Typhoid

By Peter Galvin, MD

It is estimated that approximately 600,000 people died in the Civil War, but two-thirds of them died from disease, not battlefield wounds. The diseases they succumbed to were diseases commonly seen in crowded areas with poor sanitation, for example dysentery, typhoid fever (TF), and typhus. These diseases continue to sicken and kill people, mostly outside of the U.S. in areas of the world that are crowded and poor, such as parts of Asia, Latin America, and the Caribbean. There are about 350 cases of TF diagnosed and reported in the US each year, nearly all of whom travelled internationally, yet the CDC estimates that there are actually around 5,700 cases of TF each year; many people with TF do not seek medical care or are not tested for the disease, or diagnosed cases are not reported to public health officials.

TF is usually acquired by eating food or drinking liquids that are contaminated by the bacteria Salmonella Typhi (ST). It got into the food or drink because the preparer was an asymptomatic typhoid carrier. Typhoid should not be confused with typhus, a similar bacterial disease caused by bacteria of the Rickettsia species. Typhus is transmitted by the bite of lice and chiggers and is seen in the same areas of the world as typhoid. Symptoms of TF, which occur 6 to 30 days after ingesting the bacteria, include fever, headache, abdominal pain, weakness, loss of appetite, constipation or diarrhea, and a transient rash with rose-colored spots. Patients may also develop a bloodstream infection, which can cause life-threatening complications including bleeding and, rarely, death.

Typhoid carriage occurs when those treated for TF continue to excrete ST in stool and urine for 12 months or more. About 1% to 4% of those who recover from TF will become carriers, and although carriage symptoms are rare, they may experience fatigue and mild gastrointestinal symptoms. Carriers can spread the disease to others if their feces or urine contaminate food, water, or surfaces that are then touched by others. Carriers are monitored by health officials and often must take antibiotics to prevent disease spread. Typhoid vaccination is recommended before travelling to areas of the world where typhoid is prevalent (see above). There are two types of vaccine – an inactivated (killed) vaccine and a live, attenuated (weakened) vaccine. Note that the words “live” and “killed” are used to describe these and other viral vaccines despite the fact that viruses are not considered to be a form of life, but rather genetic material surrounded by a protein coat. The vaccines should be given at least two weeks before departure and will provide immunity for about 2 years.

Those travelling in areas of the world where typhoid is prevalent should wash their hands with soap and water before eating or preparing food. If soap and water are not available, a hand sanitizer with at least 60% alcohol can be used. Travelers should drink only bottled water or water that has been boiled for at least 1 minute, eat well-cooked foods, and avoid raw vegetables and fruits that cannot be peeled, food and drinks from street vendors, and unpasteurized dairy products.

For more information go to the website of the CDC at www.cdc.gov

Please direct questions or comments to editor@rockawaytimes.com