Typhoid Fever

Typhoid fever is caused by a bacterium, Salmonella Typhi, which is transmitted in contaminated food or drinks. It is commonly found in areas where environmental sanitation and personal hygiene are poor. According to the World Health Organisation (WHO) as of 2019, an estimated 9 million people contract typhoid fever globally each year with over 110,00 deaths. The disease continues to be a problem in low and low middle-income countries where investment in public health infrastructure is poor. High risk countries are found in Africa, Eastern Mediterranean, South-East Asia and the Western Pacific.

The risk of typhoid fever is highest in South Asia, particularly for travellers to India, Pakistan, Nepal, Bangladesh and Afghanistan. It is estimated at 1 in 3,000 per month of stay with higher risk in the summer months. Other high-risk areas include Africa, the Middle East and Western Pacific. It is considered lower in South America and the Caribbean.

Typhoid fever ranks second after malaria for the most common life-threatening travel-related health concern. Although the disease is treatable with antibiotics there is a concern with the level of multidrug resistance.

Typhoid fever is a notifiable disease in Australia. One study identified 887 cases between 2010 and 2017. The number of cases, year to date (November 2023) in Australia is 248. This is up on the five-year average of 130 cases per year, but this takes in a the period of no travel during the COVID-19 epidemic.

A vaccine for typhoid is available. It provides approximately 70% protection and a single typhoid injection protects for two to three years. The vaccines Typherix and Typhim Vi have little in the way of side effects. An oral typhoid vaccine (Vivotif oral capsules), if available, can be taken on alternative days for 3 doses (provides 3 years protection) or 4 doses (provides 5 years protection).

The vaccine is recommended for more adventurous travellers who intend to eat in markets, street stalls and local cafes. Those visiting friends and relatives in high-risk locations are most at risk. Travellers on short, resort-based holidays would be very unlucky to contract this disease.