Typhoid fever is a life-threatening illness caused by the
.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.
How is typhoid fever spread?
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
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
or if sewage contaminated with
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.
bacteria are eaten or drunk, they multiply and
spread into the bloodstream. The body reacts with fever and other
signs and symptoms.
Where in the world do you get typhoid fever?
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.
How can you avoid typhoid fever?
Two basic actions can protect you from typhoid fever:
Avoid risky foods and drinks.
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.
"Boil it, cook it, peel it, or forget it"
If you drink water, buy it bottled or bring it to a rolling
boil for one 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
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 one 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.
What are the signs and symptoms of typhoid fever?
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
What do you do if you think you have typhoid fever?
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. Typhoid fever's danger
doesn't end when symptoms disappear.
Even if your symptoms seem to go away, you may still be carrying
. 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
Have your doctor perform a series of stool cultures to ensure
S. typhi bacteria
remain in your body.
Centers for Disease Control and
Prevention, November 2000
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a