Emerging Drug Resistance and Vaccination for Typhoid Fever

To the Editor.—The case presented by Dr Zenilman¹ involving typhoid fever in a 35-year-old pregnant woman highlights the importance of adequate preparation for international travel and continual vaccine development. To evaluate typhoid vaccination practices, we analyzed 5 explanatory variables using multiple logistic regression of data on 980 travelers attending the International Travel Medicine Clinic at the University of North Texas Health Science Center from 1990 to 1994. As shown in Table 1, there was significantly greater use of typhoid vaccine in travelers to the Indian subcontinent compared with the referent travel destinations; however, vaccination decreased dramatically as the lead time between clinic attendance and departure decreased. Pediatric travelers were also significantly less likely to be vaccinated than adults. Since typhoid vaccination is not required for entry into any country, whether typhoid vaccination is given may depend on which and how many other vaccines are advisable and the time in which the vaccines may be given, perceived risk, and personal preference.