Tropical Medicine Expert Opines on Failure to Provide Typhoid Vaccination

This case involves a diabetic Plaintiff who presented to a travel medicine clinic seeking health advice and vaccinations in preparation for an extended trip to a tropical country. The patient expected to recieve vaccinations and medications for the full range of tropical disease he might have encountered during his trip. However,during his visit to the clinic, there was no discussion or advice offered concerning typhoid, typhoid vaccinations, or medications. The patient was only provided with yellow fever injections and malaria pills. During his trip, the Plaintiff got sick, with a severe fever and multiple symptoms that were eventually linked to typhoid. It was alleged that the patient should have received a vaccination for typhoid, as well as medication for the treatment of typhoid should he have contracted it.

Question(s) For Expert Witness

1. Do you have extensive experience in tropical medicine, specifically typhoid?

2. Have you ever had a patient develop the outcome noted above?

3. Are you able to review records and assess the likelihood of typhoid infection?

Expert Witness Response E-018646

The CDC recommends typhoid vaccination for most travelers to this area of the world, especially those who are visiting friends or relatives, visiting smaller cities or rural areas, and for adventurous eaters. For immunocompromised persons, the injectable Typhium Vi vaccine is recommended for persons aged 2 or greater, and should be given at least 2 weeks before travel. Even if the patient was seen only 1 week before travel, I would have advised immunization with Typhium Vi due to the prolonged stay - the vaccine would have offered protection for the majority of the stay. As a general note, type 1 diabetics are at higher risk of complications of typhoid fever, and diabetic ketoacidosis can quickly result from infection. This increased risk and the limitations of the health care system in the destination country to treat complications are further reasons to vaccinate pre-travel. Treatment of typhoid fever is with either a 3rd generation cephalosporin or a fluoroquinolone.