Typhoid Fever & Paratyphoid

What are typhoid and paratyphoid?
Typhoid fever is an illness caused by a bacterium called Salmonella Typhi. It typically causes fever, headache, nausea and severe loss of appetite. There may be cough and constipation or diarrhoea. 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. However, this bacterium generally causes a milder illness, of shorter duration and with fewer complications than that of Salmonella Typhi.

Where are you likely to find typhoid?
Typhoid and paratyphoid are uncommon in Europe and North America, but they are common in many developing countries.  Globally, it is estimated that typhoid fever causes 11-20 million illnesses and between 128,000 and 161,000 deaths every year, while paratyphoid fever causes an estimated 5 million illnesses.

Developed countries see some cases each year; most are imported from areas where the disease is common. For example, about 450 cases are diagnosed in the US and about 300 cases are diagnosed in the UK each year. In both countries, over half of cases are imported from higher-risk countries.

Ireland sees an average of 6 paratyphoid and 10 typhoid cases annually, almost all of which are acquired overseas.

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

In mild cases, the bacteria 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.

People that are ill with typhoid or paratyphoid and people who are carriers of the bacteria shed S. Typhi in their faeces and can potentially spread it to other people. Carriers are people that have recovered from typhoid or paratyphoid but continue to carry and shed the bacteria. About 1 in 20 people who have had typhoid or paratyphoid become carriers.

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.

How is typhoid spread? 
Salmonella Typhi, the organism responsible for causing typhoid only lives in humans.

In developing countries, typhoid and paratyphoid are spread mainly by contaminated food and water. Poor communities and vulnerable groups including children are at highest risk.

How can you avoid typhoid? 
As typhoid fever is common in developing parts of the world such as Africa, Asia, and South America, you should consider taking precautions if you are travelling to countries in these regions.

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 protection 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 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 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 (even if you have been vaccinated against it). The illness is diagnosed by tests on samples of stools (bowel motions) or blood.

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. 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: 25 October 2018