Typhoid fever vaccination is different. Four ways to protect against typhoid fever with vaccinations. Validity period and storage conditions

Vaccination against typhoid fever is not included in the National Calendar, but is vital in certain conditions. Every year, about 21-30 million cases of typhoid fever are registered worldwide, of which 1 to 10% are fatal. Behind last years epidemics of typhoid fever were observed in the countries of Central Asia. According to World Organization World Health Organization (WHO), more than 500,000 people die from typhoid fever every year worldwide. People aged 5-19 years are most often affected, so vaccination against typhoid fever should be given to schoolchildren in endemic areas.

The causative agent, symptoms and treatment of typhoid fever

The causative agent of the disease is salmonella (gram-negative rods). They are excreted with the feces and urine of the patient or carrier into the external environment, where they can persist for up to several months. Infection occurs through the fecal-oral route. Bacteria enter the body healthy person through gastrointestinal tract. The disease manifests itself as a persistent fever, general intoxication, enlarged liver and spleen, damage to the lymphatic system of the small intestine. The patient is concerned about constipation, bloating, nausea, general weakness. Characteristic appearance skin rash on the side of the abdomen, lower part chest, less often on the forearm.

Patients are treated in an inpatient infectious diseases hospital. The main purpose of antibiotics (Levomycetin, Ampicillin and Biseptol). Additionally used symptomatic therapy(antipyretics, sorbents, vitamins, sedatives). After the course of treatment, the patient is observed at a dispensary, repeated cultures of feces and urine are carried out.

Types of vaccines for typhoid fever

For active prevention in Russia, three types of vaccines against infection are used:

• Alive weakened oral vaccine(Tu21a). Contains pathogens weakened under artificial conditions.
• Inactivated injection liquid (,). Consists of microbial particles killed by heat or chemical treatment.
• Dry alcohol vaccine “Trifivak” is prepared on the basis of waste products of bacteria.

Characteristics of vaccines

The composition does not include pathogenic strains of pathogens that can cause clinical picture diseases. The concentration of microorganism antigens is sufficient to trigger an immune response in the body. After an injection, the body synthesizes protective proteins in response to the injected foreign elements. Antibodies spread throughout the body through the bloodstream. As a result, immunological memory is formed - the ability to respond more quickly and effectively to the pathogen antigen.

When foreign units enter again, the body easily copes with the pathogen and does not allow the disease to develop. Specific active immunity to the pathogen is formed within 14 days.

Indications for vaccine administration

The drugs are used for both emergency and routine prevention of typhoid fever. Vaccination is indicated:

• To the population living in the territory with high level morbidity.
• Persons involved in the field of municipal improvement.
• In case of going on vacation to countries where there are outbreaks of morbidity.
• To all healthcare workers and laboratory technicians who work with cell strains that cause the disease.

According to epidemic indications, vaccinations are carried out urgently when there is a threat of mass spread of the pathogen (natural disasters, accidents on the water supply and sewerage networks).

The indications and time of vaccination are determined by the doctor. Immediately before immunization, you should consult with your doctor.

Necessary:

• Carefully interview the patient to identify previous diseases (acute and chronic).
• Determine the presence of reactions or complications to the previous administration of the drug, allergic reactions to medicines and products.
• Determine the individual characteristics of the body (prematurity, birth trauma, convulsions).
• Clarify whether there are contacts with infectious patients, as well as the timing of previous vaccinations.
• Take a general blood and urine test and consult with related specialists.

Important! At acute diseases which are accompanied by an increase in temperature (sore throat, bronchitis, influenza, pneumonia, intestinal infections) vaccination should be postponed until complete recovery

Scheduled and preventive vaccinations

Immunization against typhoid fever is carried out routinely among persons working:

• At food enterprises, in public catering and retail chains.
• In children's institutions and hospitals.
• At water supply and sewerage facilities.
• At enterprises for cleaning populated areas, reception centers, warehouses.

Vaccinations are prescribed for children from 3 years of age. In older age groups, men are vaccinated up to the age of 60, women - up to 55. Revaccinations are carried out according to indications every 3 years.

For epidemic indications (incidence rate above 25 per 100 thousand population, travel to countries with high incidence rates, constant contact with bacteria carriers in conditions conducive to infection), emergency prophylaxis is prescribed.

