Travel Medicine

Emerging Infectious Diseases and Other Conditions

Typhoid Fever

What is typhoid fever?

Typhoid fever is a life-threatening bacterial infection caused by the bacterium Salmonella Typhi (S. typhi). Typhoid fever is common in developing countries, where it affects about 12.5 million persons each year. About 400 cases occur in the United States each year, and about 70 percent of those are acquired by overseas travelers.

How is typhoid fever spread?

S. typhi live only in humans, and are carried in the bloodstream and intestinal tracts of people who have typhoid fever. A small number of persons, referred to as carriers, recover from typhoid fever but continue to carry the bacteria.

Both the carriers and the people who have active typhoid fever shed S. typhi in their stools. Typhoid fever is spread by consuming food or beverages that have been handled by a person who is shedding S. typhi, or if sewage contaminated with S. typhi bacteria gets into water used for drinking or washing food.

What are symptoms of typhoid fever?

When S. typhi bacteria are consumed, they multiply and spread into the bloodstream. The body reacts with signs and symptoms such as:

a sustained fever as high as 103 to 104 F (39 to 40 C)
weakness
stomach pains
headache
loss of appetite
sometimes a rash of flat, rose-colored spots

How is typhoid fever diagnosed?

Typhoid fever can be diagnosed using a blood test or stool sample to determine the presence of S. typhi bacteria.

How can typhoid fever be prevented?

Several vaccinations for typhoid are available. One is given orally and the other by one injection. They both have equal potency. When traveling to an area where typhoid is common, consider being vaccinated against typhoid. Vaccinations must be given at least 2 weeks before travel so that the vaccine has time to take effect. The typhoid vaccine can lose effectiveness after several years, so a booster vaccination may be necessary.

Other preventives for typhoid fever are:

only use water that has been boiled or chemically disinfected for:

drinking, or preparing beverages such as tea or coffee

brushing teeth

washing face and hands

washing fruits and vegetables

washing eating utensils and food preparation equipment

washing the surfaces of tins, cans, and bottles that contain food or beverages

do not eat food or drink beverages from unknown sources -- drink bottled water or carberated beverages, etc...

any raw food could be contaminated, including:

previously peeled fruits, vegetables, salad greens

unpasteurized milk and milk products

raw meat

shellfish

Taking antibiotics is not a preventive for typhoid fever.

How may typhoid fever be treated?

See a doctor immediately if you think you have been exposed to typhoid fever. People who do not get treatment may continue to have fever for weeks or months, and may eventually die from complications. Treatment will probably include an antibiotic to treat the disease. Specific treatment will be determined by your physician(s) based on:

your overall health and medical history
extent of the disease
your tolerance for specific medications, procedures, or therapies
expectations for the course of the disease
your opinion or preference

It is important to remember that the danger of typhoid fever does not end when symptoms disappear. You could still be carrying S. typhi and the illness could return, or you could pass the disease to other people. People who have typhoid fever should:

continue taking the prescribed antibiotics for as long your physician determines is necessary.
wash your hands carefully with soap and water each time you use the bathroom.
not prepare or serve food for other people.
make sure you have a series of stool cultures to ensure that no S. typhi bacteria remain in your body.

This page was last updated on: February 14, 2008.

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