What is typhoid

Typhoid fever and paratyphoid fever are life-threatening illnesses caused by Salmonella serotype Typhi and Salmonella serotype Paratyphi, respectively. Typhoid fever is a life-threatening illness caused by the bacterium Salmonella Typhi. Typhoid fever is a Salmonella Typhi infection that can spread throughout the body, affecting many organs. Without prompt treatment, typhoid fever can cause serious complications and can be fatal.

Typhoid causes a high fever, fatigue, weakness, stomach pains, headache, loss of appetite, and sometimes a rash. If it is not treated, it can kill up to 30% of people who get it.

• Typhoid infection triggers a high temperature (can reach 103–104° F [39–40° C]), stomach pain and constipation or diarrhea, headache, general aches and pains and a cough.
• If you have a high fever and feel very ill, see a doctor immediately. If you are traveling outside the United States, you can usually call the US consulate (https://www.usembassy.gov/) for a list of recommended doctors. For more information about medical care abroad, see Getting Health Care Abroad and a list of International Joint Commission-accredited facilities (https://www.jointcommissioninternational.org/).
• Left untreated, the bacteria can get into the bloodstream and spread to other areas of the body. This can cause the symptoms of typhoid fever to get worse during the weeks after infection.
• If organs and tissues become damaged as a result of the typhoid fever infection, it can cause serious complications, such as internal bleeding or a section of the bowel splitting open.
• Some people who get typhoid become “carriers,” who can spread the disease to others. Generally, people get typhoid from contaminated food or water.

Typhoid fever is not common in the United States, Canada, Western Europe, Australia, or Japan, but it is common in many other countries ¹. Typhoid fever affects an estimated 26 million people worldwide each year and kills about 200,000. In the United States, about 350 people are diagnosed with typhoid fever each year, most often after traveling outside of the United States to countries such as India, Bangladesh, and Pakistan. These cases do not include people who do not seek medical care, who are not tested for either disease, or whose disease is not reported to Centers for Disease Control and Prevention (CDC).

Most people in the United States with typhoid fever or paratyphoid fever become infected while traveling abroad, most often to countries where these diseases are common. If you are traveling to a country where typhoid fever is common, consider being vaccinated against typhoid fever. Visit a doctor or travel clinic to discuss options. Remember that you should complete the vaccinations at least 1–2 weeks (depending on vaccine type) before you travel so that the vaccine has time to take effect. Typhoid vaccines lose effectiveness after several years. If you were vaccinated in the past, ask your doctor to if it is time for a booster vaccination. Taking antibiotics will not prevent typhoid fever; they only help treat it.

Typhoid fever is highly contagious. An infected person can pass the bacteria out of their body in their poop (feces) or, less commonly, in their pee (urine).

If someone else eats food or drinks water that’s been contaminated with a small amount of infected poop or urine, they can become infected with the Salmonella Typhi bacteria and develop typhoid fever.

Transmission through sexual contact, especially among men who have sex with men, has been documented rarely ².

Typhoid fever is treated with antibiotics. Resistance to antibiotics is increasing in the bacteria that cause typhoid fever and paratyphoid fever. When bacteria are resistant to antibiotics, the bacteria are not killed and their growth is not stopped. To help guide treatment, your doctor may order special tests to see if your type of Salmonella is antibiotic-resistant. People who do not get treatment can continue to have fever for weeks or months, and can develop complications. As many as 30% of people who do not get treatment die from complications of the typhoid fever infection.

The danger from typhoid fever or paratyphoid fever doesn’t end when symptoms disappear.

Even if your symptoms seem to go away, you may still be carrying Salmonella Typhi or Salmonella Paratyphi. If so, the illness could return, or you could pass the bacteria to other people. In fact, if you are a health care worker or work at a job where you handle food or care for small children, you might be barred (prevented) legally from going back to work until a doctor has determined you no longer carry the bacteria.

