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Key vaccine facts

Typhoid fever is a serious illness caused by a bacterium called Salmonella Typhi. It can be life-threatening and is usually spread through contaminated food or water. Typhoid is more common in places with poor sanitation and unsafe drinking water, both in cities and rural areas.

There are three recommended types of typhoid vaccines available internationally. Some countries have these included within their childhood immunisation programme. Travellers visiting certain countries are also recommended to receive a typhoid vaccine.

The increasing number of people living in certain areas, combined with climate change in areas where sanitation and water supply are contaminated, might make typhoid more common worldwide. Antimicrobial resistance, where antibiotics don’t work as well against some bacteria, makes typhoid more difficult to treat, leading to a higher number of people suffering severe disease, or death. It can also make outbreaks more difficult to contain.

Roughly 9 million people become sick from typhoid, and 110,000 people die from it worldwide each year (2019 figures). Although the number of deaths from typhoid fever has been decreasing worldwide, it remains a significant health concern, particularly for children under 14 years old.

death rate typhoid paratyphoid fever age groups

Source: Our World in Data

Who should get the vaccine?

Three types of typhoid vaccines are currently recommended by WHO for control of typhoid fever:

Name	Typhoid conjugate vaccines (TCV)	Vi capsular polysaccharide vaccines (Vi-PS)	Ty21a
Tradename(s) (Manufacturer)	Typbar TCV® (Bharat Biotech) TYPHIBEV® (Biological E)	Typhim Vi® (Sanofi Pasteur) Typherix® (GlaxoSmithKline)	Vivotif® (PaxVax)
Administration	Intramuscular injection	Intramuscular injection	Oral capsules
Age	>6 months of age	>2 years of age	>6 years of age
Number of doses	1 dose	1 dose with boosters every 2 to 3 years	3 to 4 doses
Duration of protection	> 4 years	2-3 years	up to 7 years
Effectiveness	79% to 85%	50% to 80%	50% to 80%

Source: adapted from Take on Typhoid

Typhoid conjugate vaccines are slowly being introduced into childhood immunisation programmes in countries where typhoid is prevalent. Liberia, Malawi, Nepal, Pakistan, Samoa, and Zimbabwe have already incorporated the vaccine into their schedules.

All travellers to endemic areas are potentially at risk of typhoid fever, and therefore typhoid vaccines are recommended for travellers visiting various destinations. This should be combined with other precautions, such as ensuring food is properly cooked, avoiding unsafe water, and washing hands frequently with soap and water.

In the UK, the are two vaccines available are the Vi-PS vaccine and the Ty21a vaccine. Travellers from the UK can use the NaTHNaC website, set up by the Department of Health in 2002, to find out which vaccines they need to travel.

Safety and side effects

Various typhoid vaccines are available and different countries use different vaccines. The information leaflets linked below describe the ingredients used for some of the more common typhoid vaccines. Check which vaccine is used in your country as it may not be listed below.

According to research combining data from clinical trials and post-marketing surveillance, the most common side effects of the Vi vaccine are reactions at the injection site like pain, swelling, redness, and hardness. These reactions are usually mild and don't last long.

Serious reactions to the vaccine are rare. Fever happens in about 1% of people who get the vaccine. Other uncommon side effects include headache, nausea, diarrhoea, and stomach pain.

For the Ty21a vaccine, the most common side effects are stomach issues, fever, flu-like symptoms, and headaches. If you are in the UK, and experience any severe reactions, it's important to report them to the Medicines and Healthcare products Regulatory Agency using the Yellow Card scheme.

Ingredients

Various typhoid vaccines are available and different countries use different vaccines. The information leaflets linked below describe the ingredients used for some of the more common typhoid vaccines. Check which vaccine is used in your country as it may not be listed below.

More information about the vaccine

Typhoid and antimicrobial resistance

Initially, the main antibiotics used to treat typhoid were chloramphenicol, ampicillin, and cotrimoxazole. But in the 1970s, resistance to these antibiotics started appearing and has since become widespread. Multi-drug resistant (MDR) typhoid is an issue globally, especially in regions like the Middle East, Africa, and Asia.

In the 1990s, a different type of antibiotic called fluoroquinolones started being used. However, because they were used so widely, resistance to them began to increase as well. Consequently, cephalosporins and azithromycin became the last resort antibiotics.

In 2016, extremely drug-resistant (XDR) typhoid strains emerged. These strains are resistant to five classes of antibiotics: chloramphenicol, ampicillin, cotrimoxazole, streptomycin, fluoroquinolones, and third-generation cephalosporins.

Azithromycin remains the only effective oral antibiotic against XDR typhoid, but resistance to it is also starting to emerge in some places. This situation is making treatment more complex and costly, leading to more hospitalisations and straining healthcare systems, highlighting the urgent need for widespread vaccination using the Typhoid Conjugate Vaccine in high-risk areas.

This would reduce the occurrence of the disease and slow down the spread of drug-resistant typhoid. Rolling out the TCV vaccine effectively could prevent two-thirds of cases and deaths.

Mass typhoid fever vaccination campaigns

Mass vaccination campaigns are where entire populations are vaccinated against a particular disease. They’re often utilised in times of disease outbreak, for example, during the COVID-19 pandemic. Mass vaccination against typhoid fever has been used in various countries; for example in Fiji in July 2023.

The Ministry of Health in Fiji launched a campaign aiming to immunise the entire population in the Northern Division aged between 9 months and 65 years of age. Healthcare workers administered a single dose of a typhoid conjugate vaccine to roughly 132,000 people over eight weeks.

Gavi support

Gavi is an international organisation that was created in 2000 to improve access to new and underused vaccines for children living in the world's poorest countries.

In line with recommendations from the World Health Organisation, Gavi provides co-financing support for the nationwide introduction of TCV into the routine immunisation programme; and full financing for a one-time catch-up immunisation campaign for children aged up to 15 years based on local typhoid epidemiology.

The funding support includes vaccines, vaccination supplies and operational costs for implementation.  