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Typhoid is an acute potentially fatal infection caused by the bacteria Salmonella typhi and Salmonella paratyphi A, B or C which are found in contaminated food and water. Typhoid can be found throughout the world but it is more common in developing countries where sanitary conditions are poor. The majority of typhoid occurs in Asia, particularly the Indian sub-continent and 80% of cases come from Bangladesh, China, India, Indonesia, Laos, Nepal, Pakistan, or Vietnam. However, typhoid continues to be a public health concern in many other low-income countries including in Africa and parts of South America. It is rare in the developed world although outbreaks have also been reported within certain European countries.

How is contracted?
Typhoid is transmitted by food and drink that has been contaminated with human faeces or urine. Typhoid does not affect animals, and therefore, transmission is only from human to human.  

Who is at risk
All individuals exposed to the bacteria are at high risk of developing the disease, although infants, children, and adolescents experience the greatest burden of illness.

Signs and symptoms
Typhoid caused by Salmonella typhi is a systemic infection and symptoms usually develop 1–3 weeks after exposure [19]. These include a range of symptoms, which can be mild to severe, including high fever, malaise, headache, constipation or diarrhoea, a rash on the chest, and enlarged spleen and liver.  Salmonella paratyphi causes a milder illness.

Without therapy, the illness may last for 3 to 4 weeks, although some individuals may continue to carry the bacteria after symptoms have resolved [20]. Between 3-5% individuals develop a chronic infection in the gall bladder.[21] When properly treated, only around 1% of cases are fatal but this increases to range between 10% and 30% if untreated, and even higher in some communities [22].

Treatment with an antibiotic is usually required and supportive care. 

Recommendations for travellers
Prevention is focused on ensuring safe food and water, particularly in countries where typhoid is more common. Foods to be wary of include shellfish, salads, unwashed fruit and vegetables and raw undercooked meat products. Good personal hygiene is crucial and individuals should ensure that they wash their hands prior to eating and after using the toilet. 

Individuals should consider being vaccinated if they are travelling to a country where typhoid fever is common and where they will be unable to take sufficient care with food and drink. Effective vaccines are available although these will not protect against para-typhoid fever.

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Typhoid Vaccination. Here’s the point...

Typhoid Vaccination. Here’s the point...

While readily treatable with antibiotics, prompt access to treatment is required and this may not always be possible in endemic regions while resistance to antibiotics is increasing, particularly in South Asia.