If you are being treated for typhoid fever or paratyphoid fever, it is important to do the following:

• Keep taking antibiotics for as long as the doctor has recommended.
• Wash your hands carefully with soap and water after using the bathroom, and do not prepare or serve food for other people. This will lower the chance that you will pass the bacteria on to someone else.
• Have your doctor test your stool (poop) to be sure no Salmonella Typhi or Salmonella Paratyphi bacteria remain in your body.

How is typhoid spread?

The Salmonella typhi bacteria will be in the poop (feces) of an infected person after they have been to the toilet.

If they don’t wash their hands properly afterwards, they can contaminate any food they touch. Anyone else who eats this food may also become infected.

Less commonly, the Salmonella typhi bacteria can be passed out in an infected person’s pee (urine).

Again, if an infected person handles food without washing their hands properly after peeing, they can spread the typhoid fever infection to someone else who eats the contaminated food.

In parts of the world with poor sanitation, infected human waste can contaminate the water supply.

People who drink contaminated water or eat food washed in contaminated water can develop typhoid fever.

Humans are the only source of these Salmonella typhi bacteria; no animal or environmental reservoirs have been identified.

Other ways typhoid fever can be contracted include:

• using a toilet contaminated with bacteria and touching your mouth before washing your hands
• eating seafood from a water source contaminated by infected poo or pee
• eating raw vegetables that have been fertilized with human waste
• contaminated milk products
• having oral or anal sex with a person who’s a carrier of Salmonella typhi bacteria

Typhoid carriers

Up to 1 in 20 people who survive typhoid fever without being treated will become carriers of the typhoid fever infection.

This means the Salmonella typhi bacteria continue to live in the carrier’s body and can be spread as normal in poop or pee, but the carrier doesn’t have any noticeable symptoms of the condition.

Is typhoid fever contagious?

People who are actively ill with typhoid fever or paratyphoid fever and people who are carriers of Salmonella Typhi or Salmonella Paratyphi bacteria can both spread the bacteria to other people. Carriers are people who have recovered from typhoid fever or paratyphoid fever but continue to carry the bacteria. About 1 in 20 people remain carriers after they’ve recovered. Both groups of people shed (excrete) Salmonella Typhi or Salmonella Paratyphi in their feces (poop).

Typhoid fever and paratyphoid fever are more common in areas of the world where water is more likely to be contaminated with sewage.

You can get typhoid fever or paratyphoid fever if:

• You eat food or drink a beverage that has been touched by a person who is shedding Salmonella Typhi or Salmonella Paratyphi and who has not washed their hands thoroughly after going to the bathroom.
• Sewage contaminated with Salmonella Typhi or Salmonella Paratyphi gets into water you drink.
• Sewage contaminated with Salmonella Typhi or Salmonella Paratyphi gets into water used to rinse food you eat raw.

When someone consumes a food or drink contaminated with Salmonella Typhi or Paratyphi, the bacteria can multiply and spread into the bloodstream, causing typhoid fever or paratyphoid fever.

Can animals spread typhoid fever or paratyphoid fever to people?

No. Salmonella Typhi and Salmonella Paratyphi live only in humans.

Animals can spread other kinds of Salmonella to humans, so it’s important to wash your hands after contact with animals, their feces (poop), or places where animals live, feed, or roam.

How the typhoid fever bacteria affect your body

After eating food or drinking water contaminated with the Salmonella typhi bacteria, the bacteria moves down into the digestive system, where they will quickly multiply. The incubation period of typhoid and paratyphoid infections is 6–30 days ². The onset of illness is insidious, with gradually increasing fatigue and a fever that increases daily from low-grade to as high as 102°F–104°F (38°C–40°C) by the third to fourth day of illness ². Headache, malaise, and anorexia are nearly universal, and abdominal pain, diarrhea, or constipation are common. Hepatosplenomegaly can often be detected. A transient, macular rash of rose-colored spots can occasionally be seen on the trunk. Fever is commonly lowest in the morning, reaching a peak in late afternoon or evening. This clinical presentation is often confused with malaria, and typhoid fever should be suspected in a person with a history of travel to an endemic area who is not responding to antimalarial medication. Untreated, the disease can last for a month. The serious complications of typhoid fever generally occur after 2–3 weeks of illness and may include life-threatening intestinal hemorrhage or perforation ².