Method of administration of the vaccine and dose

Vianvac is an inactivated liquid vaccine that helps prevent typhoid fever. Solution for subcutaneous administration. The vaccination dose for all ages is 0.5 ml. The vaccination is carried out once, every 3 years. Injection sites: upper third of the outer surface of the shoulder, back (subscapular region), anterolateral surface of the thigh, lateral surface of the abdominal wall.

Trivivak is a dry alcohol vaccine. Immunization is carried out by a single injection. The injection is given subcutaneously, preferably into the outer surface of the upper arm, in an amount of 0.7 ml using a disposable syringe, after disinfection of the injection site and complete evaporation of the disinfectant.

Tifim Vi is a drug for adults and children over 2 years old (photo: www.privivku.ru)

Vaccination is carried out once with a dose of 0.5 ml from 2 years of age. Solution for intramuscular or subcutaneous administration. Revaccination every 3 years if there is a risk of disease.

Tu21a is a drug for oral administration. Prescribed from the age of three according to the scheme: three doses over two days. The effect is achieved within a week. Re-introduction after three years in areas with an increased risk of infection. Formed immunity lasts for 5-7 years.

Contraindications for administration

All contraindications are divided into absolute and relative.

Absolute (does not change over time):

• Allergic reactions to previous administration and components.
• Kidney and liver failure.

Relative (administration allowed after a while):

• Acute infectious, bacterial and viral diseases(only after complete clinical recovery).
• Fever above 37 degrees Celsius.
• Chronic progressive illnesses.
• Pregnancy (especially early dates) and the period of breastfeeding.

Side effects of the vaccine

The appearance of a reaction to the vaccine indicates the formation of an immune response. The reactions are not particularly life-threatening and do not require specific treatment.

The following manifestations often occur at the injection site:

• Swelling up to 5 cm, hyperemia no more than 8 cm in diameter.
• Moderate pain and swelling.
• Local increase in temperature.
• Lump at the injection site.
• Formation of infiltrate (especially with subcutaneous injections).

Systemic reactions affect the entire body.

They appear:

• Increased body temperature and the appearance of flu-like symptoms (runny nose, cough, enlarged tonsils and red throat).
• Nausea, vomiting, diarrhea.
• Skin rash.
• Increased sweating.
• Weakness in muscles and joints.
• Malaise, apathy.
• Sleep and appetite disorders.

Application

The drugs are prescribed to adults and children according to the schedule given in the table below.

Prescribing drugs during pregnancy and breastfeeding is prohibited. Administration can lead to intrauterine infection, multiple fetal malformations, premature birth and abortions. It is not recommended to plan pregnancy within three months after immunization.

Pros and cons

Doctors advocate routine vaccination against typhoid fever in areas with increased level morbidity. Thanks to active prophylaxis, it is possible to prevent the onset of the infectious process, prevent death and long-term consequences. On the other hand, any vaccination, while increasing immunity to a certain disease, reduces the body’s overall defense, and the introduction of a foreign protein is rarely without side effects.

How to avoid unwanted consequences

To avoid negative consequences from vaccination, before administration you should consult a doctor and undergo an examination. After the injection, follow these rules:

• Stay under doctor's supervision for 30 minutes after the injection.
• It is not recommended to eat in the first hour after the injection.
• While walking, avoid crowded places and contact with infectious patients.
• If your body temperature is normal and there are no rashes, you can swim or shower.
• Try not to scratch or rub the injection site.

Doctor's advice! If symptoms progress rapidly and your health worsens, contact your doctor immediately. medical institution

Interaction with other drugs for immunoprophylaxis

Concurrent appointment allowed inactivated vaccines with other means of immunoprophylaxis for epidemic indications. It can be administered simultaneously with separate syringes into different parts of the body or at intervals of a month.

The use of cytostatics and glucocorticoids slows down the rate of formation of immunity; during therapy, the protective properties of the body are suppressed.

Vaccine storage conditions

If the safety of the drug is impaired, the vaccination may not be effective, and the risk of adverse reactions increases.

Basic conditions:

• Storage temperature from plus 2 to 25 degrees Celsius.
• It is prohibited to freeze vaccine ampoules.
• Transport in special containers for up to 14 days.
• Before opening, you should check the integrity of the packaging and labeling.
• After opening the ampoule, the solution should be administered immediately.
• Keep out of the reach of children.

After the expiration date (36 months), the vaccine cannot be used.

