Typhoid fever is a serious bacterial infection caught from food and water contaminated with the bacterium Salmonella Typhi. It is a risk in areas with poor sanitation, particularly the Indian subcontinent, and travellers prevent it through scrupulous food and water hygiene combined with typhoid vaccination.
How it spreads
By the faecal-oral route, through food or water contaminated with the stools or urine of an infected person, mainly where sanitation is poor.
Where it occurs
Across Asia, Africa, the Middle East and Central and South America, with the highest risk on the Indian subcontinent.
Main symptoms
A persistent, often stepwise rising fever, headache, tiredness, loss of appetite and abdominal pain, developing one to three weeks after exposure.
Who is most at risk
Travellers to South Asia, those visiting friends and relatives, longer-stay and off-the-beaten-track travellers, and children and young adults.
Is a vaccine available
Yes. An injectable Vi polysaccharide vaccine is most commonly used in the UK, and an oral capsule vaccine is available for some people.
How to reduce your risk
Scrupulous food and water hygiene, regular hand washing and typhoid vaccination before travel to higher-risk areas.
Typhoid fever is a serious bacterial infection caused by Salmonella Typhi, caught by consuming food or water contaminated with the bacteria, mainly in areas with poor sanitation such as the Indian subcontinent. It typically causes a persistent high fever, headache, abdominal pain and feeling unwell, and needs antibiotic treatment. Travellers prevent it through scrupulous food and water hygiene and, for higher-risk destinations, typhoid vaccination given before travel. Crewe Travel Clinic in Crewe, Cheshire offers tailored advice and typhoid vaccination as part of your pre-travel preparation.
Typhoid fever is a potentially serious illness caused by the bacterium Salmonella enterica serotype Typhi (often shortened to Salmonella Typhi). A closely related illness, paratyphoid fever, is caused by Salmonella Paratyphi and produces a similar but generally milder picture. Together these are sometimes referred to as enteric fever. The bacteria are found only in humans and are passed out in the stools and, less often, the urine of infected people, going on to contaminate food and water where sanitation and hygiene are inadequate.
For travellers, typhoid is mainly a concern when visiting regions where access to clean drinking water and safe sewage disposal cannot be relied upon. The risk is highest on the Indian subcontinent, but the infection occurs across many parts of Asia, Africa, the Middle East, Central and South America. People who stay for longer periods, visit friends and relatives, travel away from the usual tourist routes, or eat and drink in places where hygiene standards are uncertain are at greater risk. Children and young adults are particularly affected.
Untreated, typhoid can lead to serious complications and can occasionally be fatal, but it usually responds well to prompt treatment with appropriate antibiotics, although antibiotic-resistant strains are an increasing problem in some regions. Because no vaccine offers complete protection, the foundation of prevention is careful attention to what you eat and drink, supported by typhoid vaccination for those travelling to higher-risk areas. At Crewe Travel Clinic in Crewe, Cheshire, our travel health team can assess your itinerary, advise on food and water precautions and provide typhoid vaccination where it is recommended.
Typhoid fever spreads by the faecal-oral route, meaning the bacteria are taken in by mouth after food or water has been contaminated with the stools, or sometimes the urine, of an infected person. This commonly happens where sanitation is poor and where sewage can contaminate drinking water or the water used to grow, wash or prepare food. Typical sources include untreated or contaminated water and ice, raw fruit and vegetables washed in unsafe water, shellfish from polluted water, and food handled by someone who is infected and has not washed their hands properly. A minority of people who recover continue to carry and shed the bacteria for long periods without symptoms, and these chronic carriers can pass the infection to others, particularly if they handle food. Typhoid is not normally spread through casual everyday contact such as shaking hands.