Typhoid fever complications

Complications caused by typhoid fever usually only occur in people who haven’t been treated with appropriate antibiotics or who weren’t treated straight away.

In such cases, about 1 in 10 people experience complications, which usually develop during the third week of infection.

The 2 most common serious complications in untreated typhoid fever are:

• internal bleeding in the digestive system
• splitting (perforation) of a section of the digestive system or bowel, which spreads the infection to nearby tissue

These serious complications may develop in the third week of illness.

Internal bleeding

Most internal bleeding that occurs in typhoid fever isn’t life threatening, but it can make you feel very unwell.

Symptoms of internal bleeding include:

• feeling tired all the time
• breathlessness
• pale skin
• an irregular heartbeat
• vomiting blood
• poop (stools) that are very dark or tar-like

A blood transfusion may be required to replace lost blood, and surgery can be used to repair the site of the bleeding.

Bowel Perforation

Intestines perforation is potentially a very serious complication. This is because bacteria that live in your digestive system can move into your stomach and infect the lining of your abdomen (the peritoneum). This is known as peritonitis.

Peritonitis is a medical emergency as the tissue of the peritoneum is usually sterile (germ-free). Unlike other parts of the body, such as the skin, the peritoneum doesn’t have an inbuilt defence mechanism for fighting infection.

In peritonitis, the infection can rapidly spread into the blood (sepsis) before spreading to other organs. This carries the risk of multiple organ failure. If it isn’t treated properly, it may result in death.

The most common symptom of peritonitis is sudden abdominal pain that gets progressively worse.

If you’re diagnosed with peritonitis, you’ll be admitted to hospital, where you’ll be treated with antibiotic injections. This might take 10 to 14 days. Treatment usually involves being given antibiotics into a vein (intravenously). If your peritonitis was caused by kidney dialysis treatment, antibiotics may be injected directly into the stomach lining.

If you have regular kidney dialysis your doctor might discuss a different way of doing it until the peritonitis has been treated.

Surgery will then be used to seal the hole in your intestinal wall. If part of the stomach lining has been seriously damaged by infection you may need surgery to remove it. Sometimes pus-filled swellings (abscesses) develop in the lining and need to be drained with a needle under local anaesthetic. You might also need an operation to deal with the cause of the peritonitis.

Other, less common complications

Other possible complications include:

• Inflammation of the heart muscle (myocarditis)
• Inflammation of the lining of the heart and valves (endocarditis)
• Pneumonia
• Inflammation of the pancreas (pancreatitis)
• Kidney or bladder infections
• Infection and inflammation of the membranes and fluid surrounding your brain and spinal cord (meningitis)
• Psychiatric problems, such as delirium, hallucinations and paranoid psychosis

With prompt treatment, nearly all people in industrialized nations recover from typhoid fever. Without treatment, some people may not survive complications of typhoid fever.

Typhoid fever symptoms

Typhoid fever and paratyphoid fever have similar symptoms̵. People usually have a sustained fever (one that doesn’t come and go) that can be as high as 103–104° F (39–40° C).

Other symptoms of typhoid fever and paratyphoid fever include

• Weakness
• Stomach pain
• Headache
• Diarrhea or constipation
• Cough
• Loss of appetite

Some people with typhoid fever or paratyphoid fever develop a rash of flat, rose-colored spots.

Later illness if you don’t receive treatment, you may:

• Become delirious
• Lie motionless and exhausted with your eyes half-closed in what’s known as the typhoid state

In addition, life-threatening complications often develop at this time.

In some people, signs and symptoms may return up to two weeks after the fever has subsided.

What do you do if you think you have typhoid fever or paratyphoid fever?

The only way to know for sure if an illness is typhoid fever or paratyphoid fever is to have a sample of blood or stool (poop) tested for Salmonella Typhi or Salmonella Paratyphi.

