Typhoid fever is a bacterial disease caused by Salmonella typhi. Infection causes a systemic illness of varying severity with symptoms including fever, slowing heart rate, enlargement of the spleen, so-called ‘rose spots’ (pink spots which fade on pressure), abdominal pain, constipation or diarrhoea. Untreated, the infection may be fatal. 7 Around 2-5% of patients become chronic carriers with the bacteria remaining in the bowel after symptoms have resolved.53
Transmission Transmission is by consumption of food or water contaminated with the bacteria.53 For travellers, common sources are water or ice, raw fruit and vegetables, salads and shellfish.7 Occasionally direct faecal–oral transmission may occur.53
Geographical distribution Worldwide. The disease occurs most commonly in association with poor standards of hygiene in food preparation and handling and where sanitary disposal of sewage is lacking.53
Risk for travellers53 Generally the risk to travellers is low, except in parts of North and West Africa , in South Asia and in Peru . Elsewhere, travellers are usually at risk only when exposed to low standards of hygiene with respect to food handling, control of drinking-water quality, and sewage disposal.
Vaccination. Typhoid vaccination is recommended for travellers travelling to endemic countries especially those staying for longer than a month; those exposed to conditions of poor hygiene, and those visiting the Indian subcontinent and destinations where there is a possibility of antibiotic-resistant organisms (eg. Vietnam , Thailand ).
A combined typhoid/hepatitis A vaccine is also available.
Avoid consumption of potentially contaminated food or drink even if vaccinated, since typhoid vaccine may not be completely protective. (See Eating safely and Drinking safely)
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