The heat phenol inactivated injected whole cell shot has an effectiveness rate of 65 per cent but causes severe adverse reactions in one quarter of patients (Infect Control & Hosp Epidemiology, 1991; 12: 168-72).
The typhoid vaccine should not be used in children under one year, and its harmful effects are worse in people over 35. The interaction of the fever (caused by the shots) and an underlying heart condition can cause shortness of breath, dehydration and fever (Washington Times, February 23, 1993).
Pasteur Merieux's new live Typhim VI vaccine, a polysaccharide vaccine, is purported to work better and cause fewer side effects than previously available vaccines (Military Medicine, 1990; 155 (6): 272-4). In practice, this means an effectiveness rate of between 64 per cent and 81 per cent in countries where the disease is endemic (GP, May 22, 1992). The manufacturer warns that Typhim's effectiveness could be lowered if you have an immune disorder or are already receiving treatment that lowers your immunity. As with any vaccine, if you've already had a severe reaction to Typhim VI you should not receive it again, and it shouldn't be administered to children over 6 (Infec Con & Hosp Epid, March 1991; 12 (3): 168-172).
Side effects from the oral vaccine include abdominal discomfort, nausea, vomiting, fever, headache, and rash. The most common side effect from the injection is redness, hardening and tenderness in the skin, which occurs in most patients. Fever, nausea, headache and flu like symptoms have been reported in 8 per cent of patients. People who receive the shot have fewer side effects if it is given into the skin (ie, intradermally), rather than under it (J of App Phys, June 1992; 72 (6): 2322-8). Other reports of side effects include loss of consciousness, abdominal pain, vomiting, hypotension, arthralgia, kidney problems, neutropenia (lowering of blood cells) and allergic shock.
This is a well known disease that has plagued the tropics relentlessly. Yellow fever is a viral disease transmitted to humans by mosquitoes. You may not be able to avoid it if you are travelling to certain parts of Africa or South America, since you need a certificate of vaccination upon entry. The vaccine must be given at least 10 days before entering a country requiring it.
If you are dead set against the shot, it may be wise to avoid any areas requiring the certificate. Eastern and southern African states have hitherto been free of epidemic yellow fever, hence routine vaccination is not a policy in these countries.
On paper, the shot seems effective. In one study, the shot produced antibodies in 93 per cent of adults (J Biol Standards, 1986; 14: 289-95), although this fell to 60 per cent in babies (W Afr J Med, 1990; 9: 200-3).
This vaccine, which is given live, can cause encephalitis (inflammation of the brain), especially in children under nine months, although a four year trial among pregnant women and its effect on their newborn children showed no significant side effects (Transactions of the Royal Soc of Trop Med & Hyg, May-June 1993; 87 (3): 337-9).
The vaccine has also been shown to cause urticaria, bursitis, jaundice, neurititis, myalgia and low grade fever. About a quarter of patients react, and 11 per cent suffer post vaccine syndrome of multiple pains and fever (Bul Soc Path Exotique et de Ses Fil, 1986; 79: 772-6). In one African study, a number of patients developed gangrene of the arm just a few hours after being inoculated at Shaki, Nigeria in May, 1987 (Revue Roumaine de Virologie, Jan-Jun 1994; 45 (1-2): 25-30). Five went into a coma and died. Nevertheless it may have been that poor hygiene and possible contamination played a part.