If you have a high fever and feel very ill, see a doctor immediately. If you are traveling outside the United States, you can usually call the US consulate (https://www.usembassy.gov/) for a list of recommended doctors. For more information about medical care abroad, see Getting Health Care Abroad and a list of International Joint Commission-accredited facilities (https://www.jointcommissioninternational.org/).

Typhoid causes

Typhoid fever is caused by a type of bacteria called Salmonella typhi.

Although they’re related, Salmonella typhi and the bacteria responsible for salmonellosis (food poisoning), another serious intestinal infection, aren’t the same.

How the infection spreads

The Salmonella typhi bacteria will be in the poo (stools) of an infected person after they have been to the toilet.

If they don’t wash their hands properly afterwards, they can contaminate any food they touch. Anyone else who eats this food may also become infected.

Less commonly, the Salmonella typhi bacteria can be passed out in an infected person’s pee (urine).

Again, if an infected person handles food without washing their hands properly after peeing, they can spread the infection to someone else who eats the contaminated food.

In parts of the world with poor sanitation, infected human waste can contaminate the water supply.

People who drink contaminated water or eat food washed in contaminated water can develop typhoid fever.

Other ways typhoid fever can be contracted include:

• using a toilet contaminated with bacteria and touching your mouth before washing your hands
• eating seafood from a water source contaminated by infected poo or pee
• eating raw vegetables that have been fertilized with human waste
• contaminated milk products
• having oral or anal sex with a person who’s a carrier of Salmonella typhi bacteria

Typhoid carriers

Up to 1 in 20 people who survive typhoid fever without being treated will become carriers of the infection.

This means the Salmonella typhi bacteria continue to live in the carrier’s body and can be spread as normal in poo or pee, but the carrier doesn’t have any noticeable symptoms of the condition.

Risk factors for getting typhoid fever

Typhoid fever remains a serious worldwide threat — especially in the developing world — affecting an estimated 26 million or more people each year. The disease is established (endemic) in India, Southeast Asia, Africa, South America and many other areas.

Worldwide, children are at greatest risk of getting the disease, although they generally have milder symptoms than adults do.

If you live in a country where typhoid fever is rare, you’re at increased risk if you:

• Work in or travel to areas where typhoid fever is established (endemic)
• Work as a clinical microbiologist handling Salmonella typhi bacteria
• Have close contact with someone who is infected or has recently been infected with typhoid fever
• Drink water contaminated by sewage that contains Salmonella typhi

Typhoid prevention

Typhoid fever and paratyphoid fever are common in many parts of the world, but not in industrialized regions such as the United States, Canada, Western Europe, Australia, and Japan.

Vaccination against typhoid fever is recommended if you’re traveling to parts of the world where the condition is common.

Carefully selecting what you eat and drink when you travel is also important. This is because the typhoid fever vaccines do not work 100% of the time, and there is no paratyphoid fever vaccine. Avoiding risky foods will also help protect you from other illnesses, including travelers’ diarrhea, cholera, dysentery, and hepatitis A.

High-risk areas

Typhoid is found throughout the world, but it’s more likely to occur in areas where there’s poor sanitation and hygiene.

High-risk areas include:

• the Indian subcontinent
• Africa
• East and southeast Asia
• the Caribbean
• Central and South America

Vaccination is strongly recommended if you’re going to be staying or working with local people, or if you’re going to be staying for prolonged periods in areas where sanitation and food hygiene are likely to be poor.

In the US, most people who get typhoid fever develop it while visiting India, Pakistan or Bangladesh. It’s therefore particularly important that you’re vaccinated if you’re visiting these countries.

When you travel to areas of risk, remember to “Boil it, cook it, peel it, or forget it.”

• If you drink water, buy it bottled or bring it to a rolling boil for 1 minute before you drink it. Bottled carbonated water is safer than uncarbonated water.
• Ask for drinks without ice, unless the ice is made from bottled or boiled water. Avoid popsicles and flavored ices that may have been made with contaminated water.
• Eat foods that have been thoroughly cooked and are still hot and steaming.
• Avoid raw vegetables and fruits that cannot be peeled. Lettuce can remain contaminated even after it is washed.
• When you eat raw fruit or vegetables that can be peeled, peel them yourself. (Wash your hands with soap first.)
• Avoid foods and beverages from street vendors.

