The transmission of this disease is fecal-oral. All travellers to endemic areas are at risk of typhoid fever, although the risk is usually low in tourist centres with high standards of accomodation, sanitation and food hygiene. Vaccination should be recommended for persons older than two years of age that will have prolonged exposure to potentially contaminated food and water, as well as for those that travel to rural areas off the usual itineraries in the hyperendemic areas in Asia (Indian subcontinent and some parts of South-East Asia), the Middle East, Africa and Central and South America. However, vaccination may not prevent typhoid fever after exposure to large numbers of organisms.

For travel to countries where the risk of typhoid fever is high, where hygiene is poor and where there is a high prevalence of antibiotic-resistant organisms, two types of vaccines may be prescribed:

- The oral live attenuated: three capsules taken orally, two days apart (days 1-3-5). Capsules should be taken one hour before a meal, with a drink not exceeding 37ºC. The ingestion of proguanil, mefloquine and antibiotics should be avoided. This vaccine confers protection ten days after taking the third capsule, and is recommended for adults and chidren over the age of six years. Boosters (series of three capsules taken on days 1-3-5) are recomended every year for travellers from non-endemic to endemic areas, and every 3-5 years for persons living in endemic areas; and

- The "Vi capsular polysaccharide" vaccine: one intramuscular dose, with boosters every 2-3 years. This vaccine is not recommended for children below the age of two years.

Health professionals should always inform their clients that vaccination might not prevent typhoid fever after exposure to a large numbers of organisms. All travellers should be advised to take all necessary precautions to avoid contact with or ingesting potentially contaminated food and water, and that basic hygiene measures are the best way to prevent the disease.

Fernando Costa Silva, 1999 (last update: 2009)