Typhoid Fever
A Guide for Travelers

Excerpted from CDCP, where you can find much more information.

Causes

Typhoid fever is a life-threatening illness caused by a bacterium. In the United States about 400 cases occur each year, and 70% of these are acquired while traveling internationally. Typhoid fever is still common in the developing world, where it affects about 12.5 million persons each year.

Prevention

Persons with typhoid fever usually have a sustained fever as high as 39 degrees to 40 degrees C. They may also feel weak, or have stomach pains, headache, or loss of appetite. In some cases, patients have a rash of flat, rose-colored spots. The only way to know for sure if an illness is typhoid fever is to have samples of stool or blood tested for the presence of S. Typhi.

Prevention

Typhoid fever can be prevented and can usually be treated with antibiotics.

Contagiousness

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 of the world 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.

Prevention

Travelers to third-world countries can get easily vaccinated against typhoid fever. 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. Taking antibiotics will not prevent typhoid fever. Typhoid vaccines are available in the United States:
Typhoid fever vaccine information
Vaccine name How given Number of doses necessary Time between doses Total time needed to set aside for vaccination Minimum age for vaccination Booster needed every
Ty21a (Vivotif Berna, Swiss Serum and Vaccine Institute) 1 capsule by mouth 4 2 days 2 weeks 6 years 5 years
ViCPS (Typhim Vi, Pasteur Merieux) Injection 1 - 1 week 2 years 2 years
Inactivated Typhoid Vaccine (Wyeth-Ayerst) Injection 2 (1 if it is a booster dose) 4 weeks 5 weeks 6 months 3 years

Precautions

Avoid risky foods and drinks.

Treatment

Three commonly prescribed antibiotics are ampicillin, trimethoprim-sulfamethoxazole, and ciprofloxacin.

Duration

Persons given antibiotics usually begin to feel better within 2 to 3 days, and deaths rarely occur. However, persons who do not get treatment may continue to have fever for weeks or months, and as many as 20% may die from complications of the infection. Even if your symptoms seem to go away, you may still be carrying S. Typhi. If so, the illness could return, or you could pass the disease to other people.