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Typhoid


Expert reviewed by Dr Martin Wiselka, Consultant in Infectious Disease
Next review due March 2020

Typhoid and paratyphoid (also known as enteric fever) are infections caused by bacteria. They’re very rare in the UK – only about 300 to 350 people get one of these infections each year. They’re much more common in other parts of the world, particularly in less developed countries with poor sanitation. Most people in the UK catch it when they visit India, Pakistan or Bangladesh.

A woman in an airport waiting for her flight

Symptoms of typhoid and paratyphoid

You’ll usually start to get the symptoms of typhoid about one to three weeks after you get the infection. The first symptoms of typhoid can include:

  • a fever that gets steadily worse until your temperature sits at 39°C or higher
  • a headache
  • feeling weak and tired

Other symptoms can include:

  • chills
  • feeling sick or vomiting
  • tummy pain
  • diarrhoea or constipation 
  • a rash, or small pink spots on your chest or tummy
  • a cough
  • sore muscles

You might just have mild symptoms, and some people don’t get any symptoms at all.

Symptoms of paratyphoid are similar to typhoid but they aren’t normally as severe, and you might develop the fever later, after the other symptoms.

If you’ve just returned from abroad and have these symptoms, contact your GP; or if you’re really unwell, your local accident and emergency (A&E) department. Remember to tell them where you have been travelling.

Diagnosis of typhoid and paratyphoid

If you visit your GP, they’ll ask about your symptoms and examine you. They’ll also want to know if you’ve recently travelled abroad, particularly to countries where the infection is.

If your GP thinks you may have typhoid, they’ll arrange for you to see a specialist to have some tests. You may need to give a sample of your poo (faeces) – these will be sent to a laboratory to be tested to check if you have typhoid or paratyphoid. You might also need to provide blood and urine samples to be tested.  

If you are very unwell, your GP might arrange for you to be admitted to hospital.

Typhoid is a notifiable disease. This means that if your doctor thinks you have typhoid or paratyphoid, by law, they have to report it.

If somebody you travelled abroad with, live with or have close contact with becomes ill with typhoid or paratyphoid, you might have caught it too. Even if you don’t feel unwell, your GP or a doctor who specialises in public health will usually take a sample of your faeces to test.

Treatment of typhoid and paratyphoid

Typhoid and paratyphoid can be treated with antibiotics. You usually take these as tablets but if you’re really unwell, you might have them through a drip (intravenously).

It’s important to take your antibiotics as your doctor prescribes. Take the full course of tablets – don't stop taking them early, even if you get better. For more advice about how to take them, see our information on Antibiotics.

Sometimes, typhoid and paratyphoid bacteria are resistant to certain antibiotics. This means the medicine won’t cure your infection. Your doctor will choose which antibiotics to give you carefully. If they don’t work, you may need to try a different type of antibiotic.

After your treatment

After you’ve finished your treatment, your doctor might need to take samples of your poo (faeces) again and test them. This is to make sure no bacteria are left in your body. This may be particularly necessary if you handle food in your job, or are a carer. If you still have an infection, you may need to take more antibiotics.

Causes of typhoid and paratyphoid

Typhoid is caused by a bacteria called Salmonella enterica Typhi (S. typhi), while paratyphoid is caused by Salmonella enterica Paratyphi (S. paratyphi).

You can catch them if you eat food or drink water that contains bacteria from the poo (faeces) of an infected person. The bacteria can be spread to your food if an infected person touches it, or a fly lands on the poo then on food. Or it can be spread if water is contaminated by sewage, if the area you’re in has poor sanitation.

Complications of typhoid and paratyphoid

If you don’t get any treatment, typhoid (and occasionally paratyphoid) can cause serious problems, and it can even be fatal. Complications include:

  • internal bleeding in your digestive system – this can lead to a hole (perforation) in your bowel
  • kidney failure
  • inflammation in your heart muscle
  • feeling confused and effects on your mental functioning
  • pneumonia

Preventing typhoid and paratyphoid

There are ways to lower your risk of catching typhoid or paratyphoid when you travel to an area where it’s common. Here are some tips.

  • Wash your hands regularly with soap and water before you eat, and after you go to the toilet. 
  • Only drink bottled water (make sure the seal is intact) or tap water that’s been boiled or chlorinated. Remember to also use this type of water to brush your teeth.
  • Don’t have ice cubes in drinks, or eat ice cream and cold desserts.
  • Eat food that’s freshly prepared, cooked thoroughly and hot – you might want to skip buffets.
  • Don't eat any raw vegetables, such as salads, if there’s any chance they have been washed in unclean water.
  • Only eat fruit that you peel yourself.

Vaccination

There’s a vaccine for typhoid, which you can have before you go to an area where typhoid is found. It’s a good idea to have it if there isn’t clean water or good sanitation where you’re going. Make an appointment to have the vaccine at least a couple of weeks before you go.

The vaccine will reduce your risk of catching typhoid but won't completely protect you from the disease. And it doesn’t work against paratyphoid. So, it's very important to follow the prevention tips above, even if you've had the vaccine.

