Typhoid fever is a life-threatening bacterial infection that affects many organs throughout the body. The condition occurs through infection with the bacterium Salmonella Typhi, a relative of the bacteria that causes salmonella food poisoning. Unless typhoid fever is treated quickly with antibiotics, it can lead to serious complications and even death.

Typhoid fever is most common in regions that are poorly sanitized, where access to clean water is limited. Typhoid fever affects around 5,700 people in the U.S every year, with most cases acquired during international travel. Over the past decade, people travelling from the U.S to Africa, Latin America and Asia have been at particular risk.

Typhoid fever is uncommon in the U.K, affecting an estimated 500 people each year. The majority of these cases arise when people visit relatives in countries such as India, Pakistan and Bangladesh. In the developing world, typhoid fever is still common, affecting around 21.5 million people every year. As typhoid fever can be prevented and also treated, anyone travelling to countries where the infection is common should take measures to protect themselves.

Individuals infected with typhoid carry the bacteria in their intestinal tract and bloodstream. The condition is highly contagious and the bacteria can be passed out of the body in a person’s feces and sometimes their urine. One of the main ways in which typhoid infection spreads is via contaminated water and food. If someone consumes food or drink that has been contaminated with infected feces or urine, the bacteria multiply in their body and spread into the bloodstream. The body develops a fever in response, along with other symptoms of the condition such as stomach pain, loss of appetite, headache and weakness.

The disease is not transmitted from animals and only spreads between humans. The primary preventive measures for typhoid are therefore ensuring clean drinking water and maintaining good hygiene and sanitation standards.

Examples of ways in which good hygiene and sanitation can be maintained include hand washing and ensuring drinking water pipes are well separated from sewage pipes. Food should be carefully prepared and food handlers need to be especially vigilant with regard to hand washing and wearing gloves. Avoiding raw and uncooked food can also prevent the spread of typhoid and food that has been left over from a previous meal should be re-heated adequately before being eaten.

Vaccines

In many developing countries goals that may prevent the spread of typhoid fever such as safe drinking water, improved sanitation and adequate medical care may be challenging to reach and some experts believe that the best way to control the infection is to vaccinate high risk populations. A vaccine is also recommended for people travelling to nations where typhoid is widespread.

At present, there are two vaccines against typhoid fever that have been approved by the World Health Organization for the prevention of typhoid. These include:

• Ty21a – One capsule is taken orally every other day until 4 doses have been received. Children need to be at least 6 years of age to receive this vaccine and then require boosters every five years.
• ViCPS  – This is administered as a single injection. This is given to children of at least 2 years of age and requires a booster every 2 years.

Neither of these vaccines can offer complete effectiveness against typhoid fever and other guidelines should therefore also be followed when people are travelling to high risk areas. These hygiene guidelines are described below.

Preventing infecting yourself

• Wash hands frequently in hot, soapy water before eating or preparing food, as well as after using the toilet. Alcohol-based sanitizer can be used in the absence of hot water.
• Avoid drinking contaminated water by ensuring water is bottled or boiled. Carbonated bottled water is safer to drink than uncarbonated.
• Wash teeth using bottled water and avoid swallowing shower water.
• Avoid ordering drinks with ice, unless you know the ice is made form boiled or bottled water. Also avoid flavored ices that could have been made with water that is contaminated.
• Only eat foods that have been thoroughly cooked and served steaming hot and avoid foods that have been stored or served at room temperature.
• Only eat raw vegetables if they can be peeled. Items such as lettuce are particularly at risk of contamination and are very difficult to clean properly.
• Avoid food and drink being sold by street vendors as it is difficult to keep food clean in the street.

Preventing infecting others

If a person is recovering from infection with typhoid fever, they can take the following measures to prevent infecting others:

• Follow the doctor’s instructions for taking antibiotics and be sure to complete the whole course.
• Avoid preparing food for others until it is confirmed that you are no longer contagious. It will not be possible to return to a job in the food service industry until tests have confirmed there is no risk of you passing typhoid bacteria.
• Frequently wash hands using hot, soapy water before preparing or eating food, as well as after using the toilet. Hands should be scrubbed thoroughly for at least 30 seconds.