What is typhoid?

Typhoid fever, also known as enteric fever or just as typhoid, is a bacterial infection caused by the bacteria Salmonella typhi. This disease only occurs in humans, and the bacteria spreads through food and water contaminated by infected faecal matter (poo) and urine. Typhoid is not commonly found in the UK, and most cases of typhoid in the UK are brought into the country by people who have been infected with the bacteria while travelling in regions with poor sanitation or hygiene.

Typhoid, which means “typhus-like”, is named after a group of infectious diseases called typhus because they can share similar symptoms such as a fever and in some cases a spotting rash. However, they are in fact completely separate diseases caused by different bacteria, and are not caught the same way. The bacteria that causes typhoid is part of the same group of bacteria that causes food poisoning, though typhoid is typically much more severe. Symptoms may last several weeks and recovering from the disease takes some time.

Without proper treatment, around 1 in 5 people who get typhoid fever will die, and up to 1 in 10 survivors will suffer serious complications as a result of typhoid. The number of fatalities falls to to around 1 in 25 if treatment is given. The World Health Organisation (WHO) estimates that there are between 11 to 20 million cases of typhoid every year, which results in around 128,000 to 161,000 deaths per year.

What symptoms can typhoid cause?

The main symptoms of typhoid fever are:

• fever
• headache
• chills
• muscle aches and pains (myalgia)
• feeling generally unwell (malaise)
• nausea and loss of appetite
• diarrhoea
• constipation
• In some cases a rose-coloured spotty rash on the torso

You can find more detailed information on our symptoms of typhoid page.

Who is at risk of typhoid?

People in impoverished regions – typhoid is more common in regions with limited access to clean water and inadequate sanitation. Antibiotics that can treat typhoid fever may also be less readily available in these regions, which can allow the bacteria to be able to survive for longer and become more widespread. The highest risk areas for typhoid include in developing areas of Africa, the Americas, South-East Asia, and the Western Pacific regions.

Travellers – travellers who are visiting these regions are also at risk of developing typhoid, though typically at a lower-risk than those who live there. Travellers who engage in activities that may put their health at risk, such as drinking unbottled water or eating food that may be prepared in unsanitary conditions, are more likely to catch typhoid.

Children – children have weaker immune systems than adults, as they have not had the time to build up their natural defences against potential infections. Children are more vulnerable to developing typhoid fever, but their symptoms are typically milder than an adult who has been infected.

People with existing illnesses – if the body is already fighting off an infection, then it may not be able to effectively fight off the virus that causes typhoid at the same time. For example, those with conditions that suppress the immune system are especially at risk of infection.

How do you get typhoid?

Typhoid is caused by the bacteria Salmonella typhi, which is spread through a process called the “faecal-oral route” of transmission. The faecal-oral route is when diseases that are present in faecal (poo) particles are then passed to the mouth of another person. This is most common in regions with inadequate sanitation and poor hygiene practices.

Typhoid is most commonly spread by contaminated water, which can cause typhoid when drunk or when it contaminates other surfaces or foods. Fruits and vegetables that have been washed in contaminated water can spread typhoid, as can ice cubes made from contaminated water. Unsterile eating utensils, like knives and forks, can also cause typhoid if cleaned in unsanitary water.

Another common cause of transmission is by infected food handlers who do not wash their hands properly, or at all, after using the bathroom. The bacteria then gets into the food and drink they handle, which can infect the person who consumes them. Some people who have been infected can carry the bacteria without showing an symptoms at all, which means that they can spread typhoid without knowing it.

How is typhoid treated?

Antibiotics – typhoid is caused by a bacterial infection, which means it can be treated by certain antibiotics. With antibiotics, symptoms usually start to improve within 1 to 2 days and disappear within 7 to 10 days, and the case-fatality rate falls to around 1% with treatment. It is important that you finish the entire course of antibiotics if you are prescribed them, as the bacteria may still be alive in your body even if you feel better, which means they could multiply and cause a re-infection or spread to other people.

Rehydration – in cases where typhoid has caused dehydration, one treatment option is rehydration solutions. Typhoid fever can cause dehydration due to fluid loss, mostly through sweating and diarrhoea. A rehydration solution is clean water mixed with certain sugars and salts, for example potassium and sodium, which replace those that are lost.

How can I protect myself against typhoid?

Watch what you eat – typhoid spreads when infected faeces (poo) or urine is ingested, typically through contaminated food and water. The best way to avoid this happening is to avoid eating food that may have not been prepared in sanitary conditions, especially raw or unpeeled fruit and vegetables. The most common source of infection is contaminated water, so make sure that you drink bottled water. Some studies have found a link between typhoid and ice cubes, which may be made from contaminated water; so avoid ice cubes in areas with poor sanitation.

Keep your hands clean – it should go without saying, but you should wash your hands before preparing food or eating. You may pick up the bacteria from contaminated surfaces, which you could then transfer to your food while preparing or eating it. Regularly washing your hands when you have the opportunity is advisable.

Get the typhoid vaccine –
the typhoid vaccine is very effective in protecting you against infection, but does not completely eliminate the possibility that you could get typhoid. Because of this, you should still take precautions when travelling to avoid being exposed to the bacteria. The typhoid vaccine exposes you to a small amount of the bacteria that causes typhoid, allowing your immune system to safely create antibodies to more effectively fight off any future infections. You can get the typhoid vaccine at any Superdrug Health Clinic in the UK.