treated for typhoid perforation of the bowel. Forty-three of these have been treated by closure of the perforation, and 42 by end-to-side ileotransverse colostomy. These two groups are compared. Although there was no difference in mortality, postoperative morbidity in survivors was less in those having an end-to-side ileotransverse colostomy. End-to-side ileotransverse colostomy is a logical operation based upon the pathological changes in the bowel produced by typhoid fever and is the operation of choice.

Adult↗
PubMed1982

Typhoid enteric perforation.

A review of 344 patients with typhoid perforation of the intestine is presented. Patients with enteric perforations should be treated with antibiotics, by fluid and electrolyte replacement and blood transfusion. Surgery is necessary to close the perforated gut and drain the contaminated peritoneum with the minimum surgical interference which will achieve these objectives. Although better conservative management has significantly reduced the mortality of typhoid perforation, early limited surgery is most important if good results are to be obtained.

Drainage↗
PubMed1984

The surgical management of typhoid perforation in children.

Typhoid perforation still has a high mortality rate (19-59 per cent) and controversy regarding the management of patients with this complication still abounds. We report our experience of 26 children with histologically proven typhoid perforation with an operative mortality of 9.0 per cent. Timed surgery with ulcer excision, simple two-layer closure of the defect and copious peritoneal lavage were used.

Child↗
PubMed1995

Typhoid enteric perforation.

Of 306 cases of typhoid enteric perforation, 267 were reviewed retrospectively to determine prognostic indices and therapeutic options influencing outcome. The morbidity and mortality rates were 55.4 and 28.5 percent respectively, and the median duration of hospitalization was 18 days. On the basis of these findings, a prospective series of 39 patients was studied. In the preoperative period, aggressive resuscitation and antibiotic therapy with a combination of chloramphenicol, ampicillin/sulbactam and ornidazole were administered. All patients were given total parenteral nutrition to provide adequate metabolic support in the postoperative period. The morbidity and mortality rates decreased to 25 and 10 percent respectively, and the median hospitalization time was 12 days. The results of this study suggest that aggressive resuscitation and a combined antibiotic regimen in the preoperative period, selected operative procedure and metabolic support decrease the morbidity and mortality of typhoid enteric perforation.

Adolescent↗
PubMedDate not supplied

The effect of various interventions during a typhoid epidemic. Results of a simulation study.

This paper presents an epidemiological model for typhoid fever epidemics or paratyphoid diseases with an enteric course, as well as a deterministic approach for the quantitative representation of this model. The model has been tested against one typhoid and two paratyphoid epidemics which occurred in the Federal Republic of Germany. It was possible to simulate the course of these epidemics with sufficient precision, and to obtain information on the effects of various interventions (e.g. oral vaccination or hygiene measures).

Disease Outbreaks↗
PubMedDate not supplied

Clinical experience with pefloxacin in the therapy of typhoid fever.

Thirty hospitalized patients (22 men and eight women), aged between 15 and 41 years (mean = 25.4 years), with severe proven typhoid sepsis were treated with pefloxacin at daily dose of 1200 mg, divided in three doses, intravenously for the first five days and orally for the following ten days of treatment. All patients completely recovered from infection and pathogens were eradicated after 30 days of follow-up. In none of the patients was a relapse registered during the follow-up or enteric carrier state after disease. Pefloxacin therapy was well tolerated by all patients: in five patients a mild and transient epigastric pain and in one patient a mild and transient nausea were registered. Pefloxacin is a safe and effective agent for therapy of typhoid fever.

Administration, Oral↗
PubMed1991

Fluoroquinolones in the treatment of typhoid fever and the carrier state.

Typhoid fever remains an important public health problem throughout the world with a higher morbidity and mortality rate in the developing countries. Early establishment of the diagnosis and prompt initiation of treatment with chloramphenicol, ampicillin or trimethoprim-sulfamethoxazole is not necessarily followed by complete resolution of the infection. Between 1% and 6% of patients with typhoid fever become chronic biliary carriers of Salmonella typhi. These carriers are potential factors in the continued transmission of the disease. The increasing emergence worldwide of strains showing multiple resistance to the agents traditionally used in therapy has encouraged investigators to seek alternatives such as third generation cephalosporins and recently the new 4-quinolones, which have greater activity against Salmonella typhi including multi-resistant strains. The fluoroquinolones seem to be the treatment of choice in those regions where resistant strains of Salmonella typhi are prevalent.

4-Quinolones↗