Typhoid Fever

Typhoid fever is a reportable disease in Oklahoma. Typhoid fever is a disease caused by the bacteria Salmonella Typhi. In the United States, about 400 cases occur each year with approximately 75% of these cases acquired during travel to underdeveloped countries, including Asia, Africa, and Latin America. Typhoid fever is uncommon in Oklahoma; only 1 to 2 cases have been reported each year since 1990.

Symptoms of Typhoid fever include fever, headache, stomach pains, and loss of appetite. Sometimes constipation, diarrhea, or a flat, rose-color rash may appear. Persons with typhoid fever usually have a sustained fever as high as 103° to 104° F (39° to 40° C). The bacteria may be recovered from the bloodstream or bone marrow, and occasionally from the stool or urine. Symptoms usually occur within 1-2 weeks after exposure to the bacteria, but can occur from 3 days to 2 months after exposure.

Persons with typhoid fever carry the bacteria in their bloodstream or intestinal tract, and shed S. Typhi in their feces. Typhoid fever can by spread through contaminated drinking water or food that has been handled by a person shedding S. Typhi. Large epidemics in developing countries are most often related to fecal contamination of water supplies that are vulnerable to contamination with sewage, street foods, or areas of the world where hand hygiene facilities are inadequate.

Typhoid fever is treated with antibiotics. A person will usually recover in 2-3 days with prompt antibiotic treatment. People that do not get prompt medical treatment may continue to have a fever for weeks or months, and as many as 10% will continue to shed the bacteria in their feces for 3 months after experiencing symptoms. Some people (2% to 5%) recover from typhoid fever but continue to carry the bacteria as permanent carriers. Some infected persons do not show any symptoms of typhoid fever but can shed the S. Typhi bacteria in their feces for many years. These persons are called S. Typhi "carriers".

What can persons do to prevent Typhoid fever?

If you plan to travel to an area where the disease is common, use the following steps to protect yourself:

1. Get vaccinated against typhoid fever. Both injection and oral vaccines are available. Visit a doctor or travel clinic or health care provider to discuss your vaccination options.
2. Use careful selection of food and drink while you are in a developing country. Avoid raw vegetables and fruits that cannot be peeled. Leafy vegetables like lettuce are easily contaminated and may have bacteria present internally that cannot be removed by washing.
3. When you eat raw fruits or vegetables that can be peeled, wash your hands with soap, and then peel them yourself. Do not eat the peelings.
4. Only use clean water. Buy it bottled or make sure it has been brought to a rolling boil for at least one minute before you drink it.
5. Ask for drinks without ice unless the ice is made from bottled or boiled water. Avoid popsicles and flavored ice made with water from an unknown source.
6. Only eat foods that have been thoroughly cooked and that are still hot and steaming.
7. Avoid foods and beverages from street vendors.

ADS Resources:
Typhoid Fever Fact Sheet
Oklahoma Travel Health Clinics
Travel Safety Fact Sheet

Other Resources:
CDC General Typhoid Fever Information
CDC Tyhpoid Fever Traveler’s Health
WHO Typhoid Fever