Typhoid Fever

Typhoid fever is a serious and sometimes life-threatening infection that mostly affects people in developing countries, where clean water and other sanitation measures are hard to come by. The disease usually causes symptoms that include a high fever, a stomachache, and achiness. It can be cured with antibiotics.

If you live in the U.S. the chances of someone in your family getting typhoid fever are slim. But if you’re planning to travel to a foreign country, especially one in the tropics, it’s a good idea to know about typhoid fever. Before you travel, get vaccinated against the disease and learn about safety precautions regarding food and water.

About Typhoid Fever

Typhoid fever is caused by bacteria called Salmonella Typhi (S. Typhi), which are related to the bacteria salmonella that cause food poisoning. S. Typhi typically live in humans and are shed through a person’s feces (poop) or urine (pee).

Once the bacteria get into the body, they quickly multiply and spread into the bloodstream. The body responds with a high fever and other symptoms, usually a week or two after exposure to the bacteria (but sometimes later). Symptoms can be mild to severe and usually disappear 2 to 5 days after antibiotic treatment begins.

Without treatment, typhoid fever may last a month or more and become very serious, even life-threatening.

After recovering from typhoid fever, some people still can become carriers of the bacteria. This means that they’ll have no symptoms, but do have the bacteria in their bodies and can pass it on to other people.

How People Get It

People usually get typhoid fever by drinking beverages or eating food that has been handled by someone who has typhoid fever or is a carrier of the illness. Those infected also can pass the disease onto others directly (for example, by touching them with unwashed hands). People also get the illness by drinking water that is contaminated by sewage that contains the S. Typhi bacteria.

For these reasons, the disease is common in areas with poor sanitation and inadequate water treatment. It is also common in tropical and subtropical areas around the world, including Africa, Asia, and Latin America.

Signs & Symptoms

The symptoms of typhoid fever may range from mild to severe, depending on factors such as the age, health, and vaccination history of the infected person and the geographic location where the infection originated.

Typhoid fever can come on suddenly or very gradually over a few weeks. Early signs and symptoms of the illness include:

• fever that can reach as high as 104°F (40°C)
• feeling achy, tired, or weak
• constipation
• diarrhea
• headache
• stomach pain and loss of appetite
• sore throat

When typhoid fever isn’t treated, symptoms become worse week by week. Besides a fever, someone may lose weight; develop a swollen or bloated belly; or develop a red, spotted rash on the lower chest or upper belly. The rash usually clears up in 2 to 5 days.

In most cases, the symptoms of typhoid fever start to go away in the third and fourth weeks, as long as the disease doesn’t cause any other health problems. After the illness has appeared to go away, it can come back.

Complications

Serious health problems (complications) as a result of typhoid fever are rare in children. When kids do develop complications, they tend to be gastrointestinal problems, specifically an intestinal perforation (a hole in the intestines). This life-threatening condition requires immediate medical attention.

Less common complications include problems with the lungs or heart, infections in the bones or joints, urinary tract infections, or mental health problems.

When to Call a Doctor

Call a doctor if you think your child has been exposed to typhoid fever or develops any symptoms of typhoid fever, even mild ones, especially after visiting an area where the infection is common.

To make a diagnosis, the doctor will evaluate the symptoms and ask you about your child’s medical history and recent travels. The doctor probably will take a sample of stool (poop), urine (pee), or blood to test it for the disease.

Treatment

Typhoid fever is treated with antibiotics that kill S. Typhi bacteria. If the doctor prescribes antibiotics, be sure your child completes the course of treatment. Do not end the treatment early even if your child begins to feel better.

Most kids start feeling better within 2 to 3 days of beginning treatment. In addition to giving antibiotics, offer your child plenty of fluids to prevent dehydration. Kids who are severely dehydrated from a loss of fluids due to diarrhea might be given IV (intravenous) fluids in a hospital or other medical care facility.

Acetaminophen can help reduce fever and make your child feel more comfortable. Call a doctor immediately if your child’s symptoms persist, if symptoms go away and then reappear, or if your child develops any new symptoms.

Stopping the Spread

If your child is recovering from typhoid fever or is a healthy carrier of the disease, washing hands frequently is the best way to prevent the spread of the disease. Use warm water and scrub hands with soap for at least 20 seconds. Also clean the things your child touches (such as toilets, door handles, and telephones) every day. People with typhoid fever should avoid handling or preparing food and should keep their personal items away from other people’s belongings.

Kids with typhoid fever should remain out of school until the disease has run its course and a doctor has cleared them of having the S. Typhi bacteria. The same goes for teens who work in the food service industry, who may not legally be allowed to return to work until a doctor has proven them to be free of the bacteria.

Preventing Infection

There are two typhoid vaccines available in the U.S. One is a series of capsules and the other an injection. In certain cases, a booster is sometimes needed.

The typhoid vaccine is not a routine childhood vaccination, so if your child will be traveling to an area where typhoid fever is common, you’ll need to ask your doctor for the vaccine. Kids should be vaccinated at least 1 to 2 weeks before traveling. This gives the vaccine time to take effect.

Even if your child has been vaccinated, keep in mind that vaccines are not completely effective and lose effectiveness over time, so make sure you and your child take the following precautions in high-risk areas:

• Sanitize water. Boil or disinfect any water that will be used for drinking, washing or preparing food, making ice, or brushing teeth. Better yet, try to drink only bottled water (carbonated is safer than regular) or other drinks that come in cans or bottles, but wipe the outside of the can or bottle before drinking from it. Tell kids to avoid tap water, fountain drinks, and ice cubes, and remind them to not swallow any water in the shower or bath.
• Cook all food. Fully cook all food, and avoid food from street vendors and food stored or served at room temperature. Instead, serve packaged foods or meals that are freshly cooked and served steaming hot.
• Avoid raw food. Avoid raw, unpeeled fruits and vegetables that may have been washed with contaminated water, especially lettuce and fruits like berries that can’t be peeled. Bananas, avocados, and oranges make better choices, but be sure you peel them yourself. For safety’s sake, you may want your kids to avoid raw foods entirely.
• Wash hands frequently. Wash with soap and clean, warm water, especially after kids use the bathroom or before they eat or prepare food. If no soap and water are available, use an alcohol-based hand sanitizer.