Typhoid fever and paratyphoid fever are life-threatening illnesses caused by

Salmonella serotype Typhi and Salmonella serotype Paratyphi, respectively.

Most people in the United States with typhoid fever or paratyphoid fever become
infected while traveling abroad, most often to countries where these diseases are
common.

Symptoms and Treatment

What are the signs and symptoms of typhoid fever and paratyphoid fever?

Typhoid fever and paratyphoid fever have similar symptoms̵. People usually have a
sustained fever (one that doesn’t come and go) that can be as high as 103–104° F
(39–40° C).
Other symptoms of typhoid fever and paratyphoid fever include
• Weakness
• Stomach pain
• Headache
• Diarrhea or constipation
• Cough
• Loss of appetite
Some people with typhoid fever or paratyphoid fever develop a rash of flat, rose-
colored spots.

What do you do if you think you have typhoid fever or paratyphoid fever?

The only way to know for sure if an illness is typhoid fever or paratyphoid fever is
to have a sample of blood or stool (poop) tested for Salmonella Typhi or
Salmonella Paratyphi.
If you have a high fever and feel very ill, see a doctor immediately. If you are
traveling outside the United States, you can usually call the U.S. consulate for a list
of recommended doctors. For more information about medical care abroad, see
Getting Health Care Abroad and a list of International Joint Commission-accredited facilities. 

How are typhoid fever and paratyphoid fever treated?

Typhoid fever is treated with antibiotics.

Resistance to antibiotics is increasing in the bacteria that cause typhoid fever and
paratyphoid fever. When bacteria are resistant to antibiotics, the bacteria are not
killed and their growth is not stopped. To help guide treatment, your doctor may
order special tests to see if your type of Salmonella is antibiotic-resistant.
People who do not get treatment can continue to have fever for weeks or months,
and can develop complications. As many as 30% of people who do not get
treatment die from complications of the infection.

The danger from typhoid fever or paratyphoid fever doesn’t end when symptoms
disappear.

Even if your symptoms seem to go away, you may still be carrying Salmonella
Typhi or SalmonellaParatyphi. If so, the illness could return, or you could pass the
bacteria to other people. In fact, if you are a health care worker or work at a job
where you handle food or care for small children, you might be barred (prevented)
legally from going back to work until a doctor has determined you no longer carry
the bacteria.
If you are being treated for typhoid fever or paratyphoid fever, it is important to do
the following:
• Keep taking antibiotics for as long as the doctor has recommended.
• 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 bacteria on to someone else.
• Have your doctor test your stool (poop) to be sure no Salmonella Typhi or
Salmonella Paratyphi bacteria remain in your body.

Vaccination
If you are traveling to a country where typhoid fever is common, consider being
vaccinated against typhoid fever. Visit a doctor or travel clinic to discuss options.
Remember that you should complete the vaccinations at least 1–2 weeks
(depending on vaccine type) 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, ask your doctor to if it is time for a booster vaccination.
Taking antibiotics will not prevent typhoid fever; they only help treat it.
Prevention Tips for Travelers
Typhoid fever and paratyphoid fever are common in many parts of the world.

Typhoid fever and paratyphoid fever are common in many parts of the world, but
not in industrialized regions such as the United States, Canada, Western Europe,
Australia, and Japan. Areas of highest risk include parts of East and Southeast Asia,
Africa, the Caribbean, and Central and South America.

Two basic actions can protect you:

1. Get vaccinated against typhoid fever.

2. Find out how to stay safe when it comes to foods and drinks.
Carefully selecting what you eat and drink when you travel is important. This is
because the typhoid fever vaccines do not work 100% of the time, and there is no
paratyphoid fever vaccine. Avoiding risky foods will also help protect you from
other illnesses, including travelers’ diarrhea, cholera, dysentery, and hepatitis A.

When you travel to areas of risk, remember to “Boil it, cook it, peel it, or forget it.”

