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Typhoid fever, or simply known as typhoid, is a global tropical bacterial disease. It was made infamous by the New York cook, ‘Typhoid Mary’, a healthy carrier of typhoid who was responsible for infecting her wealthy employees and their families. The vast majority of cases (90%) occur in Asia but cases also occur in Africa, and Central and South America. If you’re infected and treated with the appropriate antibiotics then you’ll make a full recovery. If however, typhoid fever is left untreated, death rates can be much higher, so you should make sure you’ve had the typhoid vaccination before you travel.
Typhoid, what is it?
Typhoid vaccination
Typhoid vaccination is recommended for all travellers whose planned activities put them at a higher risk in areas where sanitation and food hygiene are poor
A Typhoid Vaccination starts from £44 per dose. If you’re travelling then there’ll be a Travel Consultation and vaccine cost. If you’re not travelling then it’s only the vaccination cost you pay for. A Travel Consultation at Health Klinix is £30 per person.
Typhoid vaccine price
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You should practice good food and water hygiene precautions. These include: Regular hand washing (especially after visiting the toilet, changing nappies and before preparing or eating food). If hand washing facilities are not available, then you should use alcohol gel instead. Make sure you drink from unopened, factory produced bottles and cans, which have an intact seal. Drinks made from boiled water and served hot (e.g. tea, coffee) can generally be safe too. Do not drink tap water, or use ice. If you cannot avoid this, then there are treatments that can be used to disinfect the water instead. Recently prepared, thoroughly cooked food served hot. Fruit that you can peel yourself. Pasteurised dairy produce are good options for food. We would recommend you avoid foods such as salads, uncooked fruit and vegetables, food left uncovered in warm places, unpasteurised dairy produce, raw meat and fish
Prevention
Typhoid immunisation is the best ‘treatment’. You can also take other step reduce your risk (typhoid is at best 80% effective).
Typhoid treatment
The main symptoms of typhoid you should look out for are: Fever Headache Muscle and joint pains Constipation or diarrhoea Rash Other serious complications include intestinal bleeding and perforation can occur. As these symptoms are not always recognised by healthcare professionals, the diagnosis can sometimes be delayed. The common misconception is that typhoid fever is a diarrhoeal disease (even amongst doctors). Although diarrhoea can be a feature, you are just as likely to experience constipation. In fact, the bacteria actually causes septicaemia or "blood poisoning.” This septicaemia allows the bacteria to spread throughout your body and in serious cases it can spread to the brain causing inflammation or encephalitis. So, before you travel make sure you’ve had a typhoid jab.
Typhoid symptoms
Typhoid fever is caused by two main species of bacteria called Salmonella typhi and Salmonella paratyphi. This shouldn’t be confused with the other species of Salmonella that cause food poisoning or infectious diarrhoea. Typhoid is very different, as this bacteria invades your bloodstream and eventually migrates to your vital organs, such as your liver, spleen and bone marrow. All this leads to septicaemia (an infection of the bloodstream) which can be very serious. You’re at risk if you consume food and water that’s been somehow contaminated with faeces. As infectious diseases physicians, we call this faeco-oral transmission and is particularly common in areas of poor sanitation and hand hygiene. Although typhoid vaccination reduces your chances of getting typhoid, be aware that it doesn’t cover the second species, Salmonella paratyphi. So you should still be careful with strict food and water hygiene
Typhoid causes
Most of our clients experience no side effects from the typhoid vaccination. However, the most common reported side effects include; a sore injection site, headache, muscle ache and fatigue and these usually resolve within 48 hrs.
Typhoid vaccine side effects
You should get a booster typhoid vaccine every 3 years.
Most of our cases in the UK are returning travellers from India, Pakistan and Bangladesh.
So if you’re visiting friends and relatives on the Indian subcontinent then a typhoid vaccination is essential. Please be aware that you’re also at risk in many tropical areas including Africa, Middle East, Central and South America. Our world map of typhoid distribution gives you an indication of how widespread typhoid is throughout the world.
You’ll need to have a discussion with your healthcare provider and weigh up the benefits of the typhoid vaccine and the risk of disease. As it’s an inactivated vaccine, it can be considered if you’re pregnant, which is not the case for live vaccines.
This is usually 17-14 days but can be extremely variable 6- 60 days (WHO)
Typhoid is highly contagious. Even a healthy carrier like ‘Typhoid Mary’ the cook, passed the bacteria in her faeces. Because of her poor hand hygiene, she infected many others while preparing food for wealthy families who employed her.
Frequently asked questions
Authors:
Dr Ravi Gowda, Consultant in Infectious Diseases and Travel Medicine
MBBS, MRCP(UK), DTM&H, MRCGP, DCH, DRCOG, DFFP
Caitlin Lancaster, BSc
Resources: