Typhoid Fever

What is typhoid?
Typhoid is an acute febrile illness caused by a bacterium Salmonella Typhi. It typically causes fever, headache, nausea and severe loss of appetite. There may be cough and constipation or diarrhoea. Classic typhoid fever can be a very serious disease, but antibiotics are an effective treatment. Paratyphoid is an illness caused by a similar bacterium, Salmonella Paratyphi - it generally causes a milder illness, of shorter duration and with fewer complications. There are about 17 million cases worldwide each year.

Typhoid fever is common in many developing countries of the world. It is spread mainly by food and water and is commonest in countries with poorly developed systems for treating water and sewage. For this reason, it is now an uncommon disease in Europe and North America.

Developed countries see some cases each year; most are imported from areas where the disease is common. For example, about 400 cases are diagnosed in the US and about 200 cases are diagnosed in the UK each year. In both countries, over half of cases are imported from higher-risk countries. Ireland sees between 1 and 4 cases most years, almost all of which are acquired overseas.

How is typhoid spread?
Salmonella Typhi, the organism responsible for causing Typhoid affects only in humans. When taken into the mouth (usually by eating or drinking contaminated food or water), the organism passes to the lining of the bowel. It may just produce an unpleasant bout of diarrhoea, but in some cases will pass into the bloodstream to give symptoms of fever. It may go on to produce infection in other organs. People with typhoid fever carry the bacteria in their bloodstream and intestinal tract. In addition, a small number of people, called carriers, recover from typhoid fever but continue to carry and shed the bacteria. Both ill people and carriers shed S. Typhi in their faeces, and can potentially pass the infection on to other people.

How serious is typhoid?
Typhoid is a potentially serious illness, especially in those parts of the world where medical services are poorly developed. The illness is treated using antibiotics and correction of problems caused by fluid loss and anaemia. In developed countries in Europe and North America, these treatments are readily available, making the treatment of typhoid relatively straightforward.

Where are you likely to find typhoid?
Typhoid fever is common in developing parts of the world such as Africa, Asia, Central and South America and South East Europe. Therefore, if you are travelling to countries in these regions, you should consider taking precautions.

How can you avoid typhoid?
Three basic steps can do much to minimise your risk of contracting typhoid while travelling:

1. Always try to ensure that you wash your hands in clean, hot water before eating or drinking and after using the toilet.
2. Avoid risky foods and drinks (see below)
3. Ensure that you are vaccinated against typhoid fever if travelling to a high risk area.

Taking care with what you eat and drink when travelling is just as important as being vaccinated. This is because vaccination does not absolutely guarantee you against becoming ill. Good personal hygiene and avoiding risky foods will also help protect you from other illnesses, including travellers' diarrhoea, cholera, dysentery, and hepatitis A.

A. Wash hands before eating
It is very important to wash your hands thoroughly, where possible, before eating. Where possible hands should be washed in hand hot water, using soap, for at least 20 seconds. Hands should also be thoroughly washed after using the toilet.

B. Avoiding risky food and drinks

• If you drink water, buy it bottled or bring it to the boil for 1 minute before you drink it. Bottled carbonated water is safer than un-carbonated water.
• Ask for drinks without ice unless the ice is made from bottled or boiled water. Avoid pop-ices and flavoured ices that may have been made with contaminated water.
• Eat foods that have been thoroughly cooked and that are still hot and steaming.
• Avoid raw vegetables and fruits that cannot be peeled. Vegetables like lettuce are easily contaminated and are very hard to wash well.
• 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 traders. It is difficult for food to be kept clean on the street, and many travellers get sick from food bought from street traders.

C. Vaccination

• Vaccination against typhoid is available in Ireland.
• If you are travelling to a country where typhoid is common, you should consider being vaccinated against typhoid. Visit a doctor or travel clinic to discuss vaccination.
• Remember that you will need to complete your vaccination at least 1 week 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, check with your doctor to see if it is time for a booster vaccination.

What are the signs and symptoms of typhoid?
It takes between 10 and 20 days to develop symptoms after taking the organism into your body.

In mild cases, the organism is passed out of the body quickly, the symptoms tending to be minor and the course of the illness uncomplicated. It is possible to become a healthy carrier of infection.

With more severe illness, or illness which has not been fully treated, there is fever, headache and constipation. In some cases, patients have a rash of rose-coloured spots. Later, high fever, diarrhoea and confusion can develop. The illness is diagnosed by tests on samples of stools (bowel motions) or blood.

What do you do if you think you have typhoid?
If you think you may have developed typhoid, it is important to see a doctor immediately. Typhoid is treatable with antibiotics. Most treatment is given by mouth. Once on antibiotics, patients start to feel better within 2 to 3 days, and deaths rarely occur. The danger of typhoid lies in not getting treatment.

If typhoid is very mild or not properly treated, a patient may start to feel well but still be carrying the bacterium. If so, the illness could return, or the illness could be passed to other people. In fact, if you work at a job where you handle food or care for small children, you should not return to work until a doctor has passed you as fit to return to work.

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

• Keep taking the antibiotics prescribed for you as long as your doctor has asked you to take them.
• Wash your hands carefully with soap and hot 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 infection on to someone else.
• Your doctor will perform a series of tests on samples of your stools to ensure that your body has eliminated all the typhoid bacteria.

What happens when a case of typhoid appears in Ireland?
Every so often, cases of typhoid are diagnosed in Western European countries, including Ireland. Most of these cases will have been imported from other countries. Such cases are quickly identified and control measures put in place by Public Health physicians. These control measures are similar to those for other infectious diarrhoeal illnesses. Contacts of the ill person are identified and screened to outrule any illness. Where the ill person and their contacts work in such areas that have the potential for further spread, they must remain away from work until they are declared safe to return to work. Once these control measures are in place there is little risk of further spread.

Last updated: 1 July 2010