Basic guide: Typhoid fever

The first question: What is typhoid fever?

Typhoid fever is a life-threatening illness caused by the Salmonella Typhi bacteria, and it is spread by contaminated food and water.

Symptoms of typhoid include lasting high fevers, weakness, stomach pains, headache, and loss of appetite. Some patients have constipation, and some have a rash. Internal bleeding and death can occur, but are rare.

Fortunately, typhoid fever can be prevented, and can usually be treated with antibiotics. But if you are planning to travel outside the United States, you should know about typhoid fever and what steps you can take to protect yourself.


How is typhoid fever spread?

Salmonella Typhi lives only in humans. Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract. In addition, a small number of persons, called carriers, recover from typhoid fever but continue to carry the bacteria. Both ill persons and carriers shed Salmonella Typhi in their feces (stool).

You can get typhoid fever if you eat food or drink beverages that have been handled by a person who is shedding Salmonella Typhi or if sewage contaminated with Salmonella Typhi bacteria gets into the water you use for drinking or washing food. Therefore, typhoid fever is more common in areas of the world where handwashing is less frequent and water is likely to be contaminated with sewage.

Once Salmonella Typhi bacteria have been consumed through food or drink, they multiply and spread into the bloodstream. The body reacts with fever and other signs and symptoms.

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Who is at risk?

Typhoid fever is common in most parts of the world, except in industrialized regions such as the United States, Canada, western Europe, Australia and Japan, so travelers to the developing world should consider taking precautions. Travelers to Asia, Africa, and Latin America are especially at risk, and the highest risk for typhoid is in south Asia.

About 5,700 people get typhoid fever in the United States each year, and most cases (up to 75%) are acquired while traveling internationally. But in the rest of the world, the numbers are very different: There are about 22 million cases of typhoid fever, and 200,000 related deaths annually in developing nations.

What can travelers do to prevent typhoid fever?

Get vaccinated for typhoid
  • Ask your healthcare provider about a typhoid vaccine. This could be pills or a shot, and your doctor will help you decide which one is best for you. Unfortunately, the typhoid vaccine is only 50%-80% effective, so you should still be careful about what you eat and drink. (See tips below.)
  • See Vaccine Information Statements (VIS) for more information.
Eat safe foods


  • Food that is cooked and served hot
  • Hard-cooked eggs
  • Fruits and vegetables you have washed in clean water or peeled yourself
  • Pasteurized dairy products

Don’t Eat

  • Food served at room temperature
  • Food from street vendors
  • Raw or soft-cooked (runny) eggs
  • Raw or undercooked (rare) meat or fish
  • Unwashed or unpeeled raw fruits and vegetables
  • Peelings from fruit or vegetables
  • Condiments (such as salsa) made with fresh ingredients
  • Salads
  • Unpasteurized dairy products
  • ”Bushmeat” (monkeys, bats, or other wild game)
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Drink safe beverages


  • Bottled water that is sealed (carbonated is safer)
  • Water that has been disinfected (boiled, filtered, treated)
  • Ice made with bottled or disinfected water
  • Bottled and sealed carbonated and sports drinks
  • Hot coffee or tea
  • Pasteurized milk

Don’t drink

  • Tap or well water
  • Ice made with tap or well water
  • Drinks made with tap or well water (such as reconstituted juice)
  • Flavored ice and popsicles
  • Unpasteurized milk
  • Fountain drinks

Practice good hygiene and cleanliness

  • Wash your hands often.
  • If soap and water aren’t available, clean your hands with hand sanitizer (containing at least 60% alcohol).
  • Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.
  • Try to avoid close contact, such as kissing, hugging, or sharing eating utensils or cups with people who are sick.

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