Symptoms of typhoid usually develop gradually, typically between one and three weeks after exposure. The most common feature is a persistent, often stepwise rising fever, which may reach 39 to 40 degrees Celsius. Other symptoms include headache, general aches and pains, tiredness and a feeling of being unwell, loss of appetite, and abdominal pain or discomfort. Bowel habits can be disturbed, with either constipation or diarrhoea, and constipation is relatively common in adults. Some people develop a cough, and a small number show a faint pink rash known as rose spots. As the illness progresses, untreated typhoid can cause serious complications, most importantly internal bleeding or perforation of the bowel, which can be life-threatening. Anyone who becomes unwell with a persistent fever during or in the weeks after travel to an affected area should seek medical advice promptly and mention where they have been, as typhoid can be confused with malaria and other tropical infections.
Typhoid fever occurs in many parts of the world where sanitation and access to safe water are limited. The highest risk is on the Indian subcontinent, including India, Pakistan, Bangladesh and Nepal, where a large share of travel-associated cases originate. Risk is also present across much of Asia, including parts of Southeast Asia, as well as in Africa, the Middle East, and Central and South America. Most cases diagnosed in UK travellers are linked to travel to South Asia, frequently among people visiting friends and relatives who may stay longer, eat in family homes and venture beyond main tourist areas. The level of risk to any individual depends on the destination, the length and style of the trip, the standard of accommodation, and the hygiene of the food and water consumed. Drug-resistant strains, including extensively drug-resistant (XDR) typhoid, have been reported particularly in Pakistan, which makes prevention all the more important.
Prevention rests on two main pillars: careful food and water hygiene, and vaccination for travellers to higher-risk areas. Because the bacteria are taken in by mouth, safe eating and drinking is essential. Travellers are advised to drink only bottled water with an intact seal, water that has been boiled, or water treated with a reliable purifier, and to avoid ice unless it is known to be made from safe water. It is wise to eat food that is freshly cooked and served piping hot, to avoid raw or undercooked food, to peel fruit yourself, and to be cautious with salads, unpasteurised dairy products, shellfish and food from street vendors where hygiene is uncertain. Regular and thorough hand washing with soap, or the use of an alcohol-based hand gel when washing is not possible, further reduces the risk. Typhoid vaccination is recommended for travellers to areas where sanitation and food hygiene are likely to be poor, especially the Indian subcontinent, and for those staying with or visiting local communities or travelling for longer periods. In the UK, the injectable Vi polysaccharide vaccine is most commonly used, ideally given at least two weeks before travel, and an oral capsule vaccine is also available for some people. No typhoid vaccine is fully protective, so good food and water precautions remain important even after vaccination. The vaccine does not protect against paratyphoid fever.
Typhoid fever spreads by the faecal-oral route, meaning the bacteria are swallowed after food or water has been contaminated with the stools, or sometimes the urine, of an infected person. This commonly occurs where sanitation is inadequate and sewage can contaminate drinking water or the water used to grow, wash or prepare food. A minority of people who recover become chronic carriers, shedding the bacteria for long periods without symptoms and able to pass the infection to others, particularly if they handle food.
Because the bacteria are taken in by mouth, careful food and water hygiene is the foundation of prevention and remains important even after vaccination. Typhoid vaccination is recommended for travellers to areas where sanitation and food hygiene are likely to be poor, especially the Indian subcontinent, and for those visiting local communities or travelling for longer periods. No typhoid vaccine is fully protective, and the vaccine does not protect against paratyphoid fever.
Symptoms usually develop gradually, typically between one and three weeks after exposure, and a persistent fever is the most common feature. Untreated typhoid can lead to serious complications, most importantly internal bleeding or perforation of the bowel, which can be life-threatening, although the infection usually responds well to prompt antibiotic treatment. Typhoid can be confused with malaria and other tropical infections, so a travel history is important for an accurate diagnosis.
Vaccination provides useful additional protection for travellers to higher-risk areas, alongside good food and water precautions. In the UK the injectable Vi polysaccharide vaccine is most commonly used, and an oral capsule vaccine is also available for some people. Because protection is not complete and does not cover paratyphoid fever, careful food and water hygiene should continue throughout your trip.
The following vaccinations can help protect against Typhoid Fever.
Book an appointment with our travel health team for tailored advice on protecting against Typhoid Fever.