Other measures to prevent typhoid fever

Nonspecific prevention of typhoid fever includes:

• Improvement of populated areas.
• Supply of purified water.
• Formation of a system for removing garbage and sewage waste from cities and villages.
• Sanitary supervision over the production, transportation and sale of food products.
• Insect control.
• Maintain personal hygiene (wash vegetables, fruits and berries before eating).

Cost-effective vaccines

Vaccination is the most effective and cost-effective means of protection against infectious diseases. Officially registered drugs in the Russian Federation:

• "Trifivak" and "Vianvac" are produced in Russia.
• "Thivim Vi" is a French vaccine.

Domestic drugs are more affordable, which allows every citizen, if necessary, to purchase medicine or give an injection.

Immunity does not last long - 1-5 years. Wikipedia contains a picture of the vaccination of school-age children in the United States. We are talking about the times of World War II. The causative agent of the disease was discovered in 1880 by Ebert. A vaccine made from killed bacteria is used in lagging countries. Gives immunity for a year. Western countries use other drugs.

Two types are used: injection (Vi antigen) and oral (Ty21a). Vaccination is recommended for travelers and should be done once every 2 years. The drug is used orally once every 5 years. Outdated vaccines are less good and cause a number of complications. Example: Hiyoshi Shiga did not overcome dysentery, moving in the right direction - he did not develop immunity, and pus had to be pumped out from the injection site with drainage.

The typhoid fever vaccine (injection) consists of polysaccharides characteristic of bacteria, obtained chemically. There are two varieties:

1. Tifim Vi from Sanofi Pasteur.
2. Tiferix from GlaxoSmithKline.

Oral represents modified bacteria, sold under the name Vivotif from the company Krusell Switzerland AO. Methods for developing immunity are recommended for travelers at different frequencies - 2.5 years.

In areas with increased incidence, WHO has authorized the use of drugs since 1999. Practice has shown a way to prevent an epidemic. It is more cost-effective for states to prevent an epidemic than to treat affected people. The facts of long-term isolation from society of those who have had the disease and the need to thoroughly check contactees are taken into account.

Economic benefits of vaccination

The price is less than US dollar per vaccinated person. A sick person will take more funds from the state:

• spent on disinfection,
• places in hospitals,
• doctors time.

A hospital day costs tens of dollars. Treatment takes less than a month, excluding tests that are required 2 years after discharge.

The reduced price allows poor countries to buy drugs and vaccinate. The ways of spreading HIV have become known - doctors do not use one syringe to vaccinate several patients. Vaccination for adults is not a long-term solution. The period between injections is 2 years. The benefits of manufacturers from Switzerland and other countries, which regularly receive profits from the production of the vaccine, can be traced.

Varieties

A vaccine against typhoid fever has not been created to eliminate the danger of the disease. We have to combine methods. Therefore, two methods are mentioned above. Both measures are being taken in parallel and complement each other. WHO has been recommending combination since the 90s of the 20th century. Vaccination is carried out intravenously using genetic modifications of ViPS, capsules with Ty21a are taken orally.

It is not recommended to perform such operations on children under two years of age (no effect). The procedure is repeated every 2-3 years. The probability of the protection triggering is 55-72% - less than one. Children aged 5 years and older are vaccinated orally at intervals of 5-7 years. The results are the same.

Vi vaccine

The vaccine is a refined Vi-polysaccharide obtained from Salmonella typhus. The injectable drug is administered intramuscularly - 25 mcg. For children, the best period for starting vaccination is 2 years; for adults, it is better to get over the disease as soon as possible. The level of protection is formed 1 week after the procedure. The drug retains its properties at temperatures from 2 to 80 degrees Celsius.

A randomized study in Nepal on people aged 5-44 years. Two-year observations showed that three quarters retained immunity for the period declared by the vaccine manufacturer. Subsequent studies in South Africa predominantly focused on children (5-16 years old). More than half of those vaccinated retained immunity for the third year after the injection.

For ten years, IgG immunoglobulins are found in the blood serum in quantities capable of protecting the body from the disease. Children under 2 years of age are not vaccinated due to lack of effect. Upon reaching the age of five years, the mechanism of formation of the immune response differs little from that observed in adults.

Over time, the number of antibodies decreases. Revaccination is required after 2-3 years. The Vi-vaccine, if necessary, is administered in parallel with other vaccinations “for travelers” - drugs for hepatitis A and yellow fever.

