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Typhoid

Typhoid and paratyphoid are infections caused by bacteria. They’re also known as ‘enteric fever’. You can catch typhoid or paratyphoid by drinking water or eating food that has bacteria in it.

Typhoid and paratyphoid are very rare in the UK – only about 500 people get one of these infections each year. However, these infections are much more common in other parts of the world, such as the India, Pakistan, Bangladesh, Africa and Latin America. Roughly 22 million people get typhoid or paratyphoid across the world each year. About 200,000 of these people die from the infection. Most people in the UK with typhoid catch it when visiting Africa, Bangladesh, India or Pakistan.

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  • Symptoms Symptoms of typhoid and paratyphoid

    The symptoms of typhoid usually start eight to 14 days after you get the infection.

    The first symptoms of typhoid can include:

    • ongoing fever (usually 38°C or higher)
    • headache
    • abdominal (tummy) pain
    • diarrhoea or constipation 
    • loss of appetite 
    • a rash or small pink spots on your chest or abdomen 
    • feeling poorly
    • dry cough

    Some people may have mild symptoms or no symptoms at all.

    Symptoms of paratyphoid are similar, but may begin sooner (usually within one to 10 days) and might not be as bad. Pink spots are more common with paratyphoid.

    These symptoms aren't always caused by typhoid or paratyphoid. If you’re returning from abroad and are poorly, see your GP (or if you are seriously unwell, your local accident and emergency (A&E) department). Tell them where you have been travelling.

  • Diagnosis Diagnosis of typhoid and paratyphoid

    Your GP will ask about your symptoms and examine you. It’s important to tell them about where you’ve been travelling.

    If your GP thinks that you have typhoid or paratyphoid and you’re unwell then they will normally arrange admission to hospital.

    If your symptoms are mild then it may be the result of other conditions. Your GP may send a sample of your faeces to a laboratory for testing. You may also have your blood and urine tested.

    If a person you travelled abroad with, live with or have close contact with becomes ill with typhoid or paratyphoid, there’s a chance you may have caught it too. Even if you don’t feel unwell, a sample of your faeces may need to be tested.

    Typhoid is a notifiable disease which means that that if your doctor thinks you have typhoid or paratyphoid, by law, he or she has to report it.

  • Treatment Treatment of typhoid and paratyphoid

    Typhoid and paratyphoid can be treated with antibiotics. These are usually taken by mouth (orally), but if your symptoms are severe you may need them through a drip (intravenously).

    It’s important to take your antibiotics as explained by your doctor. Don't stop taking them early, even if your symptoms improve. The infection can come back or be passed on to other people if you don’t finish your course of antibiotics.

    Sometimes, typhoid and paratyphoid bacteria are resistant to certain antibiotics. This means the medicine won’t cure your infection. The antibiotics you’re given will be chosen carefully. If they don’t work, you may need to swap to a different type of antibiotic.

    After your treatment

    After your treatment ends, your doctor may need samples of your faeces for testing again. This is particularly likely to happen if you’re a food handler or a carer. This is to make sure no bacteria are left in your body. If you still have an infection, you may need more antibiotics.

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  • Causes Causes of typhoid and paratyphoid

    Typhoid is caused by the bacteria Salmonella enterica Typhi (S. Typhi), while paratyphoid is caused by Salmonella enterica Paratyphi (S. Paratyphi). They’re caught by eating food or drinking water containing bacteria from the faeces of an infected person. Healthcare workers can sometimes catch it from an infected person’s urine. The bacteria can be spread to food by touch, flies or sewage.

  • Complications Complications of typhoid and paratyphoid

    If left untreated, typhoid (and occasionally paratyphoid) can cause complications (serious problems) and even death. Complications include:

    • ulcers and bleeding in your intestines (guts) – this can lead to a hole (perforation) in your bowel
    • kidney failure
    • bone infection (osteomyelitis)
    • swelling and infection of the gall bladder (cholecystitis), the membranes around the brain and spinal cord (meningitis) or lungs (pneumonia)
  • Prevention Preventing typhoid and paratyphoid

    • You can reduce your risk of catching typhoid or paratyphoid when you travel to an area where the disease is more commonly found. Wash your hands regularly with soap and water before eating, after going to the toilet and after contact with young children. 
    • Only drink bottled water (make sure the seal is intact) or tap water that has been boiled. You should also use this type of water to brush your teeth.
    • Eat food that’s freshly prepared, cooked thoroughly and hot (avoid buffets).
    • Don’t have ice cubes, ice cream and cold desserts.
    • Avoid unpasteurised milk and cheese. 
    • Don't eat raw vegetables, such as salads, as they may have been washed in unclean water.
    • Only eat fruit that you have peeled.

