Overview

Typhoid fever is a potentially severe and occasionally life-threatening febrile illness caused by Salmonella enterica  serotype Typhi ( Typhi), a bacterium that only lives in humans.1

Some important things to know about typhoid fever:

  • It is usually acquired by consumption of water or food that has been contaminated by feces of an infected person.1

  • Typhoid fever is more common in areas of the world where handwashing is less frequent and water is more likely to be contaminated with sewage.2

 

Typhoid Fever Is Endemic in Many
Countries Worldwide

Typhoid fever is uncommon in the United States, with an average of about 400 cases reported annually from 2007 to 2011.3 However, travelers from the United States to Asia, Africa, and Latin America have been especially at risk.2 Even short-term travel to high-incidence areas is associated with risk for typhoid fever.3


 
  • More than 75% of travelers who contracted typhoid fever had been to India, Bangladesh, or Pakistan.3

Typhoid fever vaccination is recommended for travelers to many countries in Asia, Africa, and Latin America 2,a

Paxvax
 

a The Centers for Disease Control and Prevention (CDC) makes country-specific typhoid fever vaccination recommendations. Refer to the CDC for the most accurate and up-to-date list of countries and recommendations.

Symptoms

Once infected, the incubation period ranges from 6 to 30 days. Patients experience a slow onset of disease with gradually increasing fatigue and fever that can reach 102°F to 104°F (38°C-40°C) by the third to fourth day of illness. Almost all patients with typhoid fever suffer from headache, a general feeling of discomfort, and loss of appetite. Abdominal pain, diarrhea, or constipation are also common.1


 

The serious complications of typhoid fever usually occur after 2 to 3 weeks of illness and may include intestinal hemorrhage or perforation, which can be life-threatening.1

 

Treatment and Prevention

Typhoid fever can usually be treated with antibiotics, which shorten its clinical course and reduce the risk of death. However, multidrug resistant strains are common on the Indian subcontinent and are becoming increasingly prevalent in other areas of the world.1 Treatment options for Typhi could become scarce if antibiotic resistant strains become widespread.6

Typhoid fever can also be prevented.2 Practicing food and water precautions, frequent handwashing, and vaccination with a typhoid fever vaccine are the most important preventive measures travelers can take to reduce their risk.1

Two typhoid fever vaccines are available for use in the United States—live-attenuated, oral Ty21a and injectable Vi polysaccharide—which are both FDA approved and recommended by The Advisory Committee on Immunization Practices.3,8-10

Although vaccines are recommended to prevent typhoid fever, they may not be 100% effective; therefore, even vaccinated travelers should follow recommended food and water precautions when traveling to a country where there is a risk of typhoid fever.1

CDC Travel Recommendations

The CDC recommends 2 basic measures to help protect against typhoid fever: avoid risky foods and drinks and get vaccinated against typhoid fever.2

Avoiding Risky Food and Drinks


 

Choosing low–risk food and drinks is as important as getting vaccinated since vaccines may not be completely effective. Practicing food and drink precautions while abroad may also help travelers avoid other diseases such as travelers’ diarrhea, cholera, dysentery, and hepatitis A.2

Typhoid Fever Vaccination

Routine typhoid fever vaccination is not recommended in the United States. However, vaccination is recommended for the following groups3:

  • Travelers to areas where there is a recognized risk for exposure to S  Typhi
     
    • Risk is greatest for travelers who have prolonged exposure to possibly contaminated foods and beverages, although short-term travelers are also at risk
    • Most travel-associated typhoid fever cases in the United States occur among travelers who are visiting friends or relatives; travelers in this group do not always seek pretravel health care
    • Antibiotic–resistant strains of S  Typhi have become common in many regions. Travelers who become infected with an antibiotic-resistant strain risk death
  • Persons with intimate exposure, such as household contact, to a documented
    Typhi chronic carrier (defined as excretion of S  Typhi in urine or stool for
    >1 year)
  • Microbiologists and other laboratory workers routinely exposed to cultures of
    Typhi or specimens containing this organism or who work in laboratory environments where these cultures or specimens are routinely handled
References
  1. Newton A, Routh JA, Mahon BE. Typhoid and Paratyphoid Fever. CDC Health Information for International Travel 2016. New York, New York: Oxford University Press; 2015. http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/typhoid-paratyphoid-fever. Accessed October 13, 2015.
  2. Typhoid fever: general information. Centers for Disease Control and Prevention website.  http://www.cdc.gov/nczved/divisions/dfbmd/diseases/typhoid_fever/. Updated 2013. Accessed October 13, 2015.
  3. Jackson BR, Iqbal S, Mahon B. Updated Recommendations for the Use of Typhoid Vaccine-Advisory Committee on Immunization Practices, United States, 2015. CDC Morbidity and Mortality Weekly Report. 2015;64(11):305-308.
  4. Typhoid fever: technical information. Centers for Disease Control and Prevention website. http://www.cdc.gov/nczved/divisions/dfbmd/diseases/typhoid_fever/technical.html. Updated 2015. Accessed December 3, 2015.
  5. First Consult. Typhoid fever. https://www.clinicalkey.com/#!/content/medical_topic/21-s2.0-1014611. Updated 2011. Accessed December 16, 2015.
  6. Wain J, Hendriksen RS, Mikoleit ML, Keddy KH, Ochiai RL. Typhoid fever. Lancet. 2015;385(1136):1145. http://dx.doi.org/10.1016/S0140-6736(13)62708-7.
  7. Travel smart: get vaccinated. Centers for Disease Control and Prevention website. http://www.cdc.gov/features/vaccines-travel/. Updated 2015. Accessed December 3, 2015.
  8. World Health Organization. Typhoid vaccines: WHO position paper. http://www.who.int/wer/2008/wer8306.pdf?ua=1. Updated 2008. Accessed October 13, 2015.
  9. US Food and Drug Administration. FDA Approved Products: Vivotif. http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm094070.htm. Updated 2014. Accessed October 22, 2015.
  10. US Food and Drug Administration. FDA Approved Products: Typhim Vi. http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm201417.htm. Updated 2010. Accessed October 22, 2015.