Typhoid Fever
What is typhoid fever?
Typhoid fever and paratyphoid fever are similar diseases caused by bacteria. Salmonella Typhi bacteria cause typhoid fever. Salmonella Paratyphi bacteria cause paratyphoid fever.
People infected with these bacteria can spread them to others. This typically happens when an infected person uses the bathroom and does not wash their hands. The bacteria can stay on their hands and contaminate everything that the person touches, including food and drinks.
In countries with poor sanitation, the water used to rinse and prepare food and beverages, including tap water, can also be contaminated with these bacteria. Travelers who eat foods or drink beverages contaminated with these bacteria can then get sick.
Typhoid fever and paratyphoid fever cause similar symptoms. People with these diseases usually have a fever that can be as high as 103 to 104°F (39 to 40°C). They also may have weakness, stomach pain, headache, diarrhea or constipation, cough, and loss of appetite. Some people have a rash of flat, rose-colored spots. Internal bleeding and death can occur but are rare.
Who is at risk?
Where are you going?
Typhoid and paratyphoid fever are most common in parts of the world where water and food may be unsafe and sanitation is poor. Travelers to Eastern and Southern Asia (especially Pakistan India, and Bangladesh), Africa, the Caribbean, Central and South America, and the Middle East are at increased risk for typhoid and paratyphoid fever.
People visiting friends or relatives are more likely than other travelers to get typhoid fever because they may stay in the country longer, may be less cautious about the food they eat or the beverages they drink because they eat local food prepared in people’s homes, and may not think to get vaccinated before traveling.
In the United States each year, about 425 people are diagnosed with typhoid fever and about 125 people are diagnosed with paratyphoid fever each year. Most of these people travelled internationally.
What can travelers do to prevent typhoid fever?
Getting vaccinated, choosing food and drinks carefully, and washing your hands are the best ways to avoid getting typhoid.
Check if the typhoid fever vaccination is recommended for your destination. Two typhoid vaccines are available in the United States. Visit your doctor or a travel clinic at least one month before traveling to discuss your options.
- Pill vaccine. People 6 years old and older can take the pill vaccine. Finish taking all four pills (one pill every other day) at least 1 week before travel.
- Shot vaccine. People 2 years old and older can get the shot vaccine. Get one shot (or a booster shot) at least 2 weeks before travel.
Typhoid vaccines are only 50 to 80% effective, so you should still be careful about what you eat and drink to lower your risk of getting typhoid fever. Also, there isn’t a vaccine that protects against paratyphoid fever. For these reasons, it’s very important that you also take the following steps to prevent typhoid.
Choose food and drinks carefully
- Only eat foods that are cooked and served hot
- Avoid food that has been sitting on a buffet
- Eat raw fruits and vegetables only if you have washed them in clean water or peeled them
- Only drink beverages from factory-sealed containers
- Avoid ice because it may have been made from unsafe water
- Only drink pasteurized milk
Wash your hands
- Wash hands often with soap and water for 20 seconds, especially after using the bathroom and before eating
- If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol
- Keep your hands away from your face and mouth
After Travel
If you traveled and feel sick, particularly if you have a fever, talk to a healthcare provider and tell them about your travel.
If you need medical care abroad, see Getting Health Care During Travel.