Typhoid

Typhoid is spread through ingestion of food or water which is contaminated by faeces or urine from an infected person. If an infected person handles food without washing their hands properly after going to the toilet, they can spread the infection to someone else who eats the contaminated food.

In areas 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.

Typhoid fever can be spread by:

• Using a toilet contaminated with bacteria and touching the mouth before washing hands
• Eating seafood from a water source contaminated by infected faeces or urine
• Eating raw vegetables that have been fertilised with human waste
• Contaminated milk products
• Having oral or anal sex with a person who is a carrier of S. typhi bacteria

 Carriers

Up to 1 in 20 people who survive typhoid fever without being treated will become carriers of the infection. This means the S. typhi continue to live in the carrier’s body and can be spread as normal in faeces or urine, but the carrier does not have any noticeable symptoms of the condition.²

Typhoid fever is commonly found in parts of the world that have poor sanitation and limited access to clean water.

Worldwide, children are thought to be most at risk of developing typhoid fever. This may be because their body’s natural defence against germs is still developing. However, children with typhoid fever tend to have milder symptoms than adults.

In 2016, the global annual rate of typhoid fever was estimated to be around 11.8 million cases with 128,000 deaths per year.³

The areas with the highest rates of typhoid fever and paratyphoid fever are:

• The Indian subcontinent
• Africa
• South and South East Asia
• South America
• The Middle East
• Europe
• Central America

A summary map can be found here.⁴

Symptoms of typhoid fever:

The incubation period is usually between 7-14 days, but can be as short as three days, or as long as 30 days. Symptoms vary from mild to severe and life-threatening and may include:

• Fever
• Dehydration
• Headache
• Rash (rose-coloured spots which lose their colour with pressure)
• Stomach pain
• Loss of appetite
• Diarrhoea – more common in children
• Severe constipation – more common in adults
• Feeling sick (nausea)
• Cough

 Symptoms of paratyphoid fever:

 Paratyphoid fever is similar to typhoid; but it tends to come on more quickly, has milder symptoms, and lasts for a shorter time.⁵

Common complications include:

• Bleeding from the bowel
• Rupture of the bowel

These may be life-threatening and may require a surgical operation.⁶

Other possible complications include:

• Infection of the heart Infection of the nervous system
• Liver and gallbladder Inflammation of the pancreas
• Kidney failure
• Abscesses around the body
• Dehydration⁵

If experiencing headache, fever, stomach pains, cough or diarrhoea then seek medical advice promptly. This is regardless of the vaccination status  as vaccination does not guarantee complete protection.⁷

Typhoid fever can usually be successfully treated with a course of antibiotic medication. Hospital admission is only required for severe cases.

 Treatment at home

• Antibiotic medication – if typhoid is diagnosed in the early stage. This should be started as soon as possible and helps reduce the chances of serious complications.
• Drink plenty of fluids to prevent dehydration
• Plenty of rest
• Eat smaller and more frequent meals
• Medication such as paracetamol to help reduce fever⁸

The spread of typhoid can be minimised by:

• Being careful of what food is consumed and to wash hands thoroughly after using the toilet, before eating and before preparing food
• Only eat food that is freshly prepared, cooked and served piping hot, or fruit that has been peeled by yourself, such as a banana or mango
• Only drink bottled or cooled boiled water
• When drinking bottled water, ensure the seal is unbroken or choose sparkling water to ensure the bottle has not been refilled
• Only drink pasteurised milk
• Use bottled or boiled water to brush teeth. Do not use tap water
• Frequent and thorough hand washing , especially after using the toilet

 Avoid:

• Uncooked food such as salads
• Raw or uncooked shellfish
• Buffets (at a buffet choose steaming hot dishes)
• Unpasteurised milk and cheese
• Tap water and ice cubes
• Ice-cream products
• Cold desserts in restaurants
• Leftovers⁵

Remember: BOIL IT, COOK IT, PEEL IT OR FORGET IT!

People who are recommended to have the vaccine are:

• Travellers visiting countries where typhoid fever is common – especially if staying with, or visiting, the local population
• Travellers who frequently visit areas where sanitation and food hygiene are likely to be poor
• Laboratory personnel who may handle  typhiin the course of their work⁹

Vaccination is sometimes advised for travellers visiting lower risk areas if they are:

• Venturing off the usual tourist routes to visit rural areas where access to adequate sanitation and safe water may be limited
• Visiting friends and relatives
• Those with a weak immune system
• Long stay travellers

A previous typhoid illness does not necessarily mean a person will be immune, vaccination is still recommended.

In the UK, there are two types of immunisation against typhoid:

• Vi vaccine – this is given as a single injection¹⁰
• Ty21a (Live Oral) immunisation – this is given as three capsules to take on alternate days¹¹

The typhoid vaccine requires booster vaccinations every 3 years if regularly travelling to at risk areas.

Combined typhoid and hepatitis A vaccinations are also available for people aged 15 or over. Speak to the pharmacist for more detail regarding this.¹²

The vaccine is not 100% effective and therefore travellers are advised to use precautionary measures such as regular hand washing, avoiding potentially contaminated food and drinking boiled or bottled water.⁹

For paratyphoid fever, food and water precautions are the only prevention method, as no vaccines are available.¹³

This information is taken from trusted third party websites, NaTHNaC (Travel Health Pro) and EMIS (Patient info) and use of all information has been licenced under the Open Government Licence http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/.

Although the materials are being used/replicated under the provisions of the Open Government Licence this in no way represents endorsement of Traveljab.co.uk by NaTHNaC, Emis, Public Health England, the NHS or the Department of Health and Social Care.

1. Travel Health Pro: Typhoid and paratyphoid
2. NHS: Causes
3. World Health Organisation (WHO): Epidemiology and global burden of disease of typhoid ever
4. Centers for disease control: Distribution of typhoid fever
5. Patient.info: Typhoid and paratyphoid fever
6. NHS: Complications
7. NHS: Symptoms
8. NHS: Treatment
9. info: Typhoid vaccination
10. Electronic Medicines Compedium (eMC): Typhim Vi summary of product characteristics
11. Electronic Medicines Compedium (eMC): Vivotif ty21a summary of product characteristics
12. Travel Health Pro: Typhoid fever
13. The Green Book: Chapter 33 Typhoid