Tu21a vaccine

A live vaccine from the genetically modified strain Tu2 of the subspecies S. Typhi was developed in the 80s. Protection parameters are determined by the volume of the drug and the interval between doses. The vaccination procedure is divided into several days. Scheme: three doses over two days, the effect is achieved after 1 week (after the final dose). In areas of high risk, the procedure should be repeated after three years. For people on long-term trips, doctors impose the procedure more often. The dose must be repeated annually.

Capsules are not suitable for children under 3 years of age – additional research was not carried out. The percentage expected to repel a bacterial attack during a hypothetical infection is similar to injections. The mechanism for developing immunity is different. Doctors recommend parallel appointments.

The duration of the effect ranges from 5-7 years. Field trials took place in Chile, where the feasibility of using the vaccine in children was shown. The liquid vaccine is more expensive, is used from the age of two years, and has a greater ability to develop immunity. The studies were conducted on adolescents. After 5 years, 79% still had established defense mechanisms against bacteria.

Sticks with modified genes are perfectly acceptable. The vaccine is used in parallel with others necessary for travelers and residents of epidemiologically dangerous areas.

When vaccinating, do not use antibiotics, proguanil. The only restriction applies to HIV-infected people. Tu21a is used when the content of T cells with the CD4 marker is more than 200 units per cubic millimeter. To create similar drugs, other strains of the subspecies are being studied.

Contraindications

There are few contraindications for vaccination - allergic reactions, individual intolerance to the components of the drug. There is a risk of injection into HIV-infected people. Antibody production is directly related to the level of expression of CD4+ lymphocyte antigens.

The observed adverse reactions do not pose a serious danger. Possible symptoms:

• Increase in temperature (less than 1%).
• Migraines up to 3% of cases.
• Redness of the insertion site, colorless compaction up to 1 cm in diameter (up to 7% of cases).

Due to the lack of a booster effect indicating the emergence of long-term immune memory, doctors continued research with an emphasis on the development of protein-related vaccines.

Did not help…

The vaccine against typhoid fever has an efficiency of less than 100%. In the West, rehydration is considered a necessary measure. Bacterial activity is suppressed using antibiotics - fluoroquinolones (Ciprofloxacin). Or use third generation cephalosporins - Ceftriaxone, Cefotaxime. Cefixime is prescribed orally.

From drugs broad action Chloramphenicol, Ampicillin, Amoxicillin are common. Thoughtful treatment reduces mortality by 1%. In the absence of measures (hospitalization), the fatality rate ranges from 10 to 30%. The maximum recorded level is 47%.

The USSR was not spared from typhoid epidemics. One was recorded in 1933 in the city of Vitebsk. 70 new patients were identified daily. The situation was taken seriously; it appeared in the OGPU reports under the heading “top secret.”

Typhoid fever– spicy infection, which affects the intestines and its The lymph nodes. The disease is accompanied by an enlarged liver and spleen, severe intoxication with high fever and clouding of consciousness.

Although the incidence of the disease has decreased over the past hundred years, the problem still remains very relevant. Every year, about 20 million people around the world become infected with typhoid fever, and 800 thousand die from this disease. People get sick more often in developing countries where there is not enough drinking water, poor sanitary standards and thriving street food trading. Therefore, tourists who go to Central Asia, Africa or South America you should be extremely careful.

It is especially dangerous to swim in bodies of water that may be contaminated. wastewater and buy ready-made meals at markets. Most high risk associated with dairy and meat products, in them the bacteria at a temperature of +18 C begins to actively multiply.

In Russia, thanks to sanitary control, typhoid fever was almost completely eliminated. But in recent years there has been new danger. Migrants who come to work and our tourists bring Salmonella typhoid from other countries. One sick person can cause infection to many people, especially if he works in the food industry.

You can become infected with typhoid fever from a sick person and from a bacteria carrier who feels completely healthy. The route of transmission is fecal-oral. This means that the bacterium is released from the intestines of a sick person and enters the mouth of a healthy person through food, drinking water, dirty hands or household items.

Large outbreaks and epidemics occur in the summer-autumn period. At high temperature The typhoid bacillus multiplies rapidly. In addition, flies contribute to its spread.

Sensitivity to the bacterium that causes typhoid fever is high and people of any age can become infected. But according to statistics, children and young people under 30 get sick more often. This is due to the fact that they are more active: they travel more often and eat outside the home.

