First typhoid inoculation. Army Medical School, March, 1909.
Images from the History of Medicine (NLM)
Symptoms and Causative Agent
Typhoid fever is a bacterial disease caused by Salmonella typhi. While rare in industrialized countries, typhoid fever is a significant threat in some low-income countries.
Symptoms of typhoid fever range from mild to serious and usually develop one to three weeks after exposure to the bacteria. Symptoms include fever, headache, nausea, constipation or diarrhea, loss of appetite, and a rose-colored rash on the body.
Typhoid fever symptoms are similar to those of other common gastrointestinal illnesses. The only way to know that a person is ill with typhoid is to have their blood or feces tested for Salmonella typhi.
Typhoid fever spreads from person to person via contaminated food and water. Transmission is via the fecal-oral route, meaning that contaminated feces (and sometimes urine) may enter water supplies or food supplies, which may then be consumed by and infect others. Salmonella typhi lives only in humans; there is no animal reservoir for the bacteria.
About 21 million cases of typhoid fever and 220,000 deaths occur annually worldwide.
Treatment and Care
Typhoid fever is found more commonly in densely populated areas where water supplies are vulnerable to contamination. Good water sanitation methods and proper storage and handling of food and water can help prevent spread of S. typhi.
Antibiotics are the only effective treatment for typhoid fever. Most patients improve after beginning antibiotic treatment, especially if the disease is detected early.
Typhoid fever may lead to intestinal bleeding and perforation. This in turn can cause severe abdominal pain, nausea, vomiting, and sepsis. Surgery may be needed to repair the intestinal damage.
Less common complications that can occur are inflammation of the heart muscle, inflammation of the lining of the heart and valves, pneumonia, inflammation of the pancreas, meningitis, kidney or bladder infections, and delirium.
Available Vaccines and Vaccination Campaigns
Two typhoid vaccines are licensed for use in the United States; these are typically reserved for people traveling to areas where typhoid fever is common or for people who may come into direct contact with the disease.
Ty21a is a live, attenuated vaccine given in oral capsule form. Within the first two years of vaccination, the vaccine is moderately effective at preventing disease. Three years after initial vaccination, the vaccine offers no protection. The minimum age for this vaccine is six years.
Vi capsular polysaccharide (ViCPS) is an injected subunit vaccine. In clinical trials, it reduced disease rates by nearly 66%, though effectiveness wanes after several years. The minimum age for this vaccine is two years.
U.S. Vaccination Recommendations
Typhoid fever vaccination is neither required nor recommended for routine use in people who live in the United States. Vaccination with Ty21a or ViCPS may be recommended for travel to areas where there is a risk for typhoid infection. Travelers are usually advised to take the typhoid vaccine one to two weeks before departure.
Both Ty21a and ViCPS are approved by the World Health Organization for use to control endemic disease and to control outbreaks.
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Centers for Disease Control and Prevention. National Center for Emerging and Zoonotic Diseases. Typhoid Fever. Accessed 04/12/2017.
Centers for Disease Control and Prevention. Typhoid Fever Vaccination. Accessed 04/12/2017.
The Mayo Clinic. Typhoid Fever. Accessed 04/12/2017.
Szu, S.C. (November 2013). Development of Vi conjugate – a new generation of typhoid vaccine. Expert Review of Vaccines 12 (11): 1273–86. Accessed 04/12/2017.
World Health Organization. Typhoid Fever. Accessed 04/12/2017.
World Health Organization. Typhoid Fever Vaccines. Accessed 04/12/2017.