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What is typhoid fever?

Typhoid fever is a life-threatening infection caused by the bacterium Salmonella Typhi. Once ingested, Salmonella Typhi multiplies and may cause fever, fatigue, headache, nausea, abdominal pain, and constipation or diarrhea.[1]

11 21 MILLION CASES of typhoid fever annually [2]
~ 200 K DEATHS PER YEAR [2]

Typhoid fever has been found in:

  • South and South-East Asia
  • Latin America
  • the Caribbean
  • the Eastern Mediterranean
  • African regions.[3]

Incidence rate of typhoid fever, by country, in 2017 (per 100,000 population).[4]

Map source: Bonville C, Domachowske J. Typhoid Fever.[4]

Antibiotic resistant strains of typhoid fever are an increasing concern

16 countries imported extensively resistant S. Typhi (XDR) from Pakistan since 2016.[5]

In Asia one third of typhoid fever isolates were multidrug resistant (MDR).[6]

>70% of reported  typhoid fever cases in EU were resistant to at least one antimicrobial (i.e. antibiotic) and more than quarter were resistant to multiple antibiotics.[7]

How is typhoid fever transmitted?

You can get typhoid fever by consuming water or food contaminated by feces of an infected person or carrier due to a lack of proper hand hygiene.[2,8]

When Salmonella Typhi bacteria are ingested, they multiply and spread into the bloodstream, affecting numerous organs.[1] 

Even people being treated for the disease may still be contagious as they can continue to shed typhoid bacteria in their feces until their treatment is complete.[1] 

  • Increasing resistance to antibiotics is making it easier for typhoid to spread in communities that lack access to safe drinking water or adequate sanitation.[1] 
  • Urbanization and climate change have the potential to increase the spread of typhoid.[1] 

Signs and symptoms

If you’ve contracted typhoid fever, you’ll usually start having symptoms after 6-30 days of exposure to S. Typhi. You might start feeling fatigued and later get a fever as high as 38°C–40°C (102°F–104°F) by the third or fourth day of illness.[2]

You may experience the following symptoms:[1] 

  • High Fever
  • Constipation or diarrhea
  • Fatigue
  • Headache
  • Nausea
  • Stomach pain
  • Rash

Although not all cases are severe, some people with typhoid fever can have serious complications or even death.[1]

Treatment

Typhoid fever can be treated with antibiotics, but it is becoming increasingly more complicated to treat due to resistance to different types of antibiotics.[1]

It is important for people being treated for typhoid fever to do the following:[1]

Have their doctor test to ensure that no Salmonella Typhi bacteria remains in their body.

AM I AT RISK?

If you are traveling to areas of typhoid risk, remember to “Boil it, cook it, peel it, or forget it”, as the disease is contracted through contaminated food or water.[9]
If you fit the following groups and circumstances, your risk may be higher:

  • If you do not seek pre-travel health consultation or typhoid vaccination[2]
  • Children are at high risk[1]
  • If you are staying at your destination for an extended time (although travelers have acquired typhoid fever even during visits of <1 week)[2]
  • If you are visiting friends and family, it might be more difficult to follow the appropriate food and water precautions[2]

92.4% of typhoid and paratyphoid cases in the EU were travel related.[7]

Protecting yourself

All travelers to endemic areas are at risk of typhoid fever, but following preventative measures, like getting vaccinated and following other safety measures, significantly reduces the risk.[1,9] 

Vaccination against typhoid fever

Safe drinking water

Practice safe eating habits

Before you travel, consider visiting a travel medicine specialist at least two weeks before you leave to get vaccinated against typhoid fever.[10]

During your visit, consider following these recommendations to ensure safety:[1]

  • Cook food properly and serve while still hot 
  • Avoid raw milk and raw milk products 
  • Avoid ice unless you are sure it is from safe drinking water
  • Boil water if you aren’t sure that it’s safe. If that’s not possible, you can disinfect it with a slow-release agent (usually available at pharmacies)
  • Wash hands often and thoroughly with soap
  • Wash fruits and vegetables carefully if they are eaten raw, or peel them 

vaccination

There are effective vaccines available to protect you against typhoid fever. Prevention is becoming more important as antibiotic resistance is increasing.[1]

Your typhoid vaccine may be given to you orally in capsule form or as an injection.[1] 

The oral vaccine can be given to people at least 5 years old and consists of three or four pills taken every other day. It should be finished at least 1 week before traveling. A booster dose is recommended every 5 years for those who remain at risk.[1, 10]

The injectable vaccine can be given to people at least 2 years old, at least 2 weeks before travel. A dose is recommended every 2 years for those who remain at risk.[1]

Read more on the official recommendations on vaccinations for travelers: 

https://www.cdc.gov/typhoid-fever/typhoid-vaccination.html

https://www.who.int/news-room/fact-sheets/detail/typhoid

References

  1. World Health Organization. Typhoid 2023 [Available from: https://www.who.int/news-room/fact-sheets/detail/typhoid.
  2. Hughes M, Appiah, G, Watkins, LF. Typhoid & Paratyphoid Fever CDC Yellow Book 2024. [Available from: https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/typhoid-and-paratyphoid-fever]
  3. Hancuh M, Walldorf J, Minta AA, Tevi-Benissan C, Christian KA, Nedelec Y, et al. Typhoid Fever Surveillance, Incidence Estimates, and Progress Toward Typhoid Conjugate Vaccine Introduction – Worldwide, 2018-2022. MMWR Morb Mortal Wkly Rep. 2023;72(7):171-6.
  4. Bonville C, Domachowske J. Typhoid Fever. In: Domachowske J, Suryadevara M, editors. Vaccines: A Clinical Overview and Practical Guide. Cham: Springer International Publishing; 2021. p. 373-81.
  5. Walker J, Chaguza C, Grubaugh ND, Carey M, Baker S, Khan K, et al. Assessing the global risk of typhoid outbreaks caused by extensively drug resistant Salmonella Typhi. Nat Commun. 2023;14(1):6502.
  6. Marchello CS, Carr SD, Crump JA. A Systematic Review on Antimicrobial Resistance among Salmonella Typhi Worldwide. Am J Trop Med Hyg. 2020;103(6):2518-27.
  7. ECDC. Typhoid and paratyphoid fever. Annual Epidemiological Report for 2019. 2019. [Available from: https://www.ecdc.europa.eu/sites/default/files/documents/typhoid-paratyphoid-fever-annual-epidemiological-report-2019.pdf]
  8. Coalition against typhoid. Typhoid and Safe Water, Sanitation, and Hygiene 2018 [Available from: https://www.coalitionagainsttyphoid.org/the-issues/typhoid-and-wash/.
  9. Centers for Disease Control and Prevention. Prevention Tips for Travelers 2020 [updated 19 May 2020. Available from: https://www.cdc.gov/typhoid-fever/prevention.html.
  10. Vivotif SmPC.