The causative agent of typhoid fever

Typhoid fever is distinguished from other diseases by the following symptoms:

• heat
• skin pale and dry
• enlarged dry tongue, coated in the center and clean around the edges
• soreness and rumbling under the right rib
• slight rash in the form of red spots in the upper abdomen and lower chest (appears on day 8-9)
• reduction in heart rate at high temperatures
• signs of intoxication: weakness, lethargy, depression, lethargy, headache

General clinical tests

1. Hemogram or clinical (general) blood test. Determines the amount of all elements that make up blood. With typhoid fever the following changes appear:
   • moderate leukocytosis - in the first days of the disease, the number of leukocytes slightly increases and the ratio of their types changes. but over the course of a week their number decreases sharply.
   • leukopenia – low number of white blood cells
   • aneosinophilia – absence of eosinophils in the blood
   • relative lymphocytosis - an increase in the percentage of lymphocytes compared to all other leukocytes.
   • increased ESR - erythrocyte sedimentation rate increases, but not significantly
2. General urine analysis. Urine examination in the laboratory. A laboratory assistant studies the physicochemical characteristics and examines the sediment under a microscope. With typhoid fever, the following is found in the urine:
   • red blood cells
   • cylinders

For laboratory diagnostics They take blood, urine, bile and feces. They are inoculated on nutrient media and placed in a thermostat, where the temperature is constantly maintained at 37 C. If the tests contain typhoid bacteria, they form colonies that can be examined under a microscope. Bacteria in the blood can only be found in sick people, but in feces and urine, salmonella can be found in both a sick person and a carrier of the bacteria.

1. Hemoculture– isolation of Salmonella typhoid from the blood. This is the earliest and most accurate diagnostic method. Bacteria appear in the blood in incubation period and remain until the end of the illness. To detect them, blood (10 ml) is taken from the antecubital vein and inoculated on Rappoport’s liquid nutrient medium. Preliminary result can be obtained on the second day, but the entire study lasts 4 days.


2. Coproculture– isolation of typhoid bacteria from feces. Salmonella is found in the intestinal contents from 8-10 days of illness. In this case, solid nutrient media are used.


3. Urine culture– determination of typhoid bacteria in urine. It is examined no earlier than on the 7-10th day of illness.


4. Bile culture– to study bile, a probe is inserted into small intestine. Bile is collected in sterile tubes and cultured. This study is carried out after recovery.


5. Bone marrow culture– a sample is taken during a puncture in the second or third week of illness. It is carried out if there is a suspicion that typhoid fever has seriously damaged Bone marrow.

Serological research methods

Starting from the second week, special antigens appear in the blood. These are particles of the membrane and flagella of typhoid Salmonella. They can be identified using studies based on immune responses. For analysis, blood is taken from a finger and the serum is separated from it.

1. Vidal reaction– determines whether there are O- and H-antigens in the venous blood serum. After interacting with special substances, cells containing particles of typhoid bacteria stick together and precipitate. Positive result can occur not only in the patient, but also in a person who has recovered from the disease, a carrier, or after vaccination. To know for sure that bacteria are multiplying in the blood, the reaction is carried out several times. In case of illness, the titer (level) of antibodies is 1:200 and is constantly increasing.
2. Passive hemagglutination reaction (RPHA with cysteine)– the blood serum of a sick person sticks together (aglutenizes) red blood cells coated with antigens. This study also needs to be carried out several times to see if the antibody titer increases. In a sick person it is 1:40 and can increase 3 times. The first analysis is taken on day 5, and then as needed at intervals of 5 days. Vi- and H-antibodies may be elevated in convalescents and carriers.

Treatment of typhoid fever

Treatment of typhoid fever proceeds in several directions at once.

Fighting infection

At severe forms a combination of antibiotics Ampicillin and Gentamicin is used. Or new generation drugs Azithromycin, Ciprofloxacin.

If antibiotics do not work or are poorly tolerated, then antimicrobial drugs of other groups are prescribed: Biseptol, Bactrim, Septrim, Cotrimoxazole. They are taken 2 tablets 2 times a day. Course 3-4 weeks.

Fighting intoxication and dehydration

In case of moderate condition, it is necessary to cleanse not only the intestines, but also the blood. To do this, glucose-saline solutions are administered intravenously so that toxins are eliminated faster by the kidneys. The drugs used are: Lactasol, Kvartasol, Acesol, 5% glucose solution. They are prescribed up to 1.5 liters per day.

