Traps for the unwary

November 2010

Clinical

Typhoid and paratyphoid fever

Prevention in travellers

Volume 39, No.11, November 2010 Pages 847-851

Cora A Mayer

Amy A Neilson

This article forms part of our travel medicine series for 2010, providing a summary of prevention strategies and vaccinations for infections that may be acquired by travellers. The series aims to provide practical strategies to assist general practitioners in giving travel advice, as a synthesis of multiple information sources which must otherwise be consulted.

Background

Typhoid and paratyphoid (enteric) fever, a potentially severe systemic febrile illness endemic in developing countries, is associated with poor sanitation, reduced access to treated drinking water and poor food hygiene. It is one of the leading causes of infectious disease in the developing world.

Objective/s

This article discusses the clinical features and prevention opportunities for typhoid and paratyphoid fever.

Discussion

Travellers to developing countries are at risk of infection. This risk varies from 1:30 000 for prolonged stays in endemic regions to 1:3000 in high endemicity areas such as the Indian subcontinent, where risk is highest. The mainstay of prevention is hygiene and food and water precautions. Vaccines against typhoid fever are discussed. However, when used alone they provide incomplete protection. Treatment and future developments in typhoid fever diagnostics and vaccines are also briefly discussed to provide a general overview of typhoid fever and its prevention for use in travel related consultations in general practice.

Typhoid and paratyphoid fever, collectively termed 'enteric fever', are similar severe febrile systemic illnesses caused by infection with the invasive Gram negative bacterium Salmonella enterica, subspecies Enterica serovar Typhi (S. typhi) and Enterica serovar Paratyphi A or B respectively. Unlike other salmonella species these infect only humans.1–4 Globally, S. typhi is the commonest cause of disease, but S. paratyphi A infections are common in some parts of the world,5 especially Asia,6 and are often associated with travellers. S. paratyphi B (and C) infections occur less frequently.5 Typhoid fever is one of the leading causes of infectious disease in developing countries.4

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Correspondence afp@racgp.org.au

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