What is typhoid?
Typhoid is a serious bacterial infection caused by Salmonella Typhi. People usually become infected by consuming contaminated water or food. The disease is more common in regions with inadequate sanitation and limited access to safe drinking water.
What are the symptoms of typhoid?
Typhoid symptoms may appear gradually and at first resemble other infections. The most common symptoms include:
prolonged or high fever;
headache;
weakness and general fatigue;
abdominal pain;
nausea;
constipation or diarrhea;
loss of appetite.
Some patients may also develop a rash. If left untreated, the disease can cause serious complications.
How does typhoid spread?
Typhoid spreads by the fecal-oral route, most often through food or water contaminated with the bacteria. The risk of infection is higher in places with poor hygiene and sanitation. Vaccination is important, but even after vaccination it is still necessary to be careful about water, ice, undercooked food, and hand hygiene.
Risk of typhoid for travelers
The risk of typhoid is not the same everywhere for travelers. In general, the risk is lower for tourists staying in places with good sanitary conditions, but it increases when traveling to endemic regions, during longer stays, with closer exposure to local conditions, or when staying in places with lower food and water safety standards. A particularly high risk is often associated with travel to South Asia, including India.
Who should receive typhoid vaccination?
Vaccination is usually recommended for travelers going to regions with an increased risk of typhoid, especially if:
the trip is longer;
the traveler will stay outside standard tourist infrastructure;
conditions with lower sanitation standards are expected;
the destination has an increased risk of antibiotic resistance;
travel is planned to South Asia or other endemic regions.
Typhoid vaccine
Currently, two types of typhoid vaccines are widely used for travelers:
an injectable inactivated vaccine;
an oral live attenuated Ty21a vaccine.
The injectable vaccine is usually given as a single dose and should be received at least 2 weeks before travel. The CDC indicates that a booster dose is generally recommended every 2 years if the risk remains. The oral Ty21a vaccine in the United States is a 4-capsule course taken according to a specific schedule, and revaccination is usually considered every 5 years if the risk continues. Availability and schedules may vary between countries, so the specific vaccine should be chosen together with a doctor or vaccination specialist.
Warnings and contraindications
The oral Ty21a vaccine is a live attenuated vaccine, so it may not be suitable for everyone. Antibiotics and some antimalarial medicines can affect how this vaccine works, so the vaccination plan should be discussed with a doctor before travel. Vaccination options for younger children depend on the type of vaccine and the child’s age. The CDC states that the injectable vaccine is intended for people aged 2 years and older, while the oral Ty21a vaccine is intended for people aged 6 years and older.
How else can the risk be reduced?
Even after vaccination, it is important to:
drink only safe water;
avoid ice in drinks of unknown origin;
avoid insufficiently cooked food;
wash hands thoroughly;
follow food hygiene rules throughout the trip.