Typhoid fever (enteric fever) is a bacterial infectious disease of the digestive tract. It is caused by the Gram-negative bacillus Salmonella Typhi.
How does infection occur? Infection spreads via the fecal-oral route:
drinking water contaminated with feces of a sick person or carrier,
eating contaminated food (e.g., street food, vegetables washed with dirty water, ice),
transferring bacteria to the mouth with dirty hands ("dirty hands disease").
Who is the source of the pathogen? The only reservoir of Salmonella Typhi is humans:
a sick person,
a carrier who can excrete bacteria in feces for even more than a year.
Incubation period: From infection to the appearance of symptoms usually takes 10–14 days, but it can last from approx. 1 to 3 weeks – this depends, among other things, on the dose of bacteria and the body's immunity.
Who is most at risk?
tourists and travelers going to countries with low hygienic and sanitary standards,
people eating frequently in street gastronomy in endemic countries,
people planning a longer stay (work, volunteering, visiting family) in risk areas,
water and sewage workers, people professionally exposed to contact with waste, some groups of medical personnel.
2. Symptoms of typhoid fever
The course of typhoid fever can be severe and can be divided into several phases, each lasting roughly a week. The disease often starts insidiously – symptoms increase from day to day.
Most common symptoms
First, so-called "flu-like" and intestinal symptoms appear:
increasing fever (even up to 40°C, usually lower in the morning and higher in the evening),
weakness, fatigue, apathy,
headache,
abdominal pain and bloating, constipation or diarrhea,
loss of appetite, sometimes nausea,
insomnia.
In a more advanced phase, there may occur:
enlargement of the spleen and liver,
dry mouth, brown coating on the tongue,
typhoid rose spots – a fine, pink rash mostly on the trunk,
bradycardia (slow heart rate) and so-called "dicrotic pulse",
disturbances of consciousness – confusion, disorientation,
lung symptoms (pneumonia).
Possible complications
Untreated typhoid fever can lead to severe complications:
gastrointestinal bleeding,
ulceration and perforation (rupture) of the small intestine → peritonitis,
sepsis,
damage to the liver, heart muscle, endocarditis, osteomyelitis,
neurological and psychiatric disorders (delirium),
dehydration, disseminated organ abscesses.
Without treatment, 10–30% of cases end in death. Early implementation of antibiotic therapy significantly reduces this risk.
When to urgently see a doctor?
Urgent consultation (preferably ER) is necessary if after a stay in a country with poorer sanitary conditions the following appear:
high fever > 38.5°C lasting more than 3 days,
severe abdominal pain, "hard" abdomen, symptoms suggesting acute peritonitis,
blood in stool or tarry, black stools,
disturbances of consciousness, confusion, difficulty making contact,
features of clear dehydration (dry tongue, very little urine, dizziness).
3. Where does typhoid fever occur?
Typhoid fever is a cosmopolitan disease – it can occur all over the world, but the greatest risk of illness concerns areas with low hygiene standards and poor water quality.
Regions of highest risk
South Asia – especially India, Nepal, and neighboring countries,
Southeast Asia – including Indonesia, other countries of the region,
South America – e.g., Peru and selected countries with worse sanitary conditions,
North and West Africa, other parts of Africa,
selected regions of the Caribbean and Middle East.
In Poland, cases happen rarely and almost always concern people who got infected abroad.
For whom is this information most important?
For people planning:
exotic holidays with eating outside hotels,
"backpacking" trips,
volunteering, missions, longer business trips,
work in regions with limited access to clean water and medical care.
4. How to protect yourself against typhoid fever?
A. General prevention
Even vaccinated people must take care of hygiene – the vaccine does not give 100% protection and does not protect against other traveler's diarrhea.
Most important rules:
Water and drinks
drink only bottled water (with an intact cap) or boiled water,
avoid ice in drinks (may be made from tap water),
do not use tap water for brushing teeth in areas with poor water quality.
Food
choose freshly cooked, hot meals,
avoid raw salads and vegetables washed with uncertain water,
approach street stalls cautiously – the risk of contamination is greater,
avoid undercooked meat, raw seafood.
Hand hygiene
wash hands often with soap and water – especially before eating and after leaving the toilet,
use alcohol-based sanitizing gels (min. 60%) when there is no access to water.
Other rules
do not touch your face unnecessarily (mouth, nose, eyes) with dirty hands,
take care of the cleanliness of dishes, cutlery, and meal preparation areas.
B. Vaccination against typhoid fever
This is a key element of prevention for people traveling to endemic regions or professionally exposed.
Types of vaccines available in Poland
Inactivated (killed) vaccines – given by injection:
contain whole, killed Salmonella Typhi cells or purified Vi capsular polysaccharide,
administered intramuscularly or subcutaneously,
example preparation: Typhim Vi (polysaccharide vaccine).
vaccination is best done at least 2–3 weeks before departure,
immunity lasts approx. 3 years, then a booster dose is recommended if exposure risk continues.
Live, oral vaccine (Vivotif, capsules)
age: usually from 5–6 years of age (in PL from 6 years),
3 capsules taken on an empty stomach:
day 1 – 1 capsule,
day 3 – 1 capsule,
day 5 – 1 capsule,
the capsule is swallowed whole, about an hour before a meal, washed down with cold or lukewarm water,
the whole cycle should be completed at least 10 days before departure,
immunity lasts approx. 3 years – then a repeat cycle as a booster dose.
Important practical notes
Interactions with antibiotics: Live oral vaccine should not be taken:
during and immediately after antibiotic therapy – at least a 3-day break is recommended (longer with long-acting antibiotics, e.g., azithromycin),
at least 3 days before starting malaria chemoprophylaxis (except atovaquone/proguanil, which can be used simultaneously).
Combining with other vaccinations: Live oral vaccine can be administered simultaneously with e.g. yellow fever vaccination (Stamaril) or cholera (Dukoral) – according to current recommendations.
Storage: All typhoid vaccines should be stored in a refrigerator, at a temperature of 2–8°C, in the original packaging.
Effectiveness: The vaccine does not protect against paratyphoid fever or other traveler's diarrhea. Despite vaccination, one still needs to take great care of water, food, and hand hygiene.
5. Summary
Typhoid fever is a serious bacterial disease of the digestive tract that can lead to damage to the intestines, liver, sepsis, and even death. The greatest risk of illness concerns people traveling to countries with poor sanitary conditions in Asia, Africa, or Latin America.
Vaccination gives protection for about 3 years and significantly reduces the risk of severe disease course and complications. It should be especially considered by people going to endemic regions, eating "out" and planning a longer stay.
It is best to plan a visit to a pharmacy vaccination point about 3 weeks before departure – then there is time to select the preparation, administer the vaccine, and develop immunity. Even after vaccination, adhering to simple rules is key: safe water, well-cooked food, and frequent hand washing. Thanks to this, the risk of typhoid fever during travel can be significantly limited.