Drug-Resistant Typhoid in a Returned Traveller

A drug-resistant case of typhoid in a returned traveller to Germany.

A letter to the CDC journal, Emerging Infectious Diseases, highlights the risk of contracting antibiotic-resistant typhoid fever in South Asia. According to the report, the individual travelled for a period of 4 weeks in southwest India in 2024 and was diagnosed on return to Germany.

Initial testing suggested a bacterial cause for his fever and gastrointestinal symptoms, and he was treated with a three-day course of ciprofloxacin. His condition deteriorated, and further pathology testing identified a strain of typhoid which was resistant to several antibiotics, including the fluoroquinolones (ciprofloxacin). Fortunately, it was not the multi drug resistant strain of typhoid and was susceptible to other available medications. He received a 14-day course of treatment and recovered well.
He had been vaccinated for typhoid more than three years previously but had not received a booster dose prior to this trip.
The identified strain has also been found in Pakistan and poses a major health threat for the future.

See Carbapenem-Resistant Salmonella Typhi Infection in Traveler Returning to Germany from India.

Surveillance, vaccination and antibiotic stewardship are key aspects to limiting the spread of this strain of typhoid.

Typhoid cases in Australia

Typhoid fever is a notifiable disease in Australia.

Two hundred and six cases have been reported to the National Surveillance System to 23 November 2025. This is in line with the annual case report prior to the pandemic but higher than the annual mean for the past five years. It is likely trending upwards.

Typhoid risk for Australian travellers

An excellent study of typhoid risk for Australian travellers was published in the Journal of Travel Medicine in 2021. It looked at notifications between January 2010 and June 30, 2017. There were nine hundred and twenty-three notifications. The major determinant of risk was country of destination. The top destinations included Bangladesh, India, Pakistan and Nepal. Over seventy percent of notifications were in travellers who had visited South Asia. Another 10 percent came from Southeast Asia. Samoa and Papua New Guinea were identified as destinations of risk in Oceania. Unfortunately, there are some limitations to the data.

Is country of birth a major factor for Samoa as it is for South Asia and Africa. In other words, does a traveller to a resort setting to Samoa have the same risk as someone returning home to see family and friends. In country health statistics would suggest both Papua New Guinea and Samoa have risk for long term residents.

What Is 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.

Risk of typhoid fever in travellers

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 Vaccination

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).

More information on the vaccine and variations from product information can be found here.

Who is most at risk and prevention advice

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 countries are most at risk. Travellers on short, resort-based holidays with limited local travel, would be very unlucky to catch this disease.

Attention to the rules of eating and drinking safely should be always followed.