• If you drink water, buy it bottled or bring it to a rolling boil for 1 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
contaminated water.
• Eat foods that have been thoroughly cooked and are still hot and steaming.
• Avoid raw vegetables and fruits that cannot be peeled. Lettuce can remain
contaminated even after it is washed.
• When you eat raw fruit or vegetables that can be peeled, peel them yourself.
(Wash your hands with soap first.)
• Avoid foods and beverages from street vendors.

https://www.cdc.gov/typhoid-fever/symptoms.html
National Typhoid and Paratyphoid Fever
Surveillance
CDC has conducted surveillance for typhoid fever since 1975. State and local
health officials use a standard report form to report detailed epidemiologic
information on laboratory-confirmed cases, including patient demographic and
clinical information, typhoid vaccination status, and travel history. A case of
typhoid fever is defined as an acute illness compatible with typhoid fever in which
Salmonella serotype Typhi was isolated from a normally sterile site or from stool
or urine. Travel-associated typhoid fever is defined as illness in a person who
traveled outside of the United States in the 30 days before illness began, and
domestically acquired typhoid fever is defined as illness in a person without such a
travel history.
CDC has conducted surveillance for paratyphoid fever since 2008. Paratyphoid
fever, which is caused by Salmonella serotypes Paratyphi A, tartrate-negative
Paratyphi B, and Paratyphi C, is nationally notifiable, which means jurisdictions
notify CDC of reported cases.

https://www.nhs.uk/conditions/typhoid-fever/

Typhoid fever is a bacterial infection that can spread throughout the body, affecting many
organs. Without prompt treatment, it can cause serious complications and can be fatal.

It's caused by a bacterium called Salmonella typhi, which is related to the bacteria that cause
salmonella food poisoning.

Typhoid fever is highly contagious. An infected person can pass the bacteria out of their body in
their poo (stools) or, less commonly, in their pee (urine).

If someone else eats food or drinks water that's been contaminated with a small amount of infected
poo or urine, they can become infected with the bacteria and develop typhoid fever.

Read more about the causes of typhoid fever.

Who's affected?
Typhoid fever is most common in parts of the world that have poor sanitation and limited access to
clean water.

Worldwide, children are thought to be most at risk of developing typhoid fever.

This may be because their immune system (the body's natural defence against infection and illness)
is still developing.

But children with typhoid fever tend to have milder symptoms than adults.

Typhoid fever is uncommon in the UK, with an estimated 500 cases occurring each year.

In most of these cases, the person developed the infection while visiting relatives in Bangladesh,
India or Pakistan.

But you're also at risk of developing the infection if you visit Asia, Africa or South America.

Find out where typhoid fever is most common

Symptoms of typhoid fever

The main symptoms of typhoid fever are:

• a high temperature that can reach 39 to 40C
• headache
• general aches and pains
• cough
• constipation

As the infection progresses, you may lose your appetite, feel sick, and have a tummy ache and
diarrhoea. Some people may develop a rash.

If typhoid fever isn't treated, the symptoms will continue to get worse over the following weeks and
the risk of developing potentially fatal complications will increase.

Read more about the symptoms of typhoid fever and the complications of typhoid fever.

How typhoid fever is treated

Typhoid fever requires prompt treatment with antibiotics.

If typhoid fever is diagnosed early, the infection is likely to be mild and can usually be treated at
home with a 7- to 14-day course of antibiotic tablets.

More serious cases of typhoid fever usually require admission to hospital so antibiotic injections
can be given.

With prompt antibiotic treatment, most people will start to feel better within a few days and serious
complications are very rare.
Deaths from typhoid fever are now virtually unheard of in the UK.

If typhoid fever isn't treated, it's estimated that up to 1 in 5 people with the condition will die.

Some of those who survive will have complications caused by the infection.

Read more about treating typhoid fever.

Typhoid fever vaccination

In the UK, 2 vaccines are available that can provide some protection against typhoid fever.

These involve either having a single injection or taking 3 capsules over alternate days.

Vaccination is recommended for anyone planning to travel to parts of the world where typhoid fever
is widespread.

It's particularly important if you're planning to live or work closely with local people.

But as neither vaccine offers 100% protection, it's also important to follow some precautions when
travelling.

For example, you should only drink bottled or boiled water, and you should avoid foods that could
potentially be contaminated.

Read more about the typhoid fever vaccination.