Risky foods and drinks

Raw food

Raw food should generally be avoided. Raw fruits or vegetables may be safe if you can peel them yourself or wash them in safe (bottled or disinfected) water. Steer clear of platters of cut-up fruit or vegetables. (Did you see the hands that cut them? Can you be sure those hands were clean?) Salads are especially problematic because shredded or finely cut vegetables offer a lot of surface area for germs to grow on. Also avoid fresh salsas or other condiments made from raw fruits or vegetables. Raw meat or seafood may contain germs; this includes raw meat that is “cooked” with citrus juice, vinegar, or other acidic liquid (such as ceviche, a dish of raw seafood marinated in citrus juice).

Street food

Street vendors in developing countries may not be held to the same hygiene standards as restaurants (which may be low to begin with), so eat food from street vendors with caution. If you choose to eat street food, apply the same rules as to other food; for example, if you watch something come straight off the grill (cooked and steaming hot), it’s more likely to be safe.

Bushmeat

Bushmeat refers to local wild game, generally animals not typically eaten in the United States, such as bats, monkeys, or rodents. Bushmeat can be a source of animal-origin diseases, such as Ebola or SARS, and is best avoided.

Tap water

In most developing countries, tap water should probably not be drunk, even in cities. This includes swallowing water when showering or brushing your teeth. In some areas, it may be advisable to brush your teeth with bottled water. Tap water can be disinfected by boiling, filtering, or chemically treating it, for example with chlorine.

Fountain drinks

Sodas from a fountain are made by carbonating water and mixing it with flavored syrup. Since the water most likely came from the tap, these sodas are best avoided. Similarly, juice from a fountain is most likely juice concentrate mixed with tap water and should be avoided.

Ice

Avoid ice in developing countries; it was likely made with tap water.

Freshly squeezed juice

If you washed the fruit in safe water and squeezed the juice yourself, drink up. Juice that was squeezed by unknown hands may be risky. The same goes for ice pops and other treats that are made from freshly squeezed juice.

Usually Safe Foods and Drinks

Hot food

High heat kills the germs that cause travelers’ diarrhea, so food that is cooked thoroughly is usually safe as long as it is served steaming hot. Be careful of food that is cooked and allowed to sit at warm or room temperatures, such as on a buffet. It could become contaminated again.

Dry or packaged food

Most germs require moisture to grow, so food that is dry, such as bread or potato chips, is usually safe. Additionally, food from factory-sealed containers, such as canned tuna or packaged crackers, is safe as long as it was not opened and handled by another person.

Bottled or canned drinks

Drinks from factory-sealed bottles or cans are safe; however, dishonest vendors in some countries may sell tap water in bottles that are “sealed” with a drop of glue to mimic the factory seal. Carbonated drinks, such as sodas or sparkling water, are safest since the bubbles indicate that the bottle was sealed at the factory. If drinking directly from a can, wipe off the lip of the can before your mouth comes into contact with it.

Hot drinks

Hot coffee or tea should be safe if it is served steaming hot. It’s okay to let it cool before you drink it, but be wary of coffee or tea that is served only warm or at room temperature. Be careful about adding things that may be contaminated (cream, lemon) to your hot drinks (sugar should be fine; see “Dry food” above).

Milk

Pasteurized milk from a sealed bottle should be okay, but watch out for milk in open containers (such as pitchers) that may have been sitting at room temperature. This includes the cream you put in your coffee or tea. People who are pregnant or have weakened immune systems should stay away from unpasteurized milk or other dairy products (cheese, yogurt).

Alcohol

The alcohol content of most liquors is sufficient to kill germs; however, stick to the guidelines above when choosing mixers and avoid drinks “on the rocks” (see “Ice” above). The alcohol content of beer and wine is probably not high enough to kill germs, but if it came from a sealed bottle or can, it should be okay.

