Typhoid fever: symptoms, safe water and how to prevent it

Typhoid fever is an infection that spreads through unclean food and water. This article explains how it spreads, the symptoms, how it is tested and treated, and how safe water and good hygiene help prevent it. It draws on information from the World Health Organization (WHO) and the NHS.

1. Introduction

Typhoid fever is a serious infection caused by a germ (bacterium) called Salmonella Typhi. WHO explains that it is usually spread through contaminated food or water, and that once the bacteria are swallowed they multiply and move into the bloodstream ^[1]. The germ lives only in humans ^[1].

WHO estimated that about 9 million people fall ill with typhoid each year and about 110 000 die from it ^[1]. It remains a public health problem in many parts of South-East Asia, Africa and other regions ^[1]. The NHS notes that typhoid is found in parts of Asia, Africa, and Central and South America ^[2].

2. How typhoid spreads and who is at risk

People catch typhoid by drinking unclean water or eating food that was not cooked thoroughly or was washed in unclean water ^[2]. People with typhoid carry the bacteria in the gut and bloodstream, and can still pass them on through their stools after symptoms end ^[1].

WHO says the risk is higher where people lack safe water and proper sanitation (toilets and waste disposal), and that children are at the highest risk ^[1]. Its drinking-water fact sheet adds that water contaminated with germs from faeces can carry diseases including typhoid, cholera and hepatitis A ^[3]. WHO adds that covering household water storage containers may reduce faecal contamination at home ^[3].

3. Signs and symptoms

The NHS says symptoms usually begin within 3 weeks of infection, though sometimes it takes up to 6 weeks ^[2]. They include:

• A high temperature that may slowly get worse over a few days
• Headache, chills, aches and pains
• Cough
• Feeling tired or sick, and loss of appetite
• Constipation (finding it hard to pass stools)
• Stomach ache and diarrhoea, which usually come after the other symptoms

Some people get a rash of light-pink spots, usually on the upper body, which can be hard to see on brown or black skin ^[2]. Without treatment, typhoid can lead to serious problems such as internal bleeding or peritonitis, an infection of the lining of the abdomen ^[2].

4. Diagnosis and tests

WHO says typhoid can be confirmed with a blood test ^[1]. The NHS adds that blood, stool and urine may be tested when typhoid is possible, and that these tests may need to be done in hospital ^[2]. The NHS says to mention any recent travel to the people you speak with ^[2].

5. Treatment and recovery

Typhoid is treated with antibiotics, which are medicines that fight bacteria ^{[1, 2]}. Your doctor chooses the medicine. WHO warns that resistance to antibiotics is increasing, which can make treatment more complicated, so antibiotics should be taken for the full time a doctor prescribes ^[1]. The NHS says you may also be given medicine to bring down the temperature, that fever can continue for around 5 days after starting treatment, and that it is important to finish all the antibiotics even if you feel better ^[2].

Symptoms can return (relapse), usually within 2 weeks of finishing treatment, and a small number of people become carriers who can still spread the bacteria for months or years ^[2]. WHO advises people being treated to wash hands with soap and water after using the toilet, to avoid preparing or serving food for others, and to have their doctor test that no bacteria remain ^[1]. People who work with food, in healthcare or with young children may need to stay off work until stool tests are clear ^[2].

6. Prevention: safe water, food and vaccination

WHO says access to safe water, adequate sanitation, hygiene among food handlers and vaccination are all effective ways to prevent typhoid ^[1]. Practical steps from WHO and the NHS include ^{[1, 2]}:

• Boil drinking water when its safety is in doubt, or disinfect it with a reliable method; bottled drinks and cans are an option when travelling
• Wash hands thoroughly with soap, especially after using the toilet and before preparing or eating food
• Eat food that is freshly and thoroughly cooked and served hot
• Avoid ice unless it is made from safe water
• Drink only pasteurised or boiled milk
• Wash fruit and vegetables carefully, and peel them where possible
• Do not prepare food for others if you have, or may have, typhoid

Typhoid vaccines exist. WHO describes a typhoid conjugate vaccine, given as a single injection to children from 6 months of age and to adults up to 45 or 65 years depending on the vaccine. It gives longer-lasting protection than the older vaccines ^[1]. The NHS says the vaccine is usually recommended for anyone over 1 year old travelling to a high-risk area ^[2]. The NHS notes that vaccinated people can still get typhoid, so hygiene remains important ^[2]. Ask your doctor which vaccine suits you.

7. When to see a doctor

A prolonged high fever is one of the main symptoms ^[1]. The NHS advises seeking medical help if you feel unwell after travelling to an area with typhoid, even if you were vaccinated, and getting help where you are rather than waiting until you return home ^[2]. See a doctor again if symptoms get worse, do not improve or come back after treatment ^[2].

Get urgent help if you have sudden stomach pain that keeps getting worse, black or dark red stools, or vomit that contains blood or looks like coffee grounds ^[2]. In an emergency, call your local emergency number (112 in India, 911 in the United States).

8. Conclusion

Typhoid fever spreads through contaminated food and water, causes a slowly rising fever and other symptoms, and is treated with antibiotics prescribed by a doctor. Safe drinking water, handwashing, careful food habits and vaccination are the most useful ways to lower the risk. If you feel unwell after travel to an area with typhoid, see a doctor early.