High-risk areas
The areas with the highest rates of typhoid fever are:
• the Indian subcontinent
• Africa
• south and southeast Asia
• South America

When travelling to a foreign country, it's a good idea to make a list of relevant contact details and
telephone numbers in case of an emergency.

https://www.who.int/mediacentre/factsheets/typhoid/en/
Typhoid
Fact sheet
January 2018

Key facts
•Typhoid fever is a life-threatening infection caused by the bacterium SalmonellaTyphi. It is usually spread through
contaminated food or water.
•An estimated 11–20 million people get sick from typhoid and between 128 000 and 161 000 people die from it every
year.
•Symptoms include prolonged fever, fatigue, headache, nausea, abdominal pain, and constipation or diarrhoea. Some
patients may have a rash. Severe cases may lead to serious complications or even death.
•Typhoid fever can be treated with antibiotics although increasing resistance to different types of antibiotics is making
treatment more complicated.
•Two vaccines have been used for many years to prevent typhoid. A new typhoid conjugate vaccine with longer lasting
immunity was prequalified by WHO in December 2017.

Typhoid fever is a life-threatening infection caused by the bacterium SalmonellaTyphi. It is usually spread through
contaminated food or water. Once SalmonellaTyphi bacteria are eaten or drunk, they multiply and spread into the
bloodstream.
Urbanization and climate change have the potential to increase the global burden of typhoid. In addition, increasing
resistance to antibiotic treatment is making it easier for typhoid to spread through overcrowded populations in cities and
inadequate and/or flooded water and sanitation systems.
Symptoms
Salmonella Typhi lives only in humans. Persons with typhoid fever carry the bacteria in their bloodstream and intestinal
tract. Symptoms include prolonged high fever, fatigue, headache, nausea, abdominal pain, and constipation or diarrhoea.
Some patients may have a rash. Severe cases may lead to serious complications or even death. Typhoid fever can be
confirmed through blood testing.
Epidemiology, risk factors, and disease burden
Improved living conditions and the introduction of antibiotics resulted in a drastic reduction of typhoid fever morbidity
and mortality in industrialized countries. In developing areas of Africa, the Americas, South-East Asia and the Western
Pacific regions, however, the disease continues to be a public health problem.
WHO estimates the global typhoid fever disease burden at 11-20 million cases annually, resulting in about 128 000–161
000 deaths per year.
Typhoid risk is higher in populations that lack access to safe water and adequate sanitation. Poor communities and
vulnerable groups including children are at highest risk.
Treatment
Typhoid fever can be treated with antibiotics. As resistance to antibiotics has emerged including to fluoroquinolones,
newer antibiotics such as cephalosporins and azithromycin are used in the affected regions. Resistance to azithromycin has
been reported sporadically but it is not common as of yet.
Even when the symptoms go away, people may still be carrying typhoid bacteria, meaning they can spread it to others
through their faeces.
It is important for people being treated for typhoid fever to do the following:
•Take prescribed antibiotics for as long as the doctor has prescribed.
•Wash their hands with soap and water after using the bathroom, and do not prepare or serve food for other people. This
will lower the chance of passing the infection on to someone else.
•Have their doctor test to ensure that no Salmonella Typhi bacteria remain in their body.
Prevention
Typhoid fever is common in places with poor sanitation and a lack of safe drinking water. Access to safe water and
adequate sanitation, hygiene among food handlers and typhoid vaccination are all effective in preventing typhoid fever.
Two vaccines have been used for many years to protect people from typhoid fever:
•an injectable vaccine based on the purified antigen for people aged over 2 years
•a live attenuated oral vaccine in capsule formulation for people aged over 5 years
These vaccines do not provide long-lasting immunity and are not approved for children younger than 2 years old.
A new typhoid conjugate vaccine, with longer lasting immunity, was prequalified by WHO in December 2017 for use in
children from the age of 6 months.
All travelers to endemic areas are at potential risk of typhoid fever, although the risk is generally low in tourist and
business centres where standards of accommodation, sanitation and food hygiene are high. Typhoid fever vaccination
should be offered to travelers to destinations where the risk of typhoid fever is high.
The following recommendations will help ensure safety while travelling:
•Ensure food is properly cooked and still hot when served.
•Avoid raw milk and products made from raw milk. Drink only pasteurized or boiled milk.
•Avoid ice unless it is made from safe water.
•When the safety of drinking water is questionable, boil it or if this is not possible, disinfect it with a reliable, slow-release
disinfectant agent (usually available at pharmacies).
•Wash hands thoroughly and frequently using soap, in particular after contact with pets or farm animals, or after having
been to the toilet.
•Wash fruits and vegetables carefully, particularly if they are eaten raw. If possible, vegetables and fruits should be peeled.
WHO response
In December 2017, WHO prequalified the first conjugate vaccine for typhoid. This new vaccine has longer-lasting
immunity than older vaccines, requires fewer doses and can be given to children from the age of 6 months.
This vaccine will be prioritized for countries with the highest burden of typhoid disease. This will help reduce the frequent
use of antibiotics for typhoid treatment, which will slow the increase in antibiotic resistance in Salmonella Typhi.
In October 2017, the Strategic Advisory Group of Experts (SAGE) on immunization, which advises WHO, recommended
typhoid conjugate vaccines for routine use in children over 6 months of age in typhoid endemic countries. SAGE also
called for the introduction of typhoid conjugate vaccines to be prioritized for countries with the highest burden of typhoid
disease or of antibiotic resistance to Salmonella Typhi.
Shortly after SAGE’s recommendation, the Gavi Board approved US$ 85 million in funding for typhoid conjugate
vaccines starting in 2019.