Prevent infecting others

If you’re recovering from typhoid fever, these measures can help keep others safe:

• Take your antibiotics. Follow your doctor’s instructions for taking your antibiotics, and be sure to finish the entire prescription.
• Wash your hands often. This is the single most important thing you can do to keep from spreading the infection to others. Use hot, soapy water and scrub thoroughly for at least 30 seconds, especially before eating and after using the toilet.
• Avoid handling food. Avoid preparing food for others until your doctor says you’re no longer contagious. If you work in the food service industry or a health care facility, you won’t be allowed to return to work until tests show that you’re no longer shedding typhoid bacteria.

Typhoid fever vaccine

There are two vaccines to prevent typhoid. One is an inactivated (killed) vaccine gotten as a shot. The other is a live, attenuated (weakened) vaccine which is taken orally (by mouth). But neither typhoid vaccine is 100% effective, so you should always take precautions when eating food and drinking water abroad.

• Inactivated typhoid vaccine – given as a single injection. Vi capsular polysaccharide vaccine (ViCPS) (Typhim Vi, manufactured by Sanofi Pasteur) for intramuscular use.
  • Primary vaccination with ViCPS consists of one 0.5 mL (25 mg) dose administered intramuscularly. One dose should be given ≥2 weeks before travel. The manufacturer does not recommend the vaccine for infants and for children <2 years old. A booster dose is recommended every 2 years for people who remain at risk.
• Live typhoid vaccine (oral) – given as 4 capsules to take on alternate days. Oral live attenuated vaccine (Vivotif, manufactured from the Ty21a strain of serotypeTyphi by PaxVax).
  • Primary vaccination with oral Ty21a vaccine consists of 4 capsules, 1 taken every other day. The capsules should be kept refrigerated (not frozen), and all 4 doses must be taken to achieve maximum efficacy. Each capsule should be taken with cool liquid no warmer than 98.6°F (37°C), approximately 1 hour before a meal and ≥2 hours after a previous meal. This regimen should be completed ≥1 week before potential exposure. What to do when a dose of the oral vaccine is missed or taken late is unclear. Some suggest that minor deviations in the dosing schedule, such as taking a dose one day late, may not have a large effect on how well the vaccine works. However, we are unaware of any studies showing the effect of such deviations; thus, if 4 doses are not completed as directed, optimal immune response may not be achieved. The vaccine manufacturer recommends that Ty21a not be administered to infants or to children aged <6 years. A booster dose is recommended every 5 years for people who remain at risk.

Both typhoid vaccines protect 50%–80% of recipients; travelers should be reminded that typhoid immunization is not 100% effective, and typhoid fever could still occur ². Available typhoid vaccines offer no protection against paratyphoid fever.

Routine typhoid vaccination is not recommended in the United States, but typhoid vaccine is recommended for:

• Travelers to parts of the world where typhoid is common. (NOTE: typhoid vaccine is not 100% effective and is not a substitute for being careful about what you eat or drink).
• People in close contact with a typhoid carrier.
• Laboratory workers who work with Salmonella Typhi bacteria.

Inactivated typhoid vaccine (shot)

• One dose provides protection. It should be given at least 2 weeks before travel to allow the vaccine time to work.
• A booster dose is needed every 2 years for people who remain at risk.

Live typhoid vaccine (oral)

• Four doses: one capsule every other day for a week (day 1, day 3, day 5, and day 7). The last dose should be given at least 1 week before travel to allow the vaccine time to work.
• Swallow each dose about an hour before a meal with a cold or lukewarm drink. Do not chew the capsule.
• A booster dose is needed every 5 years for people who remain at risk.

Either vaccine may safely be given at the same time as other vaccines.

