Recognize and Prevent Typhoid Fever

Typhoid fever is a potentially life-threatening infection caused by the bacterium Salmonella Typhi. The bacteria is transmitted from the ingestion of food and drinks contaminated by the feces and urine of those already infected. Typhoid fever is common in the developing world where sanitary conditions (such as frequent hand washing) are less than ideal and where clean, treated water is in short supply. Most cases of typhoid occur when people are traveling internationally; in the past 10 years, Americans traveling to Asia, Latin America, and Africa have been at particularly high risk.

Steps

Recognizing the Symptoms of Typhoid Fever

1. Check for fever. The primary indication of typhoid infection is persistent, high fever in the range of 103° to 104° F (39° to 40° C). In general, symptoms develop within 1-3 weeks after exposure.
2. Check for secondary symptoms. Additional symptoms and indicators of typhoid fever include headache, general malaise or feeling of weakness, stomach pain, constipation or diarrhea, vomiting and loss of appetite.
   • Some people also report developing a rash of flat, lightly pink-colored spots, as well as an abnormally slow heartbeat - usually less than 60 beats per minute.
3. See a physician. If you have a high fever and feel ill, get to a doctor immediately. Keep in mind that if left untreated, typhoid fever can become fatal and as many as 20% of those infected may die from complications related to the illness.
   • If you are sick and may have typhoid fever, make sure to avoid contact with other people. Also, you should not prepare or serve food to other people.
   • If you are traveling, you can usually get in touch with your consulate to get a list of recommended (and usually English-speaking) doctors.
   • You doctor will confirm the diagnosis through a clinical analysis of a stool sample or blood test in order to test for the presence of Salmonella Typhi.
   • In areas without a lab or where lab results would be delayed, the doctor may assess the size of your liver and spleen by pressing down and also tapping on your organs. Enlargement of the liver and spleen is often a "positive" sign for typhoid fever.
   • It is important to confirm this diagnosis as the fever and additional symptoms that accompany typhoid fever overlap with other diseases common to developing regions like dengue fever, malaria, and cholera.

Preventing Typhoid Fever

1. Avoid Avoid Getting Sick from Food when Traveling. When traveling to areas where infection with typhoid fever is a potential danger, one of the most important ways to protect yourself is to avoid certain foods and types of food preparation. Take the following precautions to ensure you are not ingesting foods that may be infected:
   • Eat food that has been well cooked and is served steaming hot. Heat helps to kill bacteria.
   • Avoid raw vegetables and fruits and vegetables that don't have a peel. For example, vegetables like lettuce are easily contaminated because they're hard to wash well and have a lot of surface area and nooks and crannies where bacteria can hide.
   • If you do want to eat fresh produce, peel and clean fruits and vegetables yourself. Wash your hands first with hot, soapy water and make sure not to eat any of the peelings.
2. Be careful with what you drink. Make sure to drink water from clean, untainted sources. Follow these guidelines:
   • When you drink water, drink it from a sealed bottle or bring it to a boil for one minute before drinking it. In general, carbonated, bottled water is safer than uncarbonated water.
   • Even ice can be contaminated, so either do without it, or make sure the water used to make the ice was either from a bottle or boiled. Try to avoid anything made with water, like popsicles or flavored ices, which may have been made with contaminated water.
3. Avoid foods and beverages from street vendors. It is difficult for food to be kept clean on the street and in fact many travelers report getting sick specifically because they ate or drank something purchased from a street vendor.
4. Practice hygiene and cleanliness. You should wash your hands often. If both soap and water are not available, you can use hand sanitizer that has at least 60% alcohol to clean your hands. Don't touch your face unless your hands are clean. You should also avoid close contact (i.e. sharing eating utensils or cups, kissing, or hugging) with people who are sick.
5. Remember a helpful mantra. As designed by the Centers for Disease Control and Prevention, learn the phrase: "Boil it, cook it, peel it, or forget it." If ever you have doubts about whether to eat something, think of this mantra. Remember it's always better to be safe than sorry!
6. Get vaccinated before you travel. If you are traveling to or through any part of the developing world where exposure to the disease is possible, particularly in Asia, Latin America, and Africa, then you should plan to get the typhoid vaccine before you leave on your trip. Visit your doctor or a travel clinic nearby to get the vaccine and discuss whether it is right for you. Keep in mind that if you've been vaccinated in the past, you should still consult with your physician to make sure that you don't need a booster shot. Typically, typhoid vaccines become less effective after several years.
   • Two forms of the vaccine are available in the United States, one in capsule form which requires you to take 4 capsules (one every other day for a total of eight days) with a two-day break in between each capsule, and a one-time injection.
   • Both vaccines are equally effective at preventing typhoid fever. However, the capsule provides protection for five years and the injection only for two years.
   • Keep in mind as well that the treatment regime for the capsular requires completion one week before potential exposure, while the injection requires two weeks.
7. Know the restrictions for each type of vaccine. For the injection, you should not vaccinate children younger than two years old, anyone will is ill at the time the vaccination is schedule, and anyone who is allergic to any component in the vaccine (consult your physician to confirm you whether you may be allergic).
   • For the oral capsule, there is a longer list of restrictions, including children younger than six years old, anyone with a weakened immune system or recent or current illness, HIV/AIDS patients, anyone with cancer or receiving radiation treatment, anyone who has taken antibiotics within three days prior, anyone on steroids, and any one with an allergy to any part part of the vaccine (consult your physician to confirm whether you may be allergic).
8. Do not rely solely on vaccination. Vaccination is only 50 to 80 percent effective at preventing typhoid fever, so make certain to take as many preventative measures as possible, namely by watching what you eat and drink.
   • Taking caution with what you eat and drink will also help to protect you from other illnesses transmitted through risky food and drinks, including hepatitis A, traveler's diarrhea, cholera, and dysentery.

Tips

• Find out as soon as possible if the area you live in or plan to visit puts you at risk of contracting typhoid fever. Don't wait until the last minute to get vaccinated, as it takes one to two weeks for the vaccine to be effective, depending on which vaccine you have taken (injection or capsule).
• Typhoid fever is preventable. However, if you do become infected, it can usually be treated with antibiotics.

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