Typhoid fever
Cause
The typhoid bacillus Salmonella typhi, which infects humans only. Paratyphoid and enteric fevers are caused by other
species of Salmonella, which infect domestic animals as well as humans.
Transmission
The typhoid bacillus is transmitted by consumption of contaminated food or water. Occasionally, direct faecal–oral
transmission may occur. Shellfish taken from sewage-polluted areas are an important source of infection; transmission
also occurs through eating raw fruit and vegetables fertilized by human excreta and through ingestion of contaminated
milk and milk products. Flies may cause human infection through transfer of the infectious agents to foods. Pollution of
water sources may produce epidemics of typhoid fever when large numbers of people use the same source of drinking-
water.
Nature of the disease
Typhoid fever is a systemic disease of varying severity. Severe cases are characterized by gradual onset of fever,
headache, malaise, anorexia and insomnia. Constipation is more common than diarrhoea in adults and older children.
Without treatment, some patients develop sustained fever, bradycardia, hepatosplenomegaly, abdominal symptoms and,
occasionally, pneumonia. In white-skinned patients, pink spots, which fade on pressure, appear on the skin of the trunk in
up to 20% of cases. In the third week, untreated cases may develop gastrointestinal and cerebral complications, which may
prove fatal in up to 10–20% of cases. The highest casefatality rates are reported in children <4 years="" of="" age.=""
around="" 2–5%="" of="" those="" who="" contract="" typhoid="" fever="" become="" chronic="" carriers,="" as=""
bacteria="" persist="" in="" the="" biliary="" tract="" after="" symptoms="" have="">
Geographical distribution
There is a higher risk of typhoid fever in countries or areas with low standards of hygiene and water supply facilities.
Risk for travellers
The risk for travellers is generally low, except in parts of northern and western Africa, in southern Asia, in parts of
Indonesia and in Peru. Elsewhere, travellers are usually at risk only when exposed to low standards of hygiene. Even
vaccinated travellers should take care to avoid consumption of potentially contaminated food and water as the vaccine
does not confer 100% protection.

https://www.who.int/ith/diseases/typhoidfever/en/

Overview
Typhoid fever is caused by Salmonella typhi bacteria. Typhoid fever is rare in industrialized
countries. However, it remains a serious health threat in the developing world, especially
for children.

Typhoid fever spreads through contaminated food and water or through close contact with
someone who's infected. Signs and symptoms usually include a high fever, headache,
abdominal pain, and either constipation or diarrhea.

Most people with typhoid fever feel better within a few days of starting antibiotic treatment,
although a small number of them may die of complications. Vaccines against typhoid fever
are available, but they're only partially effective. Vaccines usually are reserved for those
who may be exposed to the disease or are traveling to areas where typhoid fever is
common.

