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What is typhoid fever?

Typhoid fever is a life-threatening illness caused by the bacterium Salmonella Typhi. Typhoid fever is not common in the United States, Canada, Western Europe, Australia, or Japan, but it is common in many other countries. It affects an estimated 22 million people worldwide each year. These cases do not include people who do not seek medical care, who are not tested for either disease, or whose disease is not reported to CDC.

What is paratyphoid fever?

Paratyphoid fever is a life-threatening illness caused by the bacterium Salmonella Paratyphi. Paratyphoid fever is not common in the United States, Canada, Western Europe, Australia, or Japan, but it is common in many other countries. These cases also do not include people who do not seek medical care, who are not tested for either disease, or whose disease is not reported to CDC.

How are typhoid fever and paratyphoid fever spread?

People who are actively ill with typhoid fever or paratyphoid fever and people who are carriers of Salmonella Typhi or Salmonella Paratyphi bacteria can both spread the bacteria to other people. Carriers are people who have recovered from typhoid fever or paratyphoid fever but continue to carry the bacteria. About 1 in 20 people remain carriers after they've recovered. Both groups of people shed (excrete) Salmonella Typhi or Salmonella Paratyphi in their feces (poop).

Typhoid fever and paratyphoid fever are more common in areas of the world where water is more likely to be contaminated with sewage.

You can get typhoid fever or paratyphoid fever if

  • You eat food or drink a beverage that has been touched by a person who is shedding Salmonella Typhi or Salmonella Paratyphi and who has not washed their hands thoroughly after going to the bathroom.
  • Sewage-contaminated with Salmonella Typhi or Salmonella Paratyphi gets into water you drink.
  • Sewage-contaminated with Salmonella Typhi or Salmonella Paratyphi gets into water used to rinse food you eat raw.

Can typhoid fever and paratyphoid fever be prevented?

Yes. Typhoid fever and paratyphoid fever can be prevented. Get vaccinated against typhoid fever (there is no vaccine against paratyphoid fever). Find out how to avoid getting sick from food and drinks.

Can animals spread typhoid fever or paratyphoid fever to people?

No. Salmonella Typhi and Salmonella Paratyphi live only in humans.

Animals can spread other kinds of Salmonella to humans, so it's important to wash your hands after contact with animals, their feces (poop), or places where animals live, feed, or roam.

What happens when someone ingests Salmonella Typhi or Paratyphi?

When someone consumes a food or drink contaminated with Salmonella Typhi or Paratyphi, the bacteria can multiply and spread into the bloodstream, causing typhoid fever or paratyphoid fever.

Typhoid Prevention Tips for Travelers

Typhoid fever and paratyphoid fever are common in many parts of the world.

Areas of highest risk for Typhoid fever and paratyphoid fever include parts of East and Southeast Asia, Africa, the Caribbean, and Central and South America.

Two basic actions can protect you:

  1. Get vaccinated against typhoid fever.
  2. Find out how to stay safe when it comes to foods and drinks.

Carefully selecting what you eat and drink when you travel is important. This is because the typhoid fever vaccines do not work 100% of the time, and there is no paratyphoid fever vaccine. Avoiding risky foods will also help protect you from other illnesses, including travelers’ diarrhea, cholera, dysentery, and hepatitis A.

When you travel to areas of risk, remember to “Boil it, cook it, peel it, or forget it.”

  • If you drink water, buy it bottled or bring it to a rolling boil for 1 minute before you drink it. Bottled carbonated water is safer than uncarbonated water.
  • Ask for drinks without ice, unless the ice is made from bottled or boiled water. Avoid popsicles and flavored ices that may have been made with contaminated water.
  • Eat foods that have been thoroughly cooked and are still hot and steaming.
  • Avoid raw vegetables and fruits that cannot be peeled. Lettuce can remain contaminated even after it is washed.
  • 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 vendors.

Typhoid Symptoms and Treatment

What are the signs and symptoms of typhoid fever and paratyphoid fever?

Typhoid fever and paratyphoid fever have similar symptoms. People usually have a sustained fever (one that doesn't come and go) that can be as high as 103-104° F (39-40° C).

Other symptoms of typhoid fever and paratyphoid fever include

Some people with typhoid fever or paratyphoid fever develop a rash of flat, rose-colored spots.

What do you do if you think you have typhoid fever or paratyphoid fever?

The only way to know for sure if an illness is typhoid fever or paratyphoid fever is to have a sample of blood or stool (poop) tested for Salmonella Typhi or Salmonella Paratyphi.

