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Follow-up: Typhoid in travelers to Syria

During the summer of 1992, the Qatif Primary Health Care Department detected 16 confirmed cases of typhoid fever among travelers to Syria. There had been a similar rise in the number of cases in previous years. An investigation revealed the likelihood that the common source in Syria was probably waterborne. During the summer of 1993, all 26 primary health care centers offered health education programs and typhoid vaccinations. Over three months (Moharram, Safar and Rabea Awal 1414), 13,401 vaccine doses were given. Last year, only six confirmed typhoid cases reported travel to Syria. No vaccinated person developed typhoid with the exception of one person who received only one dose of vaccine and traveled to Syria the same day. The total number of visitors to Syria was believed to be similar to the number in previous years. The attack rate of typhoid in travelers to Syria was 6.4 per 10,000 in 1992 and 2.4 per 10,000 in 1993. The incidence of acquired typhoid fever sharply declined last year compared with the year before, and the cases in 1993 were only 37.5% of the 1992 total. No one reported side effects from the typhoid vaccine.
  • All travelers to areas with a high risk of typhoid should be vaccinated.
  • Travelers should be warned that vaccination is not a substitute for careful selection of food and water.
  • The vaccine is not 100% effective, and if the number of typhoid organisms in the food or water is very high, it is of little value.
  • Vaccination should begin well before departure. Two doses of vaccine administered four weeks apart provide the greatest protection.

Editorial note:

Typhoid fever is unique to humans. It remains a significant problem in many developing countries and poses a risk to travelers who visit such endemic regions. The proportion of cases acquired in foreign countries has continued to rise. The risk of typhoid should not be underestimated as a travel-related illness. The only measure of protection is by education of the population about hygiene in water and food (e.g., using bottled water, coffee and tea and avoiding unpasteurized dairy products, tap water, and ice). Travelers should refrain from eating raw, unpeeled vegetables and salad and also should abstain from eating foods prepared by street vendors. Also recommended is vaccination of travelers to areas that have a recognized risk of exposure to typhoid.