    Vaccination

    You should have a typhoid vaccine before you go to an area where typhoid is found, especially if there isn’t clean water or good sanitation.

    This will reduce your risk of catching typhoid but won't completely protect you from the disease. The vaccine doesn’t work against paratyphoid. So, it's very important to follow advice on hand washing, drinking bottled water and steering clear of certain food, even if you've had the vaccine.

    You can have a typhoid vaccine as an injection or tablet. If you have the injection, it will protect you from typhoid for three years. After that, you can have a booster if needed, which is a second vaccine. If you have the tablet, you will be protected for one year. After that, you can have a booster if needed.

    You may be able to have a combined typhoid and hepatitis A vaccine, if available and useful.

    The vaccine is not usually recommended for children under 18 months old.

    Your GP can advise you whether or not you need the vaccine, depending on where you're travelling to.

  • Special considerations Special considerations

    Reducing the chance of passing on the infection to others

    When you’re ill with typhoid or paratyphoid (and for some time after you recover), you could pass the infection on to others.

    Your doctor will explain good hygiene (eg, hand washing) to reduce the chance of this. Older people and children are at greater risk of becoming seriously unwell if they get typhoid. Be especially careful not to pass on the infection to them. If you work caring for others or preparing food, you may need to stop work or avoid some tasks while you have the infection. Children may also need to stay out of nursery or school while they are infectious.

    Occasionally, people carry the bacteria in their bodies for months or years after they feel better. These people are known as ‘carriers’ of typhoid or paratyphoid. Up to three in 100 people with typhoid may become carriers or find that their infection comes back. If you’re a carrier, you’ll have samples of your faeces tested every month until the infection clears. You may be asked not to do certain work, such as caring for others or preparing food.

  • FAQs FAQs

    Are there any extra precautions I should take if I’m pregnant and travelling to an area where there is typhoid?

    Answer

    If you're pregnant, it's particularly important to reduce your risk of catching typhoid or paratyphoid. Follow travel advice and any general advice about foods to avoid while pregnant.

    Explanation

    Treating infections with antibiotics is more complicated if you're pregnant because there are fewer types of antibiotics you can take. Although there’s a typhoid vaccination, this is only given if the benefits outweigh the risks. This is because some vaccines shouldn’t be given to pregnant women if there’s a risk it may affect the unborn baby. Talk your options through with your doctor.

    If you're travelling to a typhoid area, it’s very important you follow advice about drinking bottled water, avoiding certain foods and washing your hands. Also follow general advice about foods to stay away from while pregnant.

    If you have any concerns, speak to your GP or obstetrician (a doctor who specialises in pregnancy and childbirth) for advice.

    How many weeks before travelling should I have a typhoid vaccination?

    Answer

    If you’re travelling to an area with typhoid, a lack of clean drinking water and poor sanitation, visit your GP to have a vaccination at least two weeks before you travel.

    Explanation

    The typhoid vaccine can take two weeks to work. So, it’s important you have it early enough before your trip abroad to be protected as much as possible.

    Remember, although the vaccine reduces your risk of catching typhoid, some risk remains. Follow advice about drinking bottled water, avoiding certain foods and washing your hands.

    Will the typhoid vaccine make me ill?

    Answer

    You may have mild side-effects after the typhoid vaccination.

    Explanation

    Side-effects are the unwanted but mostly temporary effects you may get after having a vaccination. If you have the vaccine by injection, side-effects can include:

    • pain, swelling, hardness and redness at the injection site
    • stomach problems, such as abdominal (tummy) pain, nausea and diarrhoea 
    • fever
    • headache

    Very rarely, it can cause anaphylaxis, which is a serious allergic reaction. If you have the vaccine by mouth, side-effects can include:

    • abdominal pain and cramps
    • feeling sick or vomiting
    • diarrhoea

    Speak to your GP for more information and advice.

  • Resources Resources

    Further information

    Sources

    • Public health operational guidelines for typhoid and paratyphoid (enteric fever). Health Protection Agency & Chartered Institute of Environmental Health, 2012. www.hpa.org.uk
    • Immunisations – travel. NICE Clinical Knowledge Summaries. cks.nice.org.uk, revised August 2012
    • Typhoid – health advice for travellers. Public Health England, 2014. www.hpa.org.uk
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 28 July 2014 (online version) 
    • Travel health vaccination sheets: typhoid and paratyphoid. National Travel Health Network and Centre. www.nathnac.org, published September 2012.
    • Background document: the diagnosis, treatment and prevention of typhoid fever. World Health Organization, 2003. www.who.int
    • Immunisation against infectious disease: the green book. Public Health England. www.gov.uk, accessed 15 August 2014
    • Personal communication. Professor Robert Read MD FRCP, Professor of Infectious Diseases, University of Southampton, August 2014
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