Typhoid fever is a serious bacterial infection that easily spreads through contaminated water and food. Along with high fever, it can cause abdominal pains headache, and loss of appetite.

With treatment, most people make a full recovery. But untreated typhoid can lead to life-threatening complications.

It can take a week or two after infection for symptoms to appear. Some of these symptoms are:

  • high fever
  • weakness
  • stomach pain
  • headache
  • poor appetite
  • rash
  • fatigue
  • confusion
  • constipation, diarrhea

Serious complications are rare, but can include intestinal bleeding or perforations in the intestine. This can lead to a life-threatening bloodstream infection (sepsis). Symptoms include nausea, vomiting, and severe abdominal pain.

Other complications are:

If you have any of these symptoms, tell your doctor about recent travels outside the country.

Typhoid is caused by bacteria called Salmonella typhi (S. typhi). It’s not the same bacterium that causes the foodborne illness Salmonella.

Its main method of transmission is the oral-fecal route, generally spreading in contaminated water or food. It can also be passed through direct contact with an infected person.

In addition, there are a small number of people who recover but still carry S. typhi. These “carriers” can infect others.

Some regions have a higher incidence of typhoid. These include Africa, India, South America, and Southeast Asia.

Worldwide, typhoid fever affects more than 26 million people per year. The United States has about 300 cases per year.

When traveling to countries that have higher incidences of typhoid, it pays to follow these prevention tips:

Be careful about what you drink

  • don’t drink from the tap or a well
  • avoid ice cubes, popsicles, or fountain drinks unless you’re certain they’re made from bottled or boiled water
  • buy bottled drinks whenever possible (carbonated water is safer than non-carbonated, be sure bottles are tightly sealed)
  • non-bottled water should be boiled for one minute before drinking
  • it’s safe to drink pasteurized milk, hot tea, and hot coffee

Watch what you eat

  • don’t eat raw produce unless you can peel it yourself after washing your hands
  • never eat food from street vendors
  • don’t eat raw or rare meat or fish, foods should be thoroughly cooked and still hot when served
  • eat only pasteurized dairy products and hard-cooked eggs
  • avoid salads and condiments made from fresh ingredients
  • don’t eat wild game

Practice good hygiene

  • wash your hands often, especially after using the bathroom and before touching food (use lots of soap and water if available, if not, use hand sanitizer containing at least 60 percent alcohol)
  • don’t touch your face unless you’ve just washed your hands
  • avoid direct contact with people who are sick
  • if you’re sick, avoid other people, wash your hands often, and don’t prepare or serve food

For most healthy people, the typhoid vaccine is not necessary. But your doctor might recommend one if you’re:

  • a carrier
  • in close contact with a carrier
  • traveling to a country where typhoid is common
  • a laboratory worker who may come in contact with S. typhi

The typhoid vaccine is 50 to 80 percent effective and comes in two forms:

  • Inactivated typhoid vaccine. This vaccine is a one-dose injection. It’s not for children younger than two years old and it takes about two weeks to work. You can have a booster dose every two years.
  • Live typhoid vaccine. This vaccine is not for children under age six. It’s an oral vaccine given in four doses, two days apart. It takes at least a week after the last dose to work. You can have a booster every five years.

A blood test can confirm the presence of S. typhi. Typhoid is treated with antibiotics such as azithromycin, ceftriaxone, and fluoroquinolones.

It’s important to take all prescribed antibiotics as directed, even if you feel better. A stool culture can determine if you still carry S. typhi.

Without treatment, typhoid can lead to serious, life-threatening complications. Worldwide, there are about 200,000 typhoid-related deaths a year.

With treatment, most people start to improve within three to five days. Almost everyone who receives prompt treatment makes a full recovery.