Holidaymakers at risk as doctors run out of typhoid vaccine

http://www.guardian.co.uk/travel/2012/dec/25/typhoid-vaccine-shortage-holiday-risk

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Travellers jetting off to exotic climes this winter face a scramble to get immunised against typhoid, because of a UK shortage of vaccine against the potentially fatal disease.

Immunisation against typhoid fever is usually provided free of charge on the NHS but many GP surgeries across the country say they have run out. A number of travel clinics, which charge for vaccinations, are in the same situation.

The shortage is the knock-on effect of a recall in October by Sanofi Pasteur MSD of 16 batches of its injectable typhoid vaccine Typhim Vi, equivalent to 88% of its stock. It warned that anyone vaccinated between 7 January 2011 and the recall could be affected, amounting to as many as 729,606 people, according to the Medicines and Healthcare Products Regulatory Agency (MHRA). Despite the supply problem, the Health Protection Agency said fewer cases of typhoid had been recorded in the UK in 2012 so far than in any of the previous three years.

A spokesman for Sanofi Pasteur said: "Stocks of Typhim Vi are still in short supply and this may continue into the early part of 2013."

The shortage has been compounded by GlaxoSmithKline, another manufacturer of injectable typhoid vaccines, deciding last year to concentrate on making other products for global childhood vaccination programmes, which are rated as higher priorities by the World Health Organisation. As a result, GSK says its injectable typhoid vaccine, Typherix, will not be available until at least the second quarter of 2014.

Typhoid is contracted from bacteria in contaminated food or water and occurs mostly in areas with poor sanitation. It is contagious and is spread through faeces and urine. It occurs mainly in Asia but also in Africa and parts of South America. Most patients suffer fever and headache but more severe effects such as intestinal bleeding and pneumonia are possible and it can be fatal if not treated with antibiotics. There are about 250 cases of typhoid in England, Wales and Northern Ireland each year, most contracted during foreign travel.

Many travel clinics only have stocks of the oral vaccine Vivotif – the effectiveness of which is reduced if the patient is taking antibiotics or antimalarials, and which is only suitable for people aged six and over – or the combined hepatitis A and typhoid injectable vaccines, which are only suitable for people aged 15 or 16 (depending on the manufacturer) upwards. Typhim Vi is suitable for all aged two and over.

A spokeswoman for Crucell, manufacturer of Vivotif, said the shortage of alternatives meant availability of Vivotif was "on and off".

A Department of Health spokesman said: "Typhoid is rare in this country and is usually associated with travel to countries where sanitation is inadequate.

"The vaccine is still available and we are working with manufacturers to help ensure that current supply problems are resolved as soon as possible."