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Typhoid fever (Salmonella Typhi)

What is typhoid fever?

Typhoid fever is a serious infectious disease caused by the bacterium Salmonella Typhi (S. Typhi). A person with acute typhoid fever needs medical attention and antibiotic treatment.

How common is typhoid fever infection?

Typhoid fever infections are not common in the United States. In this country, most people with typhoid fever were infected during international travel to developing countries in Asia, Africa, and Latin America, where the disease is endemic (always present). The California Department of Public Health (CDPH) receives reports of approximately 75 cases of typhoid fever each year in California.

How does a person get typhoid fever?

Salmonella Typhi bacteria are only found in humans and are passed to others through contact with an infected person’s feces or urine. This can occur by direct contact with an infected person or indirectly through drinking contaminated water or eating contaminated food. Typhoid fever can also be spread to household members or to the public by infected food handlers who do not practice proper hygiene.

What are the symptoms of typhoid fever?

The symptoms of typhoid fever may be mild or severe. Symptoms can include high fever (103° to 104° F), weakness, fatigue, stomach pain, headache, loss of appetite, and sometimes a rash. Symptoms usually appear within two weeks after a person has been exposed to the bacteria.

How is typhoid fever diagnosed?

If you are sick during or after recent travel to a developing country where typhoid fever is endemic, see your health care provider right away. If typhoid fever is suspected, your health care provider can have your blood and feces tested for the presence of the bacteria S. Typhi.

How is typhoid fever treated?

Typhoid fever is treated with antibiotics. It is very important to take all of the antibiotics your health care provider has prescribed for you. After you have completed treatment, your feces and urine will be tested multiple times to make sure no S. Typhi bacteria remain in your body.
While you are being treated for typhoid fever, it is important to wash your hands carefully with soap and water after using the bathroom, and do not prepare or serve food for other people. This will reduce the chance that you will pass the infection on to someone else.
Rarely, people who recover from typhoid fever continue to carry the bacteria in their gut; these people are called "carriers" and they do not have recognizable symptoms. If it is determined that you are a typhoid carrier, your health care provider will continue to treat you and additional testing will be performed to confirm that the bacteria are completely gone.

What can a person do to prevent typhoid fever?

If you plan to travel to an area where typhoid fever is endemic, talk to your health care provider about getting a typhoid fever vaccine. The typhoid fever vaccine is only 50-80 percent effective, however, so it is important to avoid risky food and drinks while traveling, even if you’ve been vaccinated. When traveling to typhoid endemic areas:
  • Drink bottled water or bring water to a rolling boil for 1 minute before you drink it. Bottled carbonated water is safer than noncarbonated water.
  • Avoid ice cubes, flavored ices, and popsicles unless you are sure those items were made with boiled or bottled water. 
  • Do not consume foods or beverages from street vendors. 
  • Eat foods that have been thoroughly cooked and that are still hot and steaming. 
  • Do not eat raw vegetables and fruits that cannot be peeled. 
    • If you eat raw fruits or vegetables that can be peeled, wash your hands, then peel them yourself. Do not eat the peelings.  

What is public health doing about typhoid fever?

Health care providers are required to report suspected cases of typhoid fever and typhoid carriers to the local health departments (LHDs). The LHDs, in turn, report cases to CDPH. The LHD restricts persons with typhoid fever and typhoid carriers from certain work or activities (such as food preparation and handling, patient, child or elder care) until they have been treated with antibiotics and have been cleared by the LHD.

Where can I find more information on typhoid fever?

June 2015

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