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 any food and drinks.

In countries with poor sanitation, the water used to rinse and prepare food and beverages 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 103–104°F (39–40°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?

Typhoid and paratyphoid fever are most common in parts of the world with poor sanitation. This includes parts of Asia (especially India, Pakistan, and Bangladesh), Africa, the Caribbean, Central and South America, and the Middle East.

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 350 people are diagnosed with typhoid fever and 90 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.

  • Pill vaccine. People 6 years old and older can take the pill vaccine. Finish taking all four pills (1 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.

Neither the typhoid pills or shot offer complete protection against infection (50%-80%) and both lose effectiveness over time. 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 unclean 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 aren’t available, use an alcohol-based hand sanitizer that contains at least 60% alcohol
  • Keep your hands away from your face and mouth

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If you traveled and feel sick, particularly if you have a fever, talk to a healthcare provider and tell them about your travel. Avoid contact with other people while you are sick.

If you need medical care abroad, see Getting Health Care Abroad.

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