Typhoid: What It Is, Symptoms, Causes, and Prevention

Typhoid fever is defined as a bacterial infection caused by bacteria Salmonella typhi. The infection is caused primarily through ingestion of contaminated water and food, but it can also spread through close contact from one person to another. Interestingly, animals don’t carry this disease, so transmission is only possible through consumption of contaminated food/water and from human to human. The bacteria enter the body through the mouth and spend one to three weeks in the intestine prior to reaching the bloodstream.

Although everyone can develop typhoid, children are at a higher risk than adults despite having milder symptoms. The most common risk factors for typhoid fever include drinking contaminated water, having close contact with the infected individual, working with bacteria that cause the infection, and working or traveling to high-risk areas. The infection causes a number of symptoms but with prompt treatment patients notice improvements within seven to 10 days. The primary treatment route is an intake of antibiotics.

When and where was typhoid originated?

The exact point in history and location where the disease originated is unknown, but multiple reports claim it started in ancient Greece. Some historians theorize that typhoid fever was the primary culprit for the plague that affected Athens back in 430 BC. The disease killed more than one-third of the population including Pericles, general of Athens. Thucydides, Pericles’ successor, contracted diseases as well, but he didn’t die.

Fast forward a few centuries, and we’re in Jamestown, Virginia for which historians believe it was wiped out by typhoid fever. It is also thought that thousands of soldiers in the American Civil War died due to this particular illness.

The most notable carrier of typhoid fever was Mary Mallon who worked as a cook. Although she carried the bacteria, Ms. Mallon didn’t experience symptoms associated with typhoid fever, and she infected more than 50 people.

In the 19th century, the year 1880, Karl Joseph Eberth (German bacteriologist and pathologist) described a bacterium responsible for typhoid fever. Four years later, in 1884, a Hanover-born scientist Georg Theodor August Gaffky confirmed Ebert’s discovery. The bacterium was named Eberth’s bacillus or Eberthella typhi, but today it is widely known as Salmonella typhi. The first effective vaccine for this disease was developed by the British bacteriologist Almroth Edward Wright in 1896.

What are the symptoms of typhoid?

Symptoms of typhoid usually develop within six to 30 days after the exposure to bacteria. Two main signs and symptoms of typhoid are:

  • Fever – high, increases gradually over several days and it can reach up to 39-40°C or 104°F
  • Rash – rose-colored spots mainly on the neck and abdominal area (not all patients develop a rash)

Other signs and symptoms of this infection include:

  • Abdominal pain
  • Confusion
  • Constipation or diarrhea
  • Fatigue
  • Headache
  • Poor appetite
  • Weakness

Although severe complications are uncommon, some patients may experience intestinal bleeding or perforations when the infection is left untreated. This can lead to potentially life-threatening scenarios and complications.

How to prevent typhoid?

Despite its severity, there is a lot one can do to minimize the risk of typhoid fever. The best ways to prevent the infection involve:

  • Vaccination
  • Drink bottle, preferably carbonated, water
  • Boil non-bottled water for one minute before drinking
  • Avoiding drinking water from wells and taps while traveling
  • Avoiding salads and condiments prepared from fresh ingredients while in high-risk areas
  • Peel fruit yourself and don’t eat the peel
  • Try not to eat food from street food stands
  • Eat food while it’s still hot
  • Don’t touch your face unless you’ve just washed your hands
  • Wash hands frequently
  • Eat pasteurized dairy products
  • Avoid using ice made of tap or well water
  • Use hand sanitizer
  • Avoid close contact with people who are sick


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What organs can typhoid affect?

Since typhoid is a bacterial infection it doesn’t affect one specific organ; instead, it attacks multiple organ systems in the body. After the infection, bacteria reach the bloodstream from where it reaches different organs thus causing various symptoms. The gastrointestinal tract is more severely affected including liver, spleen, and muscles. Through bloodstream, bacteria can also reach gallbladder, lungs, and kidneys.

Who should get the typhoid vaccine?

Typhoid vaccination is recommended to:

  • Laboratory workers who handle Salmonella typhi bacteria
  • Travelers who plan to visit countries prone to typhoid infections, especially if visiting smaller towns and rural areas
  • People who are in close contact with a typhoid carrier

Who should not get the typhoid vaccine?

Typhoid vaccination is not recommended to:

  • Children who don’t meet the minimum age requirement for vaccination (see below)
  • Persons with an illness that involves high temperature or fever
  • People who have experienced a severe reaction to typhoid vaccine in the past
  • Individuals whose immune system is weakened due to diseases, viruses, etc. (oral vaccination)
  • People who are currently taking antibiotics (oral vaccination)


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What is the minimum age requirement for typhoid vaccine?

Typhoid shot should not be given to children younger than two years of age. On the flip side, live typhoid vaccine (oral) should not be given to a child who is younger than 6.

How long before a trip do you have to get a typhoid vaccine?

Bearing in mind protective effects of typhoid vaccine occur seven days after vaccination, it is recommended to get a vaccine two weeks or, ideally, a month prior to your travel in order to allow the shot to work.

What is the effectiveness of the typhoid vaccine?