Symptoms
Signs and symptoms are likely to develop gradually — often appearing one to three weeks
after exposure to the disease.

Early illness

Once signs and symptoms do appear, you're likely to experience:

•Fever that starts low and increases daily, possibly reaching as high as 104.9 F (40.5
C)
•Headache

•Weakness and fatigue

•Muscle aches

•Sweating

•Dry cough

•Loss of appetite and weight loss

•Abdominal pain
 •Diarrhea or constipation

•Rash

•Extremely swollen abdomen

Later illness

If you don't receive treatment, you may:

•Become delirious

•Lie motionless and exhausted with your eyes half-closed in what's known as the
typhoid state
In addition, life-threatening complications often develop at this time.

In some people, signs and symptoms may return up to two weeks after the fever has
subsided.

When to see a doctor

See a doctor immediately if you suspect you have typhoid fever. If you are from the United
States and become ill while traveling in a foreign country, call the U.S. Consulate for a list
of doctors. Better yet, find out in advance about medical care in the areas you'll visit, and
carry a list of the names, addresses and phone numbers of recommended doctors.

If you develop signs and symptoms after you return home, consider consulting a doctor
who focuses on international travel medicine or infectious diseases. A specialist may be
able to recognize and treat your illness more quickly than can a doctor who isn't familiar
with these areas.

Causes
Typhoid fever is caused by virulent bacteria called Salmonella typhi. Although they're
related, Salmonella typhi and the bacteria responsible for salmonellosis, another serious
intestinal infection, aren't the same.

Fecal-oral transmission route

The bacteria that cause typhoid fever spread through contaminated food or water and
occasionally through direct contact with someone who is infected. In developing nations,
where typhoid fever is established (endemic), most cases result from contaminated
drinking water and poor sanitation. The majority of people in industrialized countries pick
up typhoid bacteria while traveling and spread it to others through the fecal-oral route.

This means that Salmonella typhi is passed in the feces and sometimes in the urine of
infected people. You can contract the infection if you eat food handled by someone with
typhoid fever who hasn't washed carefully after using the toilet. You can also become
infected by drinking water contaminated with the bacteria.

Typhoid carriers

Even after treatment with antibiotics, a small number of people who recover from typhoid
fever continue to harbor the bacteria in their intestinal tracts or gallbladders, often for
years. These people, called chronic carriers, shed the bacteria in their feces and are
capable of infecting others, although they no longer have signs or symptoms of the
disease themselves.

Risk factors
Typhoid fever remains a serious worldwide threat — especially in the developing world —
affecting an estimated 26 million or more people each year. The disease is established
(endemic) in India, Southeast Asia, Africa, South America and many other areas.

Worldwide, children are at greatest risk of getting the disease, although they generally
have milder symptoms than adults do.

If you live in a country where typhoid fever is rare, you're at increased risk if you:

•Work in or travel to areas where typhoid fever is established (endemic)

•Work as a clinical microbiologist handling Salmonella typhi bacteria

•Have close contact with someone who is infected or has recently been infected with
typhoid fever
•Drink water contaminated by sewage that contains Salmonella typhi

Complications
Intestinal bleeding or holes

The most serious complications of typhoid fever — intestinal bleeding or holes

(perforations) in the intestine — may develop in the third week of illness. A perforated
intestine occurs when your small intestine or large bowel develops a hole, causing
intestinal contents to leak into your abdominal cavity and triggering signs and symptoms
such as severe abdominal pain, nausea, vomiting and bloodstream infection (sepsis). This
life-threatening complication requires immediate medical care.

Other, less common complications

Other possible complications include:

•Inflammation of the heart muscle (myocarditis)

 •Inflammation of the lining of the heart and valves (endocarditis)

•Pneumonia

•Inflammation of the pancreas (pancreatitis)

•Kidney or bladder infections

•Infection and inflammation of the membranes and fluid surrounding your brain and
spinal cord (meningitis)
•Psychiatric problems, such as delirium, hallucinations and paranoid psychosis

With prompt treatment, nearly all people in industrialized nations recover from typhoid
fever. Without treatment, some people may not survive complications of the disease.

