Typhoid is found throughout the world, but it’s more likely to occur in areas where there’s poor sanitation and hygiene.

Typhoid fever is caused by a type of bacteria called Salmonella typhi. This isn’t the same bacteria that cause salmonella food poisoning, but the two are related.

High-risk areas include:

  • the Indian subcontinent
  • Africa
  • south and southeast Asia
  • South America

Vaccination is strongly recommended if you’re going to be staying or working with local people, or if you’re going to be staying for prolonged periods in areas where sanitation and food hygiene are likely to be poor.

How the bacteria affect the body

After eating food or drinking water contaminated with the Salmonella typhi bacteria, the bacteria moves down into the digestive system, where they will quickly multiply. This triggers a high temperature, stomach pain and constipation or diarrhoea. Left untreated, the bacteria can get into the bloodstream and spread to other areas of the body. This can cause the symptoms of typhoid fever to get worse during the weeks after infection. If organs and tissues become damaged as a result of the infection, it can cause serious complications, such as internal bleeding or a section of the bowel splitting open. Deaths from typhoid fever are now virtually unheard of in the UK. If typhoid fever isn’t treated, it’s estimated that up to 1 in 5 people with the condition will die. Some of those who survive will have complications caused by the infection.

How the infection spreads

The Salmonella typhi bacteria will be in the stools of an infected person after they have been to the toilet. If they don’t wash their hands properly afterwards, they can contaminate any food they touch. Anyone else who eats this food may also become infected. Less commonly, the Salmonella typhi bacteria can be passed out in an infected person’s urine. Again, if an infected person handles food without washing their hands properly after urinating, they can spread the infection to someone else who eats the contaminated food. In parts of the world with poor sanitation, infected human waste can contaminate the water supply. People who drink contaminated water or eat food washed in contaminated water can develop typhoid fever.

Symptoms

The symptoms of typhoid fever usually develop 1 or 2 weeks after a person becomes infected with the Salmonella typhi bacteria. With treatment, the symptoms of typhoid fever should quickly improve within 3 to 5 days. If it isn’t treated, it’ll usually get worse over the course of a few weeks, and there’s a significant risk of life-threatening complications of typhoid fever developing. Without treatment, it can take weeks – or even months – to fully recover, and symptoms can return.

The main symptoms of typhoid fever are:

  • a high temperature, which can reach up to 39 to 40C
  • a headache
  • general aches and pains
  • a cough
  • constipation

Later, as the infection progresses you may lose your appetite, feel sick and have a tummy ache and diarrhoea. Some people may develop a rash.

Other ways typhoid fever can be contracted include:

  • using a toilet contaminated with bacteria and touching your mouth before washing your hands
  • eating seafood from a water source contaminated by infected poo or pee
  • eating raw vegetables that have been fertilised with human waste
  • contaminated milk products
  • having oral or anal sex with a person who’s a carrier of Salmonella typhi bacteria

Carriers

Up to 1 in 20 people who survive typhoid fever without being treated will become carriers of the infection. This means the Salmonella typhi bacteria continue to live in the carrier’s body and can be spread as normal in faeces and urine, but the carrier doesn’t have any noticeable symptoms of the condition.

Choosing a typhoid vaccine

In the UK, the 2 main vaccines available to prevent typhoid fever are:

Vi vaccine – given as a single injection

Ty21a vaccine – given as 3 capsules to take on alternate days

Combined typhoid and hepatitis A injections are also available for people aged 15 or over. Protection against hepatitis A lasts 1 year and protection against typhoid lasts 3 years.

The vaccines work by stimulating your body to create antibodies (infection-fighting proteins) that prevent you getting ill if you become infected with the typhoid bacteria.

But neither typhoid vaccine is 100% effective, so you should always take precautions when eating food and drinking water abroad.

As the Ty21a vaccine contains a live sample of Salmonella typhi bacteria, it isn’t suitable for people with a weakened immune system – for example, people receiving certain types of treatment, such as chemotherapy.

It also isn’t usually recommended for children under 6, whereas children can have the Vi vaccine from 2 years of age.

It’s unclear whether the Vi and Ty21a vaccines present a risk to pregnant or breastfeeding women. But vaccination should be considered if there’s a significant risk of getting typhoid.

The typhoid vaccine should ideally be given at least 1 month before you travel, although if necessary it can be given closer to your travel date.

Booster vaccinations are recommended every 3 years if you continue to be at risk of infection with typhoid bacteria.

Treatment oral vaccination route

Vivotif is a live attenuated oral vaccine indicated for active immunisation against typhoid fever. Vivotif is recommended for adults and children from 6 years of age.

One capsule of Vivotif is to be taken on days 1, 3 and 5, with cool water at least 1 hour before meals. The immunisation schedule of 3 vaccine capsules must be completed for the optimal immune response to be achieved. The protection becomes effective 7–10 days after ingestion of the third dose of vaccine.4

Store in a refrigerator (2°C – 8°C).  Store in original package in order to protect from light.