If you have a high fever and feel very ill, see a doctor immediately.

How are typhoid fever and paratyphoid fever treated?

Typhoid fever is treated with antibiotics.

Resistance to antibiotics is increasing in the bacteria that cause typhoid fever and paratyphoid fever. When bacteria are resistant to antibiotics, the bacteria are not killed and their growth is not stopped. To help guide treatment, your doctor may order special tests to see if your type of Salmonella is antibiotic-resistant.

People who do not get treatment can continue to have fever for weeks or months, and can develop complications. As many as 30% of people who do not get treatment die from complications of the infection.

The danger from typhoid fever or paratyphoid fever doesn't end when symptoms disappear.

Even if your symptoms seem to go away, you may still be carrying Salmonella Typhi or Salmonella Paratyphi. If so, the illness could return, or you could pass the bacteria to other people.

In fact, if you are a health care worker or work at a job where you handle food or care for small children, you might be barred (prevented) legally from going back to work until a doctor has determined you no longer carry the bacteria.

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

  • Keep taking antibiotics for as long as the doctor has recommended.
  • Wash your hands carefully with soap and 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 bacteria on to someone else.
  • Have your doctor test your stool (poop) to be sure no Salmonella Typhi or Salmonella Paratyphi bacteria remain in your body.

Typhoid Vaccination

If you are traveling to a country where typhoid fever is common, consider being vaccinated against typhoid fever. Visit a doctor or travel clinic to discuss options. Remember that you should complete the vaccinations at least 1-2 weeks (depending on vaccine type) 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, ask your doctor to if it is time for a booster vaccination. Taking antibiotics will not prevent typhoid fever; they only help treat it.

Basic Information on Typhoid Vaccines

Vaccine name How given Number of doses recommended Time between doses How long to complete immunization before travel Minimum age for vaccination Booster needed
Ty21a (Vivotif, Swiss PaxVax) 1 capsule by mouth 4 2 days 1 week 6 years Every 5 years
ViCPS (Typhim Vi, Sanofi Pasteur) Injection 1 N/A 2 weeks 2 years Every 2 years

Typhoid Information for Healthcare Professionals

Clinical Features

Typhoid fever and paratyphoid fever are bacteremic illnesses that have an insidious onset characterized by fever, headache, constipation or diarrhea, malaise, chills, and myalgias, with few clinical features that reliably distinguish them from a variety of other infectious diseases. Diarrhea may occur, and vomiting is not usually severe.

A transient, maculopapular rash of rose-colored spots may be present on the trunk. Confusion, delirium, and intestinal perforation may occur in severe cases, typically after 2-3 weeks of illness. The incubation period for typhoid fever is typically 6-30 days and for paratyphoid fever, 1-10 days.

Diagnosis

Blood culture is the mainstay of diagnosis. Bone marrow cultures have sensitivity of 80% in some studies and can remain positive despite antibiotic therapy. Stool and urine cultures are positive less frequently. Multiple cultures are usually needed to identify the pathogen. Serologic tests, such as the Widal test, are not recommended because of the high rate of false positives.

Etiologic Agent

Salmonella enterica serotype Typhi for typhoid fever and Salmonella enterica serotype Paratyphi for paratyphoid fever.

Incidence

An estimated 22 million cases of typhoid fever and 200,000 deaths occur worldwide each year. An estimated 5 million cases of paratyphoid fever occur worldwide each year.

Sequelae

Without therapy, the illness can last for 3-4 weeks and death rates range between 12% and 30%. Relapse occurs in up to 10% of untreated patients approximately 1-3 weeks after recovering from the initial illness and is often more mild than the initial illness. A chronic carrier state, in which stool or urine cultures for Salmonella_Typhi remain positive for more than 1 year, occurs in up to approximately 5% of infected persons.

Transmission

Typhoid fever and paratyphoid fever are transmitted commonly through the consumption of drinking water or food contaminated with the feces of people who have typhoid fever cases or are chronic carriers.

Challenges

Reduced susceptibility to fluoroquinolones (e.g., ciprofloxacin) and the emergence of multidrug resistance has complicated treatment of infections. There have also been sporadic reports and at least one documented outbreak of ceftriaxone-resistant Salmonella Typhi infections.

Opportunities

The role of new vaccines to control epidemics or to eliminate the disease has not been explored yet. These new vaccines include two typhoid fever protein conjugated vaccines licensed for use in India.

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