Contagious Diseases Series: Typhoid and Paratyphoid

Contagious Diseases Series: Typhoid and Paratyphoid

Typhoid and paratyphoid are bacterial infections which can spread throughout the body and affect various organs.  Left untreated, they can result in serious complications and even prove fatal.

Typhoid fever is caused by the bacterium Salmonella Typhi.  Paratyphoid fever is caused by the bacterium Salmonella Paratyphi.  Both types are infections which affect the intestinal tract and bloodstream.

Globally, typhoid and paratyphoid affect 28 million people each year.  Authorities believe that children are more susceptible to contracting these infections because their immune systems are less mature than those of adults.  Almost every Australian case is contracted whilst the person is overseas with approximately 200 cases being reported in Australia each year.

How do you get it?

The bacteria responsible for typhoid and paratyphoid live in the faeces of infected persons and occasionally in urine of infected persons.

Typhoid and paratyphoid are mostly transmitted through the consumption of food or water which is contaminated by infected faeces or urine.  For travellers, this usually means consumption of food or drinks which have been prepared or touched by infected persons who have not thoroughly washed their hands after toileting.  Common sources include water and ice, raw vegetables, salads and shellfish.

Typhoid and paratyphoid can also be contracted via any of the following means:

  • Using a toilet which is contaminated with the bacteria and touching your mouth before washing your hands.
  • Eating seafood which has been obtained from a contaminated water source.
  • Eating raw fruit and vegetables that have been fertilised with human waste.
  • Drinking contaminated dairy products (eg milk).
  • Having sexual relations with a person who is a carrier of the bacteria.

Where in the world is it?

Typhoid is common in most parts of the world with the exception of the United States of America, Canada, western Europe, Australia and Japan.

Whilst infection can occur in any country, typhoid and paratyphoid are most prevalent in developing countries where hygiene standards and sanitation are poor.  Travellers to the following regions are at risk:

  • India, Pakistan and Bangladesh
  • South East Asia
  • South Pacific including Papua New Guinea
  • Central and South America
  • Caribbean countries
  • African countries
  • Middle Eastern countries

Public health authorities cite South East Asia as being the region where travellers are most at risk.

What are the symptoms?

Although paratyphoid affects more people than typhoid, the most common symptoms of each are similar and include:

  • Weakness
  • General aches and pains and malaise (feeling unwell)
  • High temperature / fever
  • Stomach pain
  • Headache
  • Diarrhea (or constipation)
  • Cough
  • Loss of appetite
  • Sweating

In some cases, people suffering from typhoid or paratyphoid can develop a rash.

How is it diagnosed and what is the treatment?

Diagnosis can only be confirmed by testing a blood or stool sample.  If you think you have been infected, it is important you consult a doctor.  If left untreated, symptoms will worsen and can result in life threatening complications such as internal bleeding or peritonitis.

Typhoid and paratyphoid are usually treated with antibiotics.  If diagnosed early, the infection is likely to be mild and involve a 7-14 day course of antibiotics.  In such cases, recovery is swift with the patient feeling better within a few days.  In advanced or severe cases, it is sometimes necessary for the patient to be admitted to hospital for treatment.

It is possible to survive typhoid and paratyphoid without treatment.  It is estimated that 1 in 20 people who survive without treatment will become a carrier of the infection.  This means that the bacteria will continue to live within the person and can be spread to others.  The carrier will not have any noticeable symptoms of their condition.

How can you minimise the risk of contracting typhoid or paratyphoid?

Pre-travel typhoid vaccinations are available to minimise the potential of infection.  Vaccination should be done no less than 2 weeks prior to travel.  The vaccine reduces the risk of contracting typhoid by 50-80% so it is still important to take care while travelling to avoid / minimise potential infection.

There is no vaccination available to guard against paratyphoid.

Here are our top tips to help minimise the potential of infection if travelling to high risk areas:

Eating and drinking
  • Eat food that is cooked and served hot. Do not eat food which is served at room temperature.
  • Avoid food prepared by street vendors.
  • Eat fruit and vegetables which you have washed and cleaned yourself.  Avoid unwashed / unpeeled fruit and vegetables.
  • Consume pasteurised daily products.
  • Avoid raw or soft-cooked eggs. If eating eggs, eat hard boiled eggs only.
  • Avoid raw or undercooked fish and meat.
  • Avoid salads and raw dairy products.
  • Consume bottled (and sealed) water. If not possible, make sure the water has been boiled, filtered and treated.
  • Use bottled water while cleaning teeth / dentures.
  • Avoid drinking local water (including cordial, ice cubes and ice blocks).
  • Avoid public drinking facilities (eg bubblers and water fountains).
Hygiene
  • Wash your hands and wash them often – particularly after visiting the toilet and/or before eating or drinking.
  • Carry (and use) hand sanitizer.
  • Avoid contact with people who are sick.
  • Avoid touching your face – mouth, eyes and nose. If you need to, ensure your hands are clean.
  • Don’t share utensils, cups or plates.
  • Do not share personal care items.
  • Practice safe sex.
  • Avoid close contact with others (eg kissing and hugging).

Many travellers are exposed to typhoid and paratyphoid.  Fortunately there are measures you can take to minimise the risk of infection.  Please speak to your doctor to find out how best to protect yourself while travelling.  Take care too when it comes to travel insurance – many policies wont cover you if you fail to obtain recommended vaccinations so best to check with your chosen provider.