Typhoid cases in Tonga

Three cases of typhoid have been confirmed in the village of Hofoa, Tonga. 

According to the Ministry of Health, transmission is localised to 2 family groups and contact tracing is ongoing.  Hofoa is located on the northwest coast of the main island of Tongatapu. The cases were identified at the end of January and have made a good recovery.

Restrictions on food preparation and distribution will remain in place until the end of March.

Periodic outbreaks of typhoid do occur in Tonga, but the number of cases is usually low. Cases are more likely to occur during the rainy season or after extreme events like cyclones.  

The disease, 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. 

Where is typhoid risk highest?

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 (23 November 2025) in Australia is 236. This is up against the five-year average of 130 but this takes in a period of no travel (COVID-19 pandemic).

Typhoid vaccination for travellers

A vaccine for typhoid is available. It provides approximately 70% protection.  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 most unlucky to catch this disease. Attention to the rules of eating and drinking safely is the best way to reduce your risk of exposure.