You can have a typhoid vaccine as an injection or capsule.

  • Capsule. Adults and children over six can take the typhoid vaccine as capsules. You’ll need to take three of them on alternate days. You’ll then be protected for one to three years, depending on how much exposure you have to the bacteria. After that, you can have a booster if you’ll be returning to areas with typhoid. Let your GP or travel clinic know if you’re taking medicines, particularly antimalarial medicines, as they might affect how well the vaccine works. Tell them when you make your appointment.
  • Injection. Adults and children over two years can have the vaccine. 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. There’s a combined typhoid and hepatitis A vaccine injection for adults and children over 15.

If you’re planning on travelling outside of the UK, take a look at our travel vaccinations page for more information.

[Video] How bacterial vaccines work

How to prevent passing 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 measures to reduce the chance of this. For example, it’s important to wash your hands often using soap and water. Do this each time before you prepare food, eat or drink, and after you go to the toilet. Older people and children are more at risk of getting seriously unwell if they get typhoid. Be especially careful not to pass on the infection to them.

If you’re a carer or work in the food industry, you’ll need to take some time off or avoid some tasks while you have the infection. For more information on how to avoid passing on the infection when preparing food, see our information on Food hygiene. If your child has typhoid or paratyphoid, they might need to stay out of nursery or school while they’re infectious.

A doctor who specialises in public health may contact you to ask you some more questions to identify how you caught typhoid. They might ask to test other members of your family or household to ensure they aren’t carrying the infection.

Typhoid carriers

Occasionally, people carry the bacteria in their bodies for months or even years after they feel better. These people are known as typhoid or paratyphoid ‘carriers’. Up to five in 100 people with typhoid become long-term (more than one year) carriers. If you’re a carrier, your doctor will give you antibiotics to treat the infection. They’ll then test your poo (faeces) after a week to check that the infection has cleared. If it hasn’t, you may need to have more treatment. If you care for others or prepare food, you might need to take time off until it clears. Ask your GP or public health specialist doctor for advice on when it’s safe for you to go back to work. Your GP will need to check with a public health specialist doctor before they can give you an answer.

Frequently asked questions

  • If you're pregnant, it's really important to take steps to lower your risk of catching typhoid or paratyphoid. This is because the treatment for typhoid is antibiotics, and, if you’re pregnant, there are fewer types of these that you can safely take.

    If you're travelling to an area with typhoid, it’s really important to follow our advice about lowering your risk – see Preventing typhoid and paratyphoid above. It’s also a good idea to follow general advice about what foods you shouldn’t eat while you’re pregnant. For more information, see Healthy eating during pregnancy.

    Although there’s a typhoid vaccine, you can only have this if the benefits of the vaccine outweigh the risks to you and your baby. This is because doctors aren’t sure if the vaccine may affect your baby. If you’re considering having the vaccine, talk your options through with your doctor.

  • If you’re travelling to an area with typhoid, make plans to have vaccination at least a couple of weeks before you travel. The typhoid vaccine injection can take this long to work; it’s important you have it early enough so you’re protected. The oral capsules take about 10 days to give you protection against typhoid.

    Remember that although the vaccine reduces your risk of catching typhoid, there’s still some risk that you’ll get it. Follow advice about preventing typhoid and paratyphoid above.

  • You might get some mild side-effects after you have the typhoid vaccine. Side-effects of the capsules can include:

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

    Side-effects of the injection include:

    • pain, swelling, hardness and redness where you were injected
    • stomach problems, such as tummy pain, feeling sick and diarrhoea
    • a fever
    • a headache

    Very rarely, it can cause anaphylaxis, which is a serious allergic reaction.


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Related information


    • Typhoid infection. BMJ Best Practice. bestpractice.bmj.com, last updated 18 October 2016
    • Enteric fever (typhoid and paratyphoid) England, Wales and Northern Ireland: 2014. Public Health England. www.gov.uk, published December 2015
    • Public health operational guidelines for typhoid and paratyphoid (enteric fever). Typhoid and Paratyphoid Reference Group. www.gov.uk, published February 2012
    • Typhoid: the green book, chapter 33. Gov.UK. www.gov.uk, last updated 28 August 2015
    • Typhoid and paratyphoid fever. PatientPlus. patient.info/patientplus, last checked 25 February 2015
    • Infection reports – volume 10 number 6. Public Health England. www.gov.uk, published 6 February 2016
    • Typhoid – health advice for travellers. Public Health England. www.gov.uk, published 2014
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    • Food and water safety. Centers for Disease Control and Prevention. wwwnc.cdc.gov, last updated 20 October 2015
    • Typhoid vaccine. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, reviewed February 2017
    • Typhoid vaccines. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, reviewed February 2017
    • Prescribing in pregnancy. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, reviewed February 2017
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  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, April 2017
    Expert reviewed by Dr Martin Wiselka, Consultant in Infectious Disease
    Next review due March 2020



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