Typhoid fever: symptoms, causes, treatment, vaccine and how long it lasts

TravelHealthPro, the UK travel health service, describes typhoid fever as a systemic disease acquired by swallowing food or water contaminated by the bacterium Salmonella enterica serovar Typhi (S. Typhi). A clinically similar illness, paratyphoid, is caused by S. Paratyphi A, B or C, and together typhoid and paratyphoid are known as enteric fevers.

The NHS says typhoid is found in parts of Asia, Africa, and Central and South America. TravelHealthPro says it mainly affects low-income areas where sanitation and clean water are lacking, and that most cases in England and Wales are seen in returning travellers from South Asia, particularly India, Pakistan and Bangladesh.

TravelHealthPro explains that S. Typhi passes out in the faeces of people who are ill with typhoid fever or are chronic carriers, and can enter the food chain and water supply if personal hygiene and general sanitation are inadequate. Direct faecal-oral transmission also occurs. Infection in overseas travellers is almost exclusively acquired by swallowing heavily contaminated food and water where sanitation is poor.

The NHS says that after recovery a small number of people become carriers, meaning they recover from typhoid but can still spread it to other people for months or years after. TravelHealthPro says between one and three percent become long-term carriers, which is more common with increasing age, in women and in people with biliary tract abnormality.

The NHS says symptoms usually begin within 3 weeks of infection but sometimes can take up to 6 weeks. TravelHealthPro adds that the severity is variable, but nearly all patients have fever and headache, and young children may have a mild illness or a severe one.

The NHS says tummy ache and diarrhoea are also common but these usually happen after the other symptoms. Some people also get a rash of light-pink spots, usually on the upper body, which can be hard to see on black or brown skin. TravelHealthPro says enlargement of the liver or spleen occurs in about 50 percent of cases.

• A high temperature that may slowly get worse over a few days

• Headache, cough, chills, aches and pains

• Feeling tired or sick, and not feeling hungry

• Constipation, or not pooing as often as normal

• Tummy ache and diarrhoea, usually later

• Sometimes a rash of light-pink spots on the upper body

The NHS says that if there is a chance you could have typhoid fever, your blood, poo and pee will be tested, and you may need to go to hospital for these tests. Typhoid is treated with antibiotics, and you may also be given medicine to lower your temperature. It is important to finish all the antibiotics you are given even if you feel better.

TravelHealthPro says typhoid and paratyphoid can be treated with appropriate antibiotics, but antibiotic resistant infections are increasingly common, which can complicate and reduce treatment options. For this reason clinicians confirm which antibiotics the bacteria are sensitive to. Chronic carriers need prolonged courses of antibiotics to clear the organism.

The NHS says you should start to feel better after starting antibiotics but may continue to have a high temperature for around 5 days. Most people who are treated make a full recovery with no other problems. Sometimes symptoms come back (relapse), usually within 2 weeks of finishing treatment, but it can be at any time, and further treatment is needed.

TravelHealthPro says relapse occurs in less than 10 per cent of patients treated with antibiotics and is usually milder than the original illness. It reports that complications occur in 10 to 15 percent of all infections and are more likely in people who are not treated or are late seeking help, and that under one percent of those treated promptly die.

The NHS says a typhoid vaccine is available for free on the NHS and is usually recommended for anyone over 1 year old travelling to an area where there is a high risk of catching typhoid. See a GP 6 to 8 weeks before travelling. It lasts for 3 years and comes as an injection or tablets. There is still a chance of getting typhoid if you have been vaccinated, so good hygiene matters.

TravelHealthPro says there is no vaccine for paratyphoid, so prevention depends on food and water hygiene.

• Wash hands regularly with soap and warm water, especially after the toilet and before preparing or eating food

• Use sanitiser gel if soap and clean water are not available

• Use bottled or cooled boiled water to brush teeth and drink bottled drinks and cans

• Eat food that has been recently and thoroughly cooked and is served hot

• Avoid ice in drinks, raw or lightly cooked meat or seafood, and salads or fruit you have not washed or peeled yourself

• Avoid unpasteurised dairy products and food left uncovered

The sources read for this guide give no specific pregnancy guidance, so ask your GP or midwife about travel vaccination and treatment if you are pregnant or planning pregnancy; typhoid is a serious infection and prompt treatment matters. The NHS says the vaccine is usually recommended from over 1 year old, and that children under 5 may need to stay off school or nursery until tests show they are not infected.

The NHS says to get help from NHS 111 if you have travelled to an area with typhoid fever and feel unwell, even if you have been vaccinated, or if you have been treated and your symptoms get worse, do not get better or come back. Tell anyone you speak to about your recent travel, and if you are still abroad get medical help where you are rather than waiting until you return.

Call 999 or go to A&E if you get a sudden stomach pain that keeps getting worse, your poo is black or dark red, or you vomit blood or have vomit that looks like ground coffee. The NHS says untreated typhoid can lead to internal bleeding or peritonitis.

The NHS says you may have to stay off work until tests of your poo show you no longer have typhoid fever if you work in certain jobs, such as with food, in healthcare or with young children. Children under 5 may also need to stay off school or nursery. Do not prepare or serve food for others if you have or think you may have typhoid, and wash hands thoroughly after the toilet.

Suspected typhoid is assessed through NHS 111, a GP or hospital infectious disease or acute medical services, because it needs blood cultures and specialist antibiotic choices. The typhoid vaccine is free on the NHS for travellers to risk areas; private travel clinics also give it, often alongside other travel vaccines, and may charge.