Until recently immunisation against typhoid fever could only be provided by parenteral vaccine of heat-killed, phenol-preserved Salmonella typhi organisms (Typhoid/Vac – Evans). Two doses of this ‘whole cell’ vaccine, 4–6 weeks apart, give up to 80% protection for around 3 years, but local and systemic reactions are common, especially if the second dose or booster doses are given subcutaneously or intramuscularly rather than intradermally. Prescribers now have two more vaccines to choose from – one parenteral, one oral. Both are marketed with claims that they are better tolerated than the old vaccine. Do they have advantages?
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