If, despite all efforts, intoxication intensifies, then Prednisolone tablets are prescribed for 5 days.
Oxygen therapy helps fight intoxication well. Oxygen is administered through catheters into the nose or using a special oxygen pressure chamber.

If medications do not help, and the condition continues to worsen over three days, then a blood transfusion is given.

Improvement of general condition

The angioprotector Ascorutin helps improve the functioning of small capillaries, normalize metabolism and blood circulation.

Tincture of ginseng, Schisandra chinensis or Eleutherococcus improves general state, gives strength and improves tone nervous system. Natural herbal preparations used together with a complex of vitamins: A, B, C, E.

Diet for typhoid fever

After discharge from the hospital (6-7 weeks of illness), the menu can be gradually expanded. Do not immediately lean on prohibited smoked and fatty foods. Try small portions of new foods for 7-10 days.

Folk remedies to combat typhoid fever

To treat typhoid fever during epidemics, decoctions of black currant or rose hips, as well as coffee with lemon were often used.

Infusions medicinal herbs help speed up the healing of ulcers in the intestines and cleanse the blood of toxins. Pour 1 tablespoon of burnet roots into a glass hot water and boil for half an hour. Take a tablespoon every 2-3 hours.

Pour 1 tablespoon of St. John's wort herb with a glass of boiling water and leave in a thermos for 1 hour. Drink in small sips throughout the day.

Prepare a mixture of centaury, sage and pharmaceutical chamomile. Pour 1 tablespoon of the mixture into a glass of boiling water, leave for 30 minutes and strain. Drink a teaspoon 7-8 times a day.

Folk remedies can be an addition to the treatment prescribed by an infectious disease doctor. But remember, you should not try to overcome the disease on your own. During the treatment of typhoid fever, antibiotics are indispensable.

Dispensary observation

You can be discharged from the hospital no earlier than a month after the onset of the disease or 21 days after the temperature drops below 37 C. Before discharge, stool and urine samples are taken 3 times. If Salmonella typhoid fever is not detected in the discharge, the patient is sent home.

Typhoid fever has the insidious property of “returning.” This repeated development of the disease is called relapse. In order not to miss the new development of bacteria in the body and carriage, after discharge the patient will have to frequently communicate with doctors and undergo tests.

For the first two months, examinations are carried out once a week. 10 days after discharge you will need to test feces and urine 5 times with an interval of 1-2 days. In the future, you will be able to visit the clinic much less often. After 4 months, it is necessary to take a bile and blood test for the reaction of RPHA with cysteine. If the result is negative and no traces of bacteria are detected, the person will be removed from the register.

Prevention of typhoid fever

Inoculation or vaccine against typhoid fever

Who needs to be vaccinated?

Since children become infected more often, they need vaccination more often. Therefore, in areas where cases of the disease often occur (25 patients per 100,000 population), children aged 5-19 years are vaccinated. Vaccination is also recommended for people at risk. For example, members of families where there is a sick person and medical workers who encounter this infection.
In our country, general compulsory vaccination is carried out only during epidemics. In other cases, doctors recommend, but do not force, vaccination against typhoid fever.

In recent years, tourists who are planning to visit Asia, South America and Africa have also been vaccinated against typhoid fever. You may not be allowed into countries that are dangerous for typhoid fever without a vaccination certificate. You can clarify this issue with tour operators. The vaccination must be done no later than 1-2 weeks before departure so that immunity has time to form. It helps protect travelers and their families and prevent the spread of this disease in Russia.

How effective are typhoid fever vaccinations?

Efficiency varies slightly among different manufacturers, but is approximately the same. It is 60-75%. This does not mean that the vaccine has no effect at all on the remaining 25-40% of people. If they get sick, it will be more mild form.
Remember that the vaccine does not guarantee against infection. Therefore, even if you were vaccinated before your trip, you will still have to take precautions.

What vaccines are used?

Hygiene

But each of us must take care of our own health. Especially in countries where typhoid fever is common. Follow basic safety rules:

• drink only store-bought water
• don't buy food on the streets
• if there is no other choice, buy dishes that have been boiled/fried, and not salads or desserts with cream
• wash your hands after using the toilet and before eating
• do not swim in open bodies of water where sewerage may enter