Typhoid is a serious disease caused by bacteria called Salmonella typhi; it is known as enteric fever. Another of this type isparatyphoid fever caused by Salmonella Paratyphi A, B or C. Typhoid can be contracted and spread by eating contaminated food, milk, water, or via a carrier. Human carriers of Typhoid can be otherwise healthy people who have recovered from a bout of the disease but who excrete the bacteria in their faeces.
If carriers don’t properly wash their hands with hot soapy water before the preparation of food, and if they don’t have good hygiene habits like washing utensils and dishes, they can pass the disease onto others. A rather sad and historical case was that of Typhoid Mary, an Irish cook from 1907 to 1938, who infected hundreds of people in America, many of whom died from the disease. In areas of poor sanitation and contaminated drinking water Typhoid is likely to occur, with estimates of more than 220,000 deaths a year globally.
What are the symptoms of Typhoid?
In the acute phase there’s a protracted fever with nausea, headaches, constipation and at times diarrhoea with a loss of appetite. The problem is, these symptoms can be mistaken for other fever-producing illnesses. In severe cases the end result of Typhoid can be serious complications or even death from intestinal bleeding or perforation.
Can I catch Typhoid?
Typhoid (fever) is very rare in the US, UK, Australia and other countries with clean, potable water and sewerage systems. Although there are around 100-150 new cases every year in Australia, most occur in returning travellers with higher rates in those visiting friends and relatives in endemic regions. There are countries without proper sanitation and water, so if you’re travelling to remote areas or to:
- Middle East, or
- Latin America
You are strongly advised to consult your travel doctor for a vaccination that is suitable for you. While in any of these countries eat only cooked food and drink clean water. Typhoid vaccine can help protect you, but it is not 100 percent effective. You still should avoid anyone infected.
What about the vaccines?
There are two types of vaccines available:
- For ages two years and over, there is an injection of a polysaccharide vaccine based on the purified Vi antigen, Vi-PS.
- A capsule containing a live attenuated oral Ty21a vaccine for those six years of age and above.
There is also a typhoid and hepatitis A combination vaccine available, so ask your travel health professional to determine which one is appropriate for you.
The World Health Organisation (WHO) advises that the Vi-PS and Ty21a vaccines be used for the control of outbreaks and endemic Typhoid cases. It also recommends that efforts including training of health professionals, public education, the development of sanitation and water systems should go hand in hand with Typhoid vaccination programs.
WHO also reports several Vi polysaccharide–protein conjugate vaccines are in the development stage or have a license which will be suitable for the immunisation of infants (& adults) but are not available as yetin many countries.
How long before I can travel?
To make sure you give yourself the highest chance of protection, the injectable Typhoid vaccine must be given at least 2 weeks before departure, so your travel doctor needs to know well in advance of your overseas plans. You should have a repeat dose every three years if you visit at-risk areas often. The oral Typhoid vaccine is given in capsule form – one every two days for three doses provides three year’s protection (an extra dose on day 5 will increase protection to five years). Be sure to follow the advice when taking the capsules – 1 hour before food and they must not be chewed. Swallow whole with water.