Typhoid fever

Typhoid fever is a life-threatening infection that affects millions of people each year. A certain strain of salmonella bacteria causes it. Typhoid fever is rare in places where few people carry the bacteria. It's also rare in places that treat water to kill germs and manage human waste well. That's why typhoid fever is rare in the United States.

Most people in the U.S. who get typhoid fever get it during travel to other countries. Africa and South Asia have the highest rates of typhoid fever.

Antibiotics can treat typhoid fever, but some antibiotics no longer work against the typhoid fever bacteria. This is called antibiotic resistance. Without treatment, there is a small chance of death from typhoid fever complications. Vaccines that protect against typhoid fever help lower the risk of getting the condition.

Symptoms are likely to start slowly, often showing up 1 to 3 weeks after contact with the bacteria.

Early illness

Early symptoms may include:

• Lasting fever that starts low and rises during the day. Fever can go as high as 104 degrees Fahrenheit (40 degrees Celsius).
• Stomach pain.
• Chills.
• Headache.
• Weakness and tiredness.
• Muscle aches.
• Trouble passing stool, called constipation, or loose stools, called diarrhea.
• Rash.

People also may have a cough and may not want to eat.

Later illness

A few weeks after symptoms start, the illness can cause complications in the intestines. Symptoms may include:

• Stomach pain.
• Swollen stomach.

In some people, symptoms may return up to a few weeks after the fever goes away.

See a healthcare professional right away if you think you might have typhoid fever. Before traveling to another country, find out where to call to get a list of healthcare professionals. In some places, that may be the closest embassy or consulate.

A strain of bacteria called Salmonella enterica serotype typhi causes typhoid fever. People who have typhoid fever or the bacteria in their body can shed the bacteria in their stool.

Salmonella enterica serotype typhi can spread in water that isn't treated to kill germs and in food that isn't cooked, such as raw fruits without a peel. Drinks that may have the bacteria include water, ice made from water that's not treated, and milk or juice that isn't treated to kill germs. Drinks that are treated to kill germs are called pasteurized.

People can swallow the bacteria if it gets into food and water. Not washing the hands well after passing stool also can spread the bacteria.

Typhoid carriers

Even after having antibiotic treatment, people who recover from typhoid fever may have the bacteria in their bodies for more than a year. Called chronic carriers, they no longer have symptoms of the condition. But they can spread it to others.

Chronic carriers may need treatment with antibiotics to prevent the spread of typhoid fever.

Typhoid fever is a serious worldwide threat, especially to children. Africa and South Asia have the highest number of infections as well as regular outbreaks. But typhoid fever happens around the world, often spreading through travelers to and from high-risk areas.

If you live in a country where typhoid fever is rare, your risk of getting it is higher if you:

• Work in or travel to areas where typhoid fever is common.
• Work in a lab that handles Salmonella enterica serotype typhi bacteria or stores samples of the bacteria.
• Have close contact with someone who is infected or recently has been infected with typhoid fever.

Typhoid fever complications may include:

• An infection caused by gut bacteria spreading throughout the body, called sepsis.
• Bleeding in the intestines. This is from holes, also called perforations, in the intestines.
• Changes in thinking, awareness and how you see what's around you.
• A weakness in an artery caused by an infection, called mycotic aneurysm.

These are life-threatening complications that need medical care right away.

A vaccine can help protect against typhoid fever. You might get the vaccine if you live where typhoid fever is common. Or you might get the vaccine if you plan to travel to a place where the risk is high.

Vaccines

There are two vaccines in the United States. They come in the form of:

• A single shot you get at least one week before travel. People age 2 and older can take this. It lasts two years.
• Four capsules you take by mouth every other day. People age 6 and older can take this form. It lasts up to 5 years.

The vaccine doesn't completely protect you from typhoid fever. So follow these guidelines when in high-risk areas:

• Wash your hands often and well. Use hot, soapy water. Wash before eating or making food and after using the toilet or changing a diaper. Carry an alcohol-based hand sanitizer for when you don't have soap and water.
• Don't use water that isn't safe. In places where typhoid fever is common, drinking water often has the bacteria that causes it. So drink only bottled water or canned or bottled carbonated drinks, wine or beer. Ask for drinks without ice. Use bottled water to brush your teeth and try not to swallow water in the shower.
• Don't eat raw fruits and vegetables. Because raw produce may have been washed in tainted water, don't eat fruits and vegetables that you can't peel, especially lettuce. To be safe, don't eat any raw foods.
• Choose hot foods. Don't eat food that's stored or served at room temperature. Cooked, steaming hot foods may be less risky than other foods.

Don't infect others

If you're recovering from typhoid fever, you can help keep others safe. Besides washing your hands well and often, do the following:

• Take your antibiotics. Do as your healthcare professional tells you when taking your antibiotics. Take all the pills in the prescription.
• Don't handle food. Don't make food for others until your healthcare professional says it's safe. If you're a food or healthcare worker, you may need to take a test to show that you've stopped shedding typhoid bacteria before you return to work.