Typhoid
fever is a life-threatening illness caused by the bacterium Salmonella Typhi.
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.
Typhoid
fever can be prevented and can usually be treated with antibiotics. If you
are planning to travel outside the United States, you should know about typhoid
fever and what steps you can take to protect yourself.
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. The body reacts with fever and other signs and symptoms.
Typhoid
fever is common in most parts of the world except in industrialized regions such
as the United States, Canada, western Europe, Australia, and Japan. Therefore,
if you are traveling to the developing world, you should consider taking precautions.
Over the past 10 years, travelers from the United States to Asia, Africa, and
Latin America have been especially at risk.
Two basic actions can protect you from typhoid fever: 1. Avoid risky foods
and drinks. 2. Get vaccinated against typhoid fever.
It may surprise
you, but watching what you eat and drink when you travel is as important as being
vaccinated. This is because the vaccines are not completely effective. Avoiding
risky foods will also help protect you from other illnesses, including travelers'
diarrhea, cholera, dysentery, and hepatitis A.
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 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.) Do not eat the peelings.
Avoid foods
and beverages from street vendors. It is difficult for food to be kept clean on
the street, and many travelers get sick from food bought from street vendors.
If you are traveling to a country
where typhoid is common, you should consider being vaccinated against typhoid.
Visit a doctor or travel clinic to discuss your vaccination options.
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; they only help treat it.
The chart below
provides basic information on typhoid vaccines that are available in the United
States.
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
N/A
1
week
2 years
2 years
The parenteral heat-phenol-inactivated vaccine (manufactured by Wyeth-Ayerst)
has been discontinued.
Persons with typhoid fever usually have a sustained fever as high as 103°
to 104° F (39° to 40° 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.
If you suspect you have typhoid fever, see a doctor immediately. If you are
traveling in a foreign country, you can usually call the U.S. consulate for a
list of recommended doctors.
You will probably be given an antibiotic
to treat the disease. Three commonly prescribed antibiotics are ampicillin, trimethoprim-sulfamethoxazole,
and ciprofloxacin. 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. In fact, if you work at a job where you handle food or care for
small children, you may be barred legally from going back to work until a doctor
has determined that you no longer carry any typhoid bacteria.
If you
are being treated for typhoid fever, it is important to do the following:
Keep taking 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, 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.
Have your doctor perform a series of stool cultures to ensure that no S. typhi
bacteria remain in your body.
Keep taking the prescribed antibiotics for as long as the doctor has asked you
to take them.
