Typhoid and paratyphoid, collectively known as enteric fevers, are serious bacterial infections acquired through the ingestion of food or water contaminated with Salmonella Typhi or Salmonella Paratyphi A, B, or C. These infections are most common in regions with poor sanitation and limited access to clean drinking water and remain a significant health risk for travellers.
In the UK, most cases are seen in people returning from South Asia, particularly India, Pakistan, and Bangladesh. While typhoid can be prevented through vaccination, there is currently no vaccine available for paratyphoid, making food and water hygiene essential.
What Are Typhoid and Paratyphoid?
Typhoid fever is caused by Salmonella enterica serovar Typhi, while paratyphoid fever is caused by closely related Salmonella Paratyphi strains. Both illnesses produce similar symptoms and can range from mild to life-threatening if not treated promptly.
Globally, the World Health Organization estimates 11–21 million cases of typhoid each year, resulting in 128,000–161,000 deaths, mainly in low-income countries where sanitation infrastructure is inadequate.
Risk Areas
Typhoid and paratyphoid are most common in parts of:
- South and Southeast Asia
- Africa
- Central and South America
Although typhoid is rare in the UK, international travel to endemic regions significantly increases the risk, particularly when visiting friends or relatives, travelling for long periods, or eating local food in areas with poor hygiene standards.
Risk for Travellers
Travellers to high-risk countries face the greatest risk of infection. In the Indian subcontinent, the estimated infection rate among travellers is 1 to 10 cases per 100,000 journeys.
Risk increases with:
- Consumption of untreated water
- Eating food from street vendors
- Staying in areas with limited sanitation
- Close contact with local populations
How Typhoid and Paratyphoid Are Transmitted
Infection occurs after consuming food or water contaminated with human faeces containing Salmonella bacteria. Transmission is closely linked to poor hygiene and sanitation practices.
People infected with typhoid may continue to shed bacteria in their stools after recovery. A small proportion become chronic carriers, capable of spreading infection for months or years without symptoms.
Signs and Symptoms
Typhoid Fever
Symptoms usually appear 10–20 days after exposure and often worsen gradually. Common symptoms include:
- Persistent fever
- Headache
- Fatigue and muscle aches
- Loss of appetite and nausea
- Abdominal pain, constipation, or diarrhoea
Some patients develop a faint pink rash (“rose spots”) on the trunk. Severe complications can include intestinal bleeding, bowel perforation, pneumonia, heart inflammation, and neurological complications. Without treatment, typhoid can be fatal.
Paratyphoid Fever
Paratyphoid has a shorter incubation period and is often milder, but it can still cause severe illness and complications similar to typhoid.
Diagnosis and Treatment
Typhoid and paratyphoid are diagnosed through blood or stool tests. Treatment involves appropriate antibiotics, guided by laboratory testing.
Antibiotic-resistant strains are increasingly common, particularly in South Asia, making prompt diagnosis and specialist treatment essential. With early treatment, mortality is very low.
Prevention
All travellers should follow strict food and water hygiene measures:
- Drink bottled or treated water
- Avoid ice, raw foods, and unpasteurised dairy
- Wash hands regularly
Typhoid Vaccination
Typhoid vaccination is recommended for travellers visiting high-risk areas, based on destination, length of stay, and planned activities. Several vaccines are available in the UK, including injectable and oral options.
Paratyphoid
There is no vaccine for paratyphoid. Prevention relies entirely on hygiene precautions.
Typhoid Vaccination at Regent Street Clinic
Regent Street Clinic provides expert travel health consultations and typhoid vaccination tailored to your destination and personal risk profile. Our experienced clinicians ensure safe, up-to-date protection before you travel.
Book your typhoid vaccination today and travel with confidence.