Typhoid fever is a life-threatening illness caused by the bacterium Salmonella Typhi. Typhoid fever is still common in the developing world, where it affects about 21.5 million persons each year.
Salmonella typhi can only attack humans, so the infection always comes from another human, either an ill person or a healthy carrier of the bacterium. The bacterium is passed on with water and foods and can withstand both drying and refrigeration.

How is typhoid fever spread?

Salmonella Typhi lives only in humans. Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract. In addition, a small number of persons, called carriers, recover from typhoid fever but continue to carry the bacteria. Both ill persons and carriers shed S. Typhi in their feces (stool).
You can get typhoid fever if you eat food or drink beverages that have been handled by a person who is shedding S. Typhi or if sewage contaminated with S. Typhi bacteria gets into the water you use for drinking or washing food. Therefore, typhoid fever is more common in areas where handwashing is less frequent and water is likely to be contaminated with sewage.
Once S. Typhi bacteria are eaten or drunk, they multiply and spread into the bloodstream. The body reacts with fever and other signs and symptoms.

What are the signs and symptoms of typhoid fever?

If you have typhoid fever you may have the following symptoms:

• constant fever up to 104°
• diarrhea
• constipation
• stomach pain
• headache
• malaise
• nonproductive cough
• slow heart rate (bradycardia)
• anorexia

How soon after exposure do symptoms appear?

Symptoms usually occur within 1-2 weeks after exposure to the bacteria, but can occur from 3 days – 3 months after exposure.

How is typhoid fever diagnosed?

Only your doctor can tell if you have typhoid fever. A blood or stool sample is needed to diagnose typhoid fever. The samples are examined for S. typhi bacteria.

How is typhoid fever treated?

Typhoid fever is treated with antibiotics. Admission to the hospital and is required and fluid therapy may also be needed. A person will usually recover in 2-3 days with prompt antibiotic treatment. People that do not get prompt medical treatment may continue to have a fever for weeks or months, and as many as 20% may die from complications of the infection. Intestinal perforation or profuse bleeding from the intestinal mucosa may occur if typhoid fever is left untreated.
If you are being treated for typhoid fever, it is important to do the following:

• Take the prescribed antibiotics for as long as the doctor has asked you to take them.
• Wash your hands carefully with soap and water after using the bathroom
• Do not prepare or serve food to other people.
• Have your doctor collect follow-up stool samples to ensure that no S. typhi bacteria remain in your body.

How can typhoid fever be prevented?

If you travel to an area where the disease is common, use the following steps to protect yourself:

1. Get vaccinated against typhoid fever. Both injectable and oral vaccines are available. Visit a doctor or travel clinic to discuss your vaccination options. Vaccines are not 100% effective, so it is important to take the additional measures listed to prevent typhoid fever. The injectable vaccine is easier to administer since it only requires one dose and has less side effects. It should be administered at least two weeks prior to potential typhoid exposure and is effective for three years.
2. Use careful selection of food and drink while traveling. This will also help protect you from other illnesses such as cholera, dysentery and hepatitis A.
3. Only use clean water. Buy it bottled or make sure it has been brought to a rolling boil for at least one minute before you drink it.
4. Ask for drinks without ice unless the ice is made from bottled or boiled water.
5. Only eat foods that have been thoroughly cooked.
6. Avoid raw vegetables and fruits that cannot be peeled.
7. When you eat raw fruits or vegetables that can be peeled, wash your hands with soap, then peel them yourself. Do not eat the peelings.
8. Avoid foods and beverages from street vendors. Many travelers get sick from food bought from street vendors.

Remember:

1. Even if your symptoms go away without treatment, you may still be carrying the S. typhi bacteria, and your illness could return and be passed to other people.
2. If you work at a job where you handle food or care for small children, you should not go back to work until a doctor has determined that you no longer carry any S.typhi bacteria.
3. Even if you are vaccinated, you should carefully select your food and drink, especially when visiting areas where typhoid fever is common.