Typhoid and paratyphoid

Typhoid is an infectious disease caused by certain types of salmonella. It can be contracted through contaminated drinking water and by eating contaminated food. Typhoid is extremely rare in Germany. Anyone traveling to a risk area can get a preventative vaccination.

What is typhoid?

Typhoid is an infectious disease caused by a subgroup of certain Salmonella bacteria is triggered.

The bacteria are mainly transmitted through contaminated drinking water and contaminated food.

Due to the good hygiene conditions in Germany, typhus is very rare here. In most cases, long-distance travelers in risk areas in Asia become infected.

There are two forms of typhoid fever:

• Abdominal typhus: also called typhus abdominal is or typhus for short. It is the far more dangerous form.
• Paratyphoid fever: It has similar symptoms to typhus, but is less severe.

Typhoid fever must always be treated with an appropriate antibiotic as the disease can lead to life-threatening complications.

What are the symptoms of typhoid fever?

Typhoid and paratyphoid fever progress very similarly.

However, the incubation period, i.e. the time between infection and the onset of the first symptoms, varies.

In addition, the symptoms vary in severity.

Symptoms of typhoid

The incubation period for typhoid fever is between 3 and 60 days, usually 8 to 14 days.

Typhoid fever begins with uncharacteristic symptoms such as headaches, aching limbs and a slightly elevated temperature. However, within 2 to 3 days the fever rises to 39 to 41 degrees.

Then a clear feeling of illness develops with:

• Drowsiness and dizziness
• Abdominal pain
• Pain in limbs
• sometimes constipation

The high fever can last up to three weeks.

In addition, the following typical symptoms may occur:

• Diarrhea
• bright red, pinhead-sized skin spots on the abdominal skin
• slow heartbeat (bradycardia)

Symptoms of paratyphoid

The incubation period for paratyphoid is 1 to 10 days.

Typical symptoms are:

• Fever up to 39 degrees
• Diarrhea
• Nausea and vomiting
• Abdominal pain

What causes typhoid?

Typhus is caused by infection with the bacteria Salmonella enterica. There are two subgroups of this bacteria that cause either typhoid or paratyphoid:

• The bacteria of the subgroup Typhi cause abdominal typhus, usually called typhus for short.
• Bacteria of the subgroup Paratyphi cause typhus-like diseases, which are summarized under the term paratyphoid.

How do you get typhoid?

The typhoid pathogens are excreted by infected people in their stool and urine and thus enter the sewage system. Infection occurs primarily when people eat food that has been contaminated with such sewage.

Human-to-human infection is also possible, but very rare.

How common is typhoid?

The pathogens that cause typhoid and paratyphoid are widespread throughout the world. In countries with inadequate hygiene conditions, such as Africa, South America and Southeast Asia, the number of cases is particularly high.

How does typhoid progress?

Typhoid fever typically begins with uncharacteristic symptoms and then with persistent high fever. This can lead to serious complications.

Patients who have not been treated with an antibiotic often take longer to fully recover from the disease.

After a partial recovery, the disease can break out again. This can happen several times.

In infants, typhus is more severe and complications are more common.

Paratyphoid fever is similar to typhoid fever, but is usually milder.

What complications are possible with typhoid?

In severe cases, the following complications, some of which are life-threatening, can occur:

• Intestinal bleeding and intestinal perforations with peritonitis
• Gallbladder inflammation
• Thromboembolism: Blood clots break off and travel to another location, where they block the blood vessel and cause an embolism.
• Inflammation of the bone or bone marrow (osteomyelitis)
• Inflammation of the inner lining of the heart (endocarditis)
• Meningitis

How can you prevent typhoid?

The most important measures to prevent typhus are:

• Be careful when consuming food when travelling to typhoid risk areas
• Get vaccinated against typhoid before travelling

Consumption of food

Typhoid pathogens are usually transmitted via drinking water. In risk areas, tap water and ice made from it for drinks should be avoided if possible.

