In March 2008, more than 1,000 people in the Philippines were hospitalized with typhoid fever -- a bacterial illness spread by contaminated food and water. An estimated 16 to 33 million people develop typhoid fever each year, and more than 500,000 die from it. Typhoid is still rampant in places around the world with poor sanitation, including large areas of Africa, South Asia, South America, Central America, and some parts of the Caribbean.

Typhoid fever is still a problem for Americans, too. According to the Centers for Disease Control and Prevention, about 400 Americans catch typhoid fever each year. (Of these, 75 percent catch the disease while traveling outside of the country.)

So if you're planning a trip to a developing country, you should know how to protect yourself from this preventable -- and treatable -- disease.

Typhoid fever is an infectious disease caused by the bacteria Salmonella typhi. It's a close relative of the salmonellagerms that cause food sickness, but typhoid fever is much more severe. S. typhi, which infects only humans, invades the bloodstream and digestive tract. It is spread through food and water that's been contaminated by fecal waste, or feces.

As the famous case of Typhoid Mary shows, people can carry the typhoid germ for many years, even though they no longer feel sick. Mary Mallon, a cook for wealthy New York families in the early 1900s, was quarantined against her will when it was discovered that 22 of her clients had fallen ill with typhoid. She appeared to be in perfect health, but tests confirmed that the germ was still active in her body.

The "fever" in typhoid fever is both stubborn and severe. The body's temperature can reach 103 or 104 degrees Fahrenheit and the fever may last for a month or longer if not treated. Other symptoms include diarrhea or constipation, weakness, stomach pain, headache, appetite loss, and, in some cases, a rash of red spots. With prompt medical treatment, typhoid fever isn't especially dangerous. But if allowed to run its course untreated, the disease causes complications that can prove fatal in as many as one out of five victims.

Although it's possible to catch typhoid fever in the United States, travelers to developing countries really have to get serious about prevention. As part of your travel plans, experts advise getting a typhoid vaccine, which is available in both pills and injections. The pill form consists of 4 doses -- one taken every other day. You should finish the fourth dose at least a week before your trip. The oral vaccine is good for 5 years.

The injected form of the typhoid vaccine is a single shot, which should be administered at least 2 weeks before traveling. Its protection lasts for 2 years.

Vaccinations aren't foolproof, however, so it's still important to take steps to avoid possible exposure to typhoid germs. The basic strategy for preventing typhoid fever will also prevent giardia, traveler's diarrhea, cholera, and other illnesses that are common in areas with poor sanitation.

Here's what to do when visiting a developing country:

•Don't drink water straight from the tap. Bottled or canned beverages are generally safe, especially if they're carbonated. Water from the tap needs to be boiled for at least one minute before it's safe to drink. (Use bottled water to brush your teeth, too.)

•Typhoid and other germs can survive in ice, so don't use ice cubes unless you're sure that they're made from bottled or boiled water. It's also a good idea to skip popsicles or other frozen treats that might be made with unsafe water.

•Watch what you eat. Unless you're staying at a hotel or eating in a restaurant that guarantees salad safety by soaking the vegetables in a disinfectant before rinsing them, don't eat raw produce that isn't protected by a thick peel. Examples of items to avoid include lettuce, sprouts, garnishes, and uncooked salsas containing fresh cilantro or green onions. Oranges, bananas, avocados, and other produce that have a thick rind are usually safer choices, but only if you peel them yourself after first washing your hands. Ceviche, which contains raw fish, should also be avoided. Any hot, steaming foods are safe bets.

•Don't eat food purchased from street vendors, no matter how delicious it may be. Many travelers have learned this lesson the hard way!

If you have typhoid fever, a course of antibiotics will kill the germ and stop the disease. After starting treatment, you should begin to feel much better within just a few days. While some strains of typhoid have built up a resistance to certain drugs, the disease is still highly treatable. If you get ill overseas, finding a good doctor is an important first step. Try calling the American consulate for advice. You might also ask your doctor if you could call him or her for advice in a pinch, or ask your hotel or travel agent about local medical resources in advance of your trip.

Before, during, and after treatment, it's important to remember the lesson of Typhoid Mary: The disease can be highly contagious, even if you don't feel sick. Until stool tests can prove that you no longer carry any typhoid germs, don't prepare or serve any food to other people. You'll also have to be extremely diligent about washing your hands with soap and warm water after using the bathroom. Without your doctor's seal of approval, you may be barred by law from working in a daycare or in the food industry.

-- Chris Woolston, MS, is a contributing editor to Consumer Health Interactive. A former staff writer for Hippocrates magazine, he has written for Health, Prevention, and other journals. He writes The Healthy Skeptic, a biweekly column in the Los Angeles Times. He is also the co-author of Generation Extra Large: Rescuing Our Children from the Epidemic of Obesity (Perseus paperback, 2006).

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First published April 29, 2008
Last updated October 23, 2009
Copyright © 2008 Consumer Health Interactive

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