Table 1. Vaccines to prevent typhoid fever

VACCINATION	AGE (years)	DOSE, MODE OF ADMINISTRA- TION	NUMBER OF DOSES	DOSING INTERVAL	BOOSTING INTERVAL
Oral, Live, Attenuated Ty21a Vaccine (Vivotif)1
Primary series	≥6	1 capsule,2 oral	4	48 hours	Not applicable
Booster	≥6	1 capsule,2 oral	4	48 hours	Every 5 years
Vi Capsular Polysaccharide Vaccine (Typhim Vi)
Primary series	≥2	0.50 mL, intramuscular	1	Not applicable	Not applicable
Booster	≥2	0.50 mL, intramuscular	1	Not applicable	Every 2 years

¹The vaccine must be kept refrigerated (35.6°F–46.4°F, 2° C–8°C).
²Administer with cool liquid no warmer than 98.6°F (37°C).

[Source ²]

Some people should not get typhoid vaccine or should wait.

Inactivated typhoid vaccine (shot)

• Should not be given to children younger than 2 years of age.
• Anyone who has had a severe reaction to a previous dose of this vaccine should not get another dose.
• Anyone who has a severe allergy to any component of this vaccine should not get it. Tell your doctor if you have any severe allergies.
• Anyone who is moderately or severely ill at the time the shot is scheduled should usually wait until they recover before getting the vaccine.

Live typhoid vaccine (oral)

• Should not be given to children younger than 6 years of age.
• Anyone who has had a severe reaction to a previous dose of this vaccine should not get another dose.
• Anyone who has a severe allergy to any component of this vaccine should not get it. Tell your doctor if you have any severe allergies.
• Anyone who is moderately or severely ill at the time the vaccine is scheduled should usually wait until they recover before getting it. Tell your doctor if you
• have an illness involving vomiting or diarrhea.
• Anyone whose immune system is weakened should not get this vaccine. They should get the typhoid shot instead. This includes anyone who:
  • has HIV/AIDS or another disease that affects the immune system,
  • is being treated with drugs that affect the immune system, such as steroids for 2 weeks or longer,
  • has any kind of cancer,
  • is taking cancer treatment with radiation or drugs.
• Oral typhoid vaccine should not be given until at least 3 days after taking antibiotics.

Ask your doctor for more information.

What are the risks from typhoid vaccine?

Like any medicine, a vaccine could cause a serious problem, such as a severe allergic reaction. The risk of typhoid vaccine causing serious harm, or death, is extremely small. Serious problems from either typhoid vaccine are very rare.

Inactivated typhoid vaccine (Shot)

• Mild reactions
  • Fever (up to about 1 person in 100)
  • Headache (up to about 1 person in 30)
  • Redness or swelling at the site of the injection (up to about 1 person in 15)

Live typhoid vaccine (Oral)

• Mild reactions
  • Fever or headache (up to about 1 person in 20)
  • Stomach pain, nausea, vomiting, rash (rare)

Typhoid fever diagnosis

You should see your doctor if you think you have typhoid fever, particularly if you have recently returned from traveling abroad. Infection with typhoid or paratyphoid fever results in a low-grade septicemia. Because there is no definitive serologic test for typhoid or paratyphoid fever, the initial diagnosis often has to be made clinically. The combination of a history of risk for infection and a gradual onset of fever that increases in severity over several days should raise suspicion of typhoid or paratyphoid fever. Typhoid fever is a nationally notifiable disease.

Your doctor will want to know whether you have traveled to parts of the world where the infection is present, or whether you have been in close contact with someone who’s traveled to these areas. Typhoid fever is most common in the Indian subcontinent, Africa, southeast Asia, Central and South America.

Testing for typhoid fever

Although blood culture is the mainstay of diagnosis in typhoid and paratyphoid fever, a single culture is positive in only approximately 50% of cases. Multiple cultures increase the sensitivity and may be required to make the diagnosis.

A diagnosis of typhoid fever can also be confirmed by analyzing samples of blood, poop (stools) or pee (urine). These will be examined under a microscope for the Salmonella typhi bacteria that cause the condition. The bacteria aren’t always detected the first time, so you may need to have a series of tests.

