Typhoid

Typhoid fever is an infectious disease caused by the bacterium salmonella typhi, which multiplies in the [Page 1694]bloodstream and gets excreted out via the digestive tract. After an incubation period of 10 to 20 days, patients present with persistent high fever, chills, sweating, coughing, lack of appetite, severe headache, low heart rate, constipation, and other symptoms. Sometimes patients also present with small red rash spots on the abdomen and chest.

Dr. Schreiber of San Augustine giving a typhoid innoculation at a rural school, San Augustine County, Texas, in 1943. Although a vaccine is recommended for international travelers from developed countries, it does not provide 100 percent protection against the bacterium.

After this first phase, which lasts about a week, a secondary phase begins, symptoms of which can include diarrhea, prolonged fever, and intestinal bleeding in severe cases. Symptoms typically persist for one to three months if the disease is left untreated, and approximately 10 to 30 percent of untreated patients die. Symptoms are similar to those of cholera, dysentery, and malaria, and typhoid can only be positively identified by stool culture. Typhoid is transmitted by ingestion of food or water contaminated with the feces of an already-infected person, and thus can be avoided by instituting precautions such as careful food preparation standards, hand washing before eating, and sterile water supplies.

Refrigeration alone does not kill the salmonella typhi bacterium. Although a vaccine exists and is recommended for international travelers from developed countries, it does not provide 100 percent protection against the bacterium. Patients can remain carriers of the bacterium even after they no longer exhibit symptoms, which poses a significant challenge to disease prevention.

Typhoid can be treated with common antibiotics such as ciprofloxin and ampicillin, although drug resistant strains are becoming increasingly common, especially in Southeast Asia. Infected individuals also often have to be intravenously rehydrated. Prompt [Page 1695]antibiotic treatment can reduce fatalities to approximately 1 percent of all incident cases.

Because of improved hygiene standards and water treatment, typhoid, once common in the United States and Europe, is almost absent from industrialized nations, with most incident cases being among travelers who have contracted the disease abroad. Worldwide, approximately 16 to 22 million cases and 220,000 deaths occur annually, and incidence is highest in children and adolescents aged 5 to 19.

While the disease is endemic in many developing countries, it is particularly prevalent in Southeast Asia, Latin America, and Asian nations of the former Soviet Union, as well as anywhere where the main water supply is contaminated with raw sewage. Especially given the emergence of multidrug resistant strains, the World Health Organization (WHO) recently recommended widespread vaccination among high risk populations in endemic areas.