Raw or insufficiently cooked foods can also be contaminated with typhoid and paratyphoid pathogens. These include leaf and delicatessen salads, seafood, unpeeled fruit or juices.

Vaccination recommendations

Vaccination is recommended before travelling to typhoid risk areas in Asia, South America and Africa, and especially if living conditions in the country are simple. Travel medicine specialists provide comprehensive advice on this.

The Standing Committee on Vaccination (STIKO) recommends vaccination for:

• Travel to South and Central Asia such as Pakistan, India, Nepal, Afghanistan, Bangladesh – regardless of travel style
• Travel under simple travel, residence or work conditions to all areas with frequent cases of illness and low hygiene standards in Asia, Africa, Central and South America. This applies, for example, to trekking trips and relief missions and especially to current outbreaks and disasters.
• Long-term stays in areas with high incidence of disease, especially in simple living conditions

There are two different vaccines available: as an injection (inactivated vaccine) and in the form of capsules (live vaccine) to be taken orally.

Many health insurance companies cover the costs of travel vaccinations. It is best to ask your health insurance company what the rules are before getting vaccinated.

Injection vaccination

The injection vaccination (syringe) is also available in combination with a vaccination against hepatitis A.

The syringe is based on a dead vaccine with killed bacteria and is administered into the muscle. It provides immune protection from day 14 for up to three years. The vaccine does not protect against paratyphoid.

Redness and swelling may occur at the vaccination site; headaches, aching limbs, malaise or feelings of weakness are also possible.

Oral vaccination

The oral vaccination is based on a live vaccine with weakened bacteria. It is taken as a capsule three times at two-day intervals (primary immunization).

The capsules are well tolerated and provide around 60 percent of those vaccinated with protection for at least a year. The live vaccine also provides partial protection against paratyphoid B.

Possible side effects of the vaccination are:

• Nausea, vomiting
• Stomach and headaches
• Fever
• Rash
• Diarrhea that occurs after fever

Revaccination and booster vaccination

For people who have received the oral vaccine and travel to a risk area again, a full revaccination is recommended after three years.

If you are staying permanently, it is recommended that you refresh your vaccination protection after three years, regardless of the vaccine.

How is typhoid diagnosed?

Typhoid and paratyphoid diseases are often confused with influenza infections or with malaria in travelers returning from the tropics .

Abnormalities in the blood count indicate typhoid and paratyphoid, but do not yet provide a reliable diagnosis.

This can only be achieved by directly detecting the pathogens. To do this, the doctor takes a blood sample and then has it grown into a bacterial culture in the laboratory. Less frequently, samples from the bone marrow, urine or stool are used.

How is typhoid treated?

The sooner typhoid is treated, the better the chances of recovery. Treatment is with an antibiotic.

The choice of active ingredient depends on the exact typhoid pathogen, which is determined in the laboratory, particularly in travelers returning from Asia. In addition, it is checked in advance whether the selected antibiotic actually works.

Number of cases in Pakistan and  worldwide

Every year, this disease affects almost 21 million people worldwide, the majority of whom are from South Asia. According to the WHO, almost 11 to 21 million cases of typhoid fever and about 200,000 deaths from typhoid fever occurred all over the world. Pakistan health authorities have confirmed that from 2016 to 2020, almost 22,354 cases of typhoid fever were reported, out of which 15,717 cases were extensive drug-resistant typhoid fever reported from the different regions of Sindh. These calculations are used to measure the disease rate of typhoid fever, ratio is about 15.5/1,000, and the XDR strain of typhoid fever is highly resistant to the antibiotic, also known as extensive drug resistance. The diagnosis of typhoid fever is done by culture tests, serological test, nucleic acid assays, protein markers, and biomarkers. The proper diagnosis is very important to ensure the strain of typhoid fever, so treatment should be started accordingly.

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