Typhoid

This factsheet is for people who have typhoid, or who would like information about it.

Typhoid is a bacterial infection that is spread through contaminated food and water. It has the potential to cause severe illness, which can be life-threatening.

About typhoid

Typhoid is spread by consuming food or water contaminated with the urine or faeces of a person infected with the bacteria. It’s particularly widespread in developing areas such as Asia, Africa and Latin America.

The World Health Organization estimates that up to 33 million people get typhoid each year. Typhoid infection causes more than 200,000 deaths worldwide – mostly in children and young adults.

In 2010, 569 people were diagnosed with typhoid in England and Wales. Most people from the UK who have the infection are likely to have visited parts of the world where the infection is common.

Symptoms of typhoid

The symptoms of typhoid usually start seven to 14 days after you get the infection. Some people may have very mild symptoms or no symptoms at all.

The first symptoms of typhoid can include:

• persistent fever (39°C to 40°C)
• headache
• loss of appetite and nausea
• constipation and sometimes diarrhoea
• stomach pain
• a rash or small pink spots on your chest or abdomen (tummy)

These symptoms aren't always caused by typhoid but if you have them, see your GP.

Complications of typhoid

If left untreated, typhoid infection can cause serious complications, such as:

• low blood pressure
• confusion, shock and delirium (a disturbed state of mind, in which you become restless and incoherent)
• intestinal bleeding – symptoms include having dark faeces
• pneumonia
• heart, liver, spleen or kidney infection
• meningitis (usually in young children)

Causes of typhoid

Typhoid is caused by the bacteria Salmonella enterica serovar Typhi (S. Typhi). It’s spread by consuming food or water contaminated with the urine or faeces of a person infected with typhoid.

Diagnosis of typhoid

Your GP will ask about your symptoms and examine you. He or she may also ask about your medical history and any recent trips you have been on.

If your GP suspects you have typhoid, he or she will take a sample of your blood, faeces or urine. This will then be sent to a laboratory for testing.

Treatment of typhoid

Typhoid can be treated with a course of antibiotics. These are usually prescribed by a hospital doctor to take by mouth (orally), but if your symptoms are severe you may need to have the medicine through a drip (intravenously).

Standard antibiotics prescribed for typhoid that you take by mouth include chloramphenicol, ampicillin, ciprofloxacin and azithromycin. It’s important to take your antibiotics as directed by your doctor. Don't stop taking them early, even if your symptoms improve.

Research shows that the S. Typhi bacterium is becoming increasingly resistant to standard antibiotics. If your symptoms come back (reoccur) within two weeks of completing your treatment, you will need to take a second course of oral antibiotics. Some people may need to have intravenous antibiotics if the symptoms reoccur – for example ceftriaxone, which you can often have at home if your local hospital has an outpatient parenteral antibiotic therapy (OPAT) service.

Special considerations

Carrier of typhoid

Following treatment, about three in 100 people who have been infected with typhoid continue to have the S. Typhi bacteria in their faeces for more than a year. If this happens, it means you're a carrier of typhoid and can infect other people, even though you don't have any symptoms. To find out whether you're a carrier, your doctor may ask you to give a sample of faeces after you have completed your treatment to be tested. If you're a carrier, your doctor may prescribe you a longer course of antibiotics.

Prevention of typhoid

There are steps you can take to reduce your risk of catching typhoid when you travel to an area where the disease is commonly found.

• Wash your hands with soap and water or with alcohol-based hand cleaners (with more than 60 percent alcohol) before eating, after going to the toilet and particularly after direct contact with young children or animals (and their faeces).
• 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 is freshly prepared, cooked thoroughly and hot.
• Don't eat raw vegetables, such as green salads, as they may have been washed in contaminated water – try to only eat raw vegetables and fruit that you can peel.

Vaccination

Before you go to an area where typhoid is found, and that doesn’t have clean water or good sanitation, you should have the typhoid vaccine. This will help to reduce your risk of catching typhoid but won't completely protect you from the disease. It's very important to look after your personal hygiene, even if you've had the vaccine.

If you have the injected typhoid vaccine, you won't need a booster for three years. A booster is a second vaccine to help increase your protection against a disease. You can also have the typhoid vaccine as a tablet. If you have the vaccination in this way, you will need a booster after one year. You may be able to have a combined typhoid and hepatitis A vaccination, if available.

The typhoid vaccine isn’t recommended for children under a year. Children aged between one and two should only be vaccinated if their risk of catching typhoid is high.

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

Produced by Krysta Munford, Bupa Health Information Team, March 2012. 

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.