Bone marrow culture increases the diagnostic yield to approximately 80% of cases and is relatively unaffected by prior or concurrent antibiotic use. But getting the sample is both time-consuming and painful, so it’s usually only used if other tests are inconclusive.

Stool culture is not usually positive during the first week of illness, so blood culture is preferred. Urine culture has no higher diagnostic yield than stool culture for acute cases.

If typhoid fever is confirmed, other members of your household may also need to be tested in case you have passed the infection on to them.

Typhoid treatment

Typhoid fever is treated with antibiotics. Resistance to antibiotics is increasing in the bacteria that cause typhoid fever and paratyphoid fever. When bacteria are resistant to antibiotics, the bacteria are not killed and their growth is not stopped. To help guide treatment, your doctor may order special tests to see if your type of Salmonella is antibiotic-resistant.

• People who do not get treatment can continue to have fever for weeks or months, and can develop complications. As many as 30% of people who do not get treatment die from complications of the infection.

If typhoid fever is diagnosed in its early stages, a course of antibiotic tablets may be prescribed for you. Most people need to take these for 7 to 14 days.

Some strains of the Salmonella typhi bacteria that cause typhoid fever have developed a resistance to one or more types of antibiotics.

This is increasingly becoming a problem with typhoid infections originating in southeast Asia.

Any blood, poop (stool) or pee (urine) samples taken during your diagnosis will usually be tested in a laboratory to determine which strain you’re infected with, so you can be treated with an appropriate antibiotic.

Your symptoms should begin to improve within 2 to 3 days of taking antibiotics. But it’s very important you finish the course to ensure the bacteria are completely removed from your body.

Make sure you rest, drink plenty of fluids and eat regular meals. You may find it easier to eat smaller meals more frequently, rather than 3 larger meals a day.

You should also maintain good standards of personal hygiene, such as regularly washing your hands with soap and warm water, to reduce the risk of spreading the infection to others.

Contact your doctor as soon as possible if your symptoms get worse or you develop new symptoms while being treated at home.

In a small number of cases, the symptoms or infection may recur. This is known as a relapse.

Staying off work or school

Most people being treated for typhoid fever can return to work or school as soon as they start to feel better.

The exceptions to this are people who work with food and vulnerable people, such as children under 5, the elderly and those in poor health.

In these cases, you or your child should only return to work or nursery after tests on 3 poo samples taken at 48-hour intervals have shown that the bacteria are no longer present.

Hospital treatment

Hospital admission is usually recommended if you have severe symptoms of typhoid fever, such as persistent vomiting, severe diarrhea or a swollen stomach.

As a precaution, young children who develop typhoid fever may be admitted to hospital.

In hospital, you’ll have antibiotic injections and you may also be given fluids and nutrients directly into a vein through an intravenous drip.

Surgery may be needed if you develop life-threatening complications of typhoid fever, such as internal bleeding or a section of your digestive system splitting. But this is very rare in people being treated with antibiotics.

Most people respond well to hospital treatment and improve within 3 to 5 days, but it may be several weeks until you’re well enough to leave hospital.

Relapses

Some people who are treated for typhoid fever experience a relapse, which is when symptoms return. In these cases, the symptoms usually return around a week after antibiotic treatment has finished.

The second time around, symptoms are usually milder and last for a shorter time than the original illness, but further treatment with antibiotics is usually recommended.

See your doctor as soon as possible if your symptoms return after treatment.

Long-term carriers

After your symptoms have passed, you should have another stool test to check whether there are still Salmonella typhi bacteria in your poop (feces).

If there are, you may have become a carrier of the typhoid infection. You may need to have a further 28-day course of antibiotics to “flush out” the bacteria.

Until test results show that you’re free of bacteria, avoid handling or preparing food.

It’s also very important that you wash your hands thoroughly after going to the toilet.

References

1. Typhoid Fever and Paratyphoid Fever. https://www.cdc.gov/typhoid-fever/sources.html
2. Chapter 3 Infectious Diseases Related to Travel. Typhoid & Paratyphoid Fever. https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/typhoid-paratyphoid-fever