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The Effect of Oral and Parenteral Typhoid Vaccination

Arch Intern Med. 1990;150(11):2422. doi:10.1001/archinte.1990.00390220148046.
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To the Editor.—The review by Schwartz et al1 on the incidence of enteric fever in tourists and expatriates in Kathmandu, Nepal, was a valuable reminder of the increased risk of these illnesses on the Indian subcontinent. We have a problem, however, with the major conclusion that typhoid vaccine should be recommended to all travelers to this area of the world. Information that is not given in the text is the life-style of the stricken traveler/resident. As you know, in traveler's health we determine the recommended immunizations for an individual not only by the area visited but also by risk. With the dramatic increase in escorted tours that include India and Nepal, it may be unreasonable to extrapolate from your data that all of these people should be inoculated against typhoid. It would be of value to classify your patients by life-style and then perhaps to re-evaluate the data


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