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Disease

Typhoid

Page last updated on 22 June 2020

Typhoid is a bacterial infection of the intestinal tract and bloodstream. The disease is usually transmitted by the consumption of contaminated food or water, and is more common in countries with poor sanitation and unsafe water supplies. Almost every case of typhoid reported in Australia is acquired during overseas travel, so travellers should consider vaccination before they leave.

The symptoms of typhoid can be quite variable, but can include fever, headache, feeling generally unwell, body aches, loss of appetite, dry cough, constipation or diarrhoea, tender stomach area, slower than usual heart rate and enlarged spleen. Some people with typhoid develop a rash of flat, pink spots. Without medical treatment, typhoid may be fatal.

Key disease information

What is typhoid?

Typhoid fever is a bacterial infections of the intestinal tract and bloodstream. The bacterium responsible for both is Salmonella typhi, and is only carried by humans.

How is typhoid spread?

Typhoid is spread by sewage contamination of food or water, or through person-to-person contact. People who are infected with typhoid pass the Salmonella typhi bacteria in their faeces and occasionally in their urine. You can get typhoid if you eat food or drink a beverage that has been touched by a person who is infected with the typhoid bacteria and has not washed their hands properly after going to the bathroom. Contamination can also occur when changing the nappy of a child with the infection.

Water sources that are contaminated with infected faeces are another common way typhoid is transmitted.

About 1 in 20 people who recover from typhoid become ‘carriers’. Typhoid carriers have no symptoms of the illness, but still excrete the Salmonella typhi bacteria in their faeces and urine. This means they can go on to infect others for an extended period of time after having the  illness. It is estimated that between 1% and 4% of treated patients still excrete Salmonella typhi bacteria in their stool 12 months or more after they were ill with typhoid. 
 

Is typhoid contagious?

Yes. Because typhoid is usually transmitted by eating or drinking contaminated food or beverages, it is more common in less-developed countries that have lower levels of sanitation, poor food handling standards, less access to hand hygiene , and untreated drinking water. In countries where sewage is not appropriately disposed of, typhoid is most commonly transmitted through the water supply. In countries with better sanitation, contaminated food is more commonly the source of typhoid infection.

Foods such as raw fruits, raw vegetables and shellfish are most closely associated with contracting typhoid. Flies may also play a role in transferring the typhoid bacteria from sewage to food.  

Is typhoid deadly?

Without prompt medical treatment, typhoid and paratyphoid fevers can be fatal. 

Treatment for typhoid may include:
•    Hospitalisation for specialised medical care
•    Antibiotics to kill the bacteria, reduce the risk of complications, and speed recovery
•    Fluids to prevent dehydration caused by diarrhoea and fever.

What are the symptoms of typhoid?

The time between contracting typhoid and the onset of symptoms (known as the incubation period) is usually around 7 to 14 days, however can range between 3 and 60 days.

Symptoms of typhoid can be quite variable, but the initial symptoms commonly include:
•    Low-grade fever
•    Headache
•    Feeling generally unwell
•    Body aches and pains
•    Loss of appetite
•    Dry cough

As the disease progresses, people with typhoid may experience:
•    Increasing fever
•    Constipation or diarrhoea
•    Tender stomach area
•    Slower than usual heart rate
•    Enlarged spleen
•    Rash of flat pink spots

If typhoid is not treated, illness can last for a month.  In about 10% of people the illness comes back, usually about 2 to 3 weeks after recovery.

Serious complications occur in about 10 to 15% of patients with typhoid. These usually occur after a person has been sick for 2 weeks, and can include bleeding or formation of holes in the intestine, effects on the brain function (typhoid encephalopathy), inflammation of other organs like the heart or pancreas, and infection in the lungs (pneumonia), kidneys, bladder, or spine.
 

How long can typhoid stay in the body?

In some people, the bacteria that causes typhoid can remain in the body for a prolonged period of time. It is estimated that between 1% and 4% of treated patients still excrete Salmonella typhi bacteria in their stool 12 months or more after they were ill with typhoid. A long course of antibiotics is necessary to get rid of the typhoid bacteria in these people.

How can typhoid be prevented?

Vaccination against typhoid is recommended for Australian travellers visiting countries where the disease is common.

Travellers are advised to visit their general practitioner or travel medicine specialist six to twelve weeks before travelling overseas to discuss suitable vaccination options .

Australians travelling in countries with increased risk of typhoid should always take extra caution to avoid contaminated food and drinks. Travellers should always drink and brush their teeth with bottled water and avoid ice in drinks. Avoid seafood, particularly shellfish, and raw foods like salads and fruit or vegetables that can’t be  peeled.

Visit your doctor to learn more about preventing typhoid. 
 

Which countries are affected by typhoid?

Typhoid may occur anywhere in the world, but is most prevalent in developing countries where there may be unsafe water supplies and/or poor sanitation, including: 

  • India, Pakistan and Bangladesh
  • most countries of South-East Asia
  • several countries of the South Pacific, including Papua New Guinea
  • African countries
  • countries of the Middle East.
     

VaccineHub offers general information only. Please see a healthcare professional for medical advice

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Sources & Citations

  1. National Notifiable Diseases Surveillance System. Number of notifications of Typhoid Fever, Australia, in the period of 1991 to 2019 and year-to-date notifications for 2020. Available at: http://www9.health.gov.au/cda/source/rpt_3.cfm (accessed 6 May 2020).
  2. Victoria State Government. Better Health Channel. Typhoid and paratyphoid. Available at: https://www.betterhealth.vic.gov.au/health/healthyliving/typhoid-and-paratyphoid (accessed 6 May 2020).
  3. Australian Government, Department of Health. The Australian Immunisation Handbook. Typhoid fever. Available at: https://immunisationhandbook.health.gov.au/vaccine-preventable-diseases/typhoid-fever (accessed 6 May 2020).
  4. Centers for Disease Control and Prevention. Typhoid Fever and Paratyphoid Fever. Symptoms and Treatment. Available at: https://www.cdc.gov/typhoid-fever/symptoms.html (accessed 6 May 2020). 
  5. Centers for Disease Control and Prevention. Typhoid Fever and Paratyphoid Fever. Questions and Answers. Available at: https://www.cdc.gov/typhoid-fever/sources.html (accessed 6 May 2020). 
  6. Centers for Disease Control and Prevention. CDC Yellow Book 2020: Health Information for International Travel. New York: Oxford University Press; 2017.
  7. NSW Government. Typhoid and Paratyphoid fevers (enteric fever) Fact Sheet. Available at: https://www.health.nsw.gov.au/Infectious/factsheets/Factsheets/typhoid.pdf (accessed 7 May 2020). 
  8. Healthdirect. Typhoid and paratyphoid. Available at: https://www.healthdirect.gov.au/typhoid-and-paratyphoid (accessed 7 May 2020).

SPANZ.SAPAS.18.04.0143(1) - Date of preparation May 2020

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