Typhoid vaccine is 50% to 80% effective measures of prevention of the infection. That being said, no vaccine is 100% effective, and it is not a substitution for paying attention to what you eat and drink. In other words, while typhoid vaccine can reduce your risk of infection, you still need to be careful and employ prevention tips mentioned above.


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What are the side effects of typhoid vaccine?

Even though the vaccine is effective, some side effects are possible. The most common adverse reactions to typhoid vaccine are:

  • Feeling of discomfort
  • Fever
  • Headache
  • Muscle pain
  • Pain, swelling, and redness at the site of injection

In rare occasions a person may also experience side effects such as:

  • Hives
  • Itchy feet and hands
  • Skin redness, particularly around ears
  • Sudden and severe tiredness and weakness
  • Swelling of face, eyes, and inside of your nose

How many shots are needed?

Typhoid vaccine can be administered via injections and orally in the form of capsules or tablets. Inactivated typhoid vaccine shot is given in a single dose, i.e., one shot is enough for protection. On the flip side, three tablets are necessary for people in Australia and Europe while Canadians and Americans need four capsules. In Australia and Europe, tablets are taken on days 1, 3, and five while in North America four tablets are ingested on days 1, 3, 5, and 7.

How long does it last for?

One dose of injectable vaccine provides protection for 2 to 3 years after which a booster dose is needed for people who are at risk. In high-risk countries or regions, protective efficacy 1.5 years after vaccination is 72% while three years later it drops to 50%.

When it comes to the oral vaccine, the series is repeated every year from persons traveling from non-endemic to endemic countries and every three years for people who live in the high-risk regions. For people from Canada oral revaccination is recommended after seven years while Americans revaccinate after five years.

What are the infected areas in the world?

Typhoid fever is widespread across the globe, but it is less common in industrialized parts of the world such as Western Europe, the United States, Canada, Japan, and Australia. Part of the world with the highest risk of infection is in South Asia. However, infections also occur in other parts of Asia, Africa, and Latin America.

What is the transmission seasonality?

A person can get typhoid fever throughout the year, but the infection is particularly common during summer. It could be due to the fact typhoid mainly affects regions with poor sanitation and bacteria spread faster in warmer weather.

When and where was the last outbreak of typhoid?

According to the WHO, last typhoid outbreak occurred in Uganda in 2015. At the beginning of the said year, the outbreak started in Kampala City, and by March 5, about 1940 cases of the infection were identified. From Kampala, typhoid fever outbreak spread to neighboring cities and regions affecting primarily men ages 20 to 39. However, that wasn’t the last outbreak of this infection. In November 2016, typhoid outbreak started in a city called Hyderabad, Pakistan. The biggest problem regarding this latest outbreak is the fact it was caused by drug-resistant superbug strain. Despite the lacking of official data, it is estimated that 800 cases of the infection were detected.

Typhoid map

Typhoid Worldwide MapAs seen above, typhoid is common in many parts of the world which is why vaccination is important if you’re traveling to the following countries (and many others):

  • Afghanistan
  • Algeria
  • American Samoa
  • Angola
  • Anguilla
  • Antigua and Barbuda
  • Argentina
  • Armenia
  • Aruba
  • Azerbaijan
  • Bahrain
  • Bangladesh
  • Barbados
  • Gabon
  • Gambia
  • Georgia
  • Ghana
  • Guatemala
  • Haiti
  • Honduras
  • India
  • Indonesia
  • Iran
  • Iraq
  • Jamaica
  • Jordan
  • Kazakhstan
  • Kenya
  • Korea (North and South)
  • Kuwait
  • Kyrgyzstan
  • Laos
  • Lebanon
  • Belize
  • Benin
  • Bhutan
  • Bolivia
  • Botswana
  • Brazil
  • Bulgaria
  • Burkina Faso
  • Burundi
  • Cambodia
  • Cameroon
  • Chad
  • Chile
  • Libya
  • Madagascar
  • Malawi
  • Malaysia
  • Maldives
  • Mali
  • Morocco
  • Mozambique
  • Namibia
  • Nepal
  • Niger
  • Nigeria
  • Oman
  • Pakistan
  • Palestine
  • Paraguay
  • Peru
  • Philippines
  • Puerto Rico
  • Russia
  • China
  • Colombia
  • Congo
  • Costa Rica
  • Cuba
  • Dominican Republic
  • Ecuador
  • Egypt
  • El Salvador
  • Eritrea
  • Ethiopia
  • Fiji
  • French Polynesia
  • Saudi Arabia
  • Senegal
  • Seychelles
  • Singapore
  • Syria
  • Taiwan
  • Tanzania
  • Thailand
  • Togo
  • Tunisia
  • Turkey
  • Ukraine
  • United Arab Emirates
  • Uruguay
  • Venezuela
  • Vietnam
  • Yemen
  • Zambia
  • Zimbabwe

Conclusion

Typhoid fever is a common disease that is caused by bacteria we introduce to our body through the intake of contaminated food and water primarily. If you’re traveling to developing countries or places with poor sanitation, it is strongly recommended to get vaccinated. Rare are the occasions when the infection causes complications, but they’re still possible especially when the disease isn’t treated properly.