Travel Health Service Enteric Fevers
Travel related diseases

Enteric Fevers

What are Enteric Fevers?

Enteric Fevers refer to typhoid fever and paratyphoid fever. Typhoid Fever is a bacterial disease caused by the bacterium Salmonella typhi. It is characterized by insidious onset of sustained fever, malaise, loss of appetite, severe headache, enlargement of spleen, and constipation or diarrhoea. One out of ten patients may die if untreated but the rate can be drastically reduced to one out of a hundred if early medical treatment is given.

Paratyphoid Fever presents a similar picture, but tends to be milder, and the death rate is much lower. It is caused by the Salmonella enteritidis bacteria.

For Typhoid Fever, incubation period varies from 3 days to 3 months with a usual range of 1-3 weeks. For Paratyphoid Fever it ranges from 1 to 10 days.

How do they spread?

Humans are the main reservoir for both kinds of bacteria. Enteric Fevers spread through food and water contaminated by stool and urine of patients and carriers. Carriers are those who recover from Typhoid Fever but continue to carry the bacteria. So you can get infected if you take food or drink beverages that have been handled by a person who is shedding the bacteria or if sewage contaminated with the bacteria gets into the water you use for drinking or washing food.

How can you prevent them?

The golden rule is to avoid risky food and drinks, e.g. food and beverages from unhygienic food vendors, undercooked food (especially oysters), exposed cut fruits, raw vegetables and unpasteurized milk. Hand-washing before preparing food, before meals and after going to the toilet are essential. These measures will also help protect you from other illnesses like Cholera, Hepatitis A, Dysentery and other causes of travellers' diarrhoea.

Oral and injectable vaccines against Typhoid Fever are available. Immunization is advised for international travelers to endemic areas, especially if travel will likely involve exposure to unsafe food and water, or close contacts with indigenous populations in rural areas. Vaccination should be completed at least one week before you travel. The oral, live vaccine requires 3 or 4 doses, two days apart. The injectable vaccine requires a single dose.

How are they treated?

Enteric Fevers are treated with antibiotics. Appropriate therapy started in the early stage of disease, is highly successful. The death rate should be under one percent and few complications should occur. The patient should wash hands carefully with soap and water after going to the toilet, and not prepare or serve food for other people. This will reduce the chance of passing the bacteria to other people. The doctor will perform repeated stool cultures to ensure that no causative bacteria remain in the patient's body. All members of the family and the travel group will need to be examined to detect any further cases and carrier.