Prevention
In many developing nations, the public health goals that can help prevent and control
typhoid fever — safe drinking water, improved sanitation and adequate medical care —
may be difficult to achieve. For that reason, some experts believe that vaccinating high-risk
populations is the best way to control typhoid fever.

A vaccine is recommended if you live in or you're traveling to areas where the risk of
getting typhoid fever is high.

Vaccines

Two vaccines are available.

•One is injected in a single dose at least one week before travel.

•One is given orally in four capsules, with one capsule to be taken every other day.

Neither vaccine is 100 percent effective, and both require repeat immunizations, as
vaccine effectiveness diminishes over time.

Because the vaccine won't provide complete protection, follow these guidelines when
traveling to high-risk areas:

•Wash your hands. Frequent hand-washing in hot, soapy water is the best way to
control infection. Wash before eating or preparing food and after using the toilet.
Carry an alcohol-based hand sanitizer for times when water isn't available.
•Avoid drinking untreated water. Contaminated drinking water is a particular problem
in areas where typhoid fever is endemic. For that reason, drink only bottled water or
canned or bottled carbonated beverages, wine and beer. Carbonated bottled water is
safer than uncarbonated bottled water is.
Ask for drinks without ice. Use bottled water to brush your teeth, and try not to swallow
water in the shower.
 •Avoid raw fruits and vegetables. Because raw produce may have been washed in
unsafe water, avoid fruits and vegetables that you can't peel, especially lettuce. To be
absolutely safe, you may want to avoid raw foods entirely.
•Choose hot foods. Avoid food that's stored or served at room temperature. Steaming
hot foods are best. And although there's no guarantee that meals served at the finest
restaurants are safe, it's best to avoid food from street vendors — it's more likely to
be contaminated.

Prevent infecting others

If you're recovering from typhoid fever, these measures can help keep others safe:

•Take your antibiotics. Follow your doctor's instructions for taking your antibiotics, and
be sure to finish the entire prescription.
•Wash your hands often. This is the single most important thing you can do to keep
from spreading the infection to others. Use hot, soapy water and scrub thoroughly for
at least 30 seconds, especially before eating and after using the toilet.
•Avoid handling food. Avoid preparing food for others until your doctor says you're no
longer contagious. If you work in the food service industry or a health care facility, you
won't be allowed to return to work until tests show that you're no longer shedding
typhoid bacteria.
https://www.mayoclinic.org/diseases-conditions/typhoid-fever/symptoms-causes/syc-20378661

Typhoid
Typhoid fever is a systemic infection caused by Salmonella Typhi, usually through ingestion of contaminated
food or water. The acute illness is characterized by prolonged fever, headache, nausea, loss of appetite, and
constipation or sometimes diarrhoea. Symptoms are often non-specific and clinically non-distinguishable from
other febrile illnesses. However, clinical severity varies and severe cases may lead to serious complications or
even death. It occurs predominantly in association with poor sanitation and lack of clean drinking water.
According to the most recent estimates, between 11 and 21 million cases and 128 000 to 161 000 typhoid-
related deaths occur annually worldwide. A similar but often less severe disease, paratyphoid fever, is caused
by Salmonella Paratyphi A and B (or uncommonly Paratyphi C).

Three typhoid vaccines are currently recommended for use by:

•an injectable typhoid conjugate vaccine (TCV), consisting of Vi polysaccharide antigen linked to tetanus toxoid protein
licensed for children from 6 months of age and adults up to 45 years of age;
•an injectable unconjugated polysaccharide vaccine based on the purified Vi antigen (known as Vi-PS vaccine) for persons
aged two years and above; and
•an oral live attenuated Ty21a vaccine in capsule formulation for those over six years of age.
WHO recommends vaccination to control endemic typhoid fever and for outbreak control. Among the available
typhoid vaccines, TCV is preferred at all ages in view of its improved immunological properties, suitability for
use in younger children and expected longer duration of protection. WHO further recommends that all typhoid
fever vaccination programmes should be implemented in the context of other efforts to control the disease,
including health education, water quality and sanitation improvements, and training of health professionals in
diagnosis and treatment.

https://www.who.int/immunization/diseases/typhoid/en/