Typhoid Fever
A systemic infection caused by Salmonella Typhi, usually acquired from food or water contaminated by an infected person or chronic carrier.
What causes Typhoid Fever?
Typhoid fever is caused by Salmonella enterica serotype Typhi. It spreads by the fecal-oral route through contaminated food or water and occurs where sanitation and safe-water systems are inadequate.
Symptoms and what to notice
Prolonged fever, weakness, headache, abdominal pain, loss of appetite, constipation or diarrhea, cough, and sometimes a faint rose-colored rash.
How long can it last?
Symptoms usually begin 6 to 30 days after exposure. Untreated illness can last weeks and relapse. Some people continue carrying and shedding bacteria after recovery.
How serious is Typhoid Fever?
Intestinal bleeding or perforation, encephalopathy, shock, liver or heart complications, and death can occur. Antimicrobial resistance complicates treatment.
Treatment and management
Antibiotics are selected using travel history and susceptibility results; ceftriaxone, azithromycin, or other agents may be used, while extensively drug-resistant infection requires expert guidance. Hydration and monitoring for intestinal complications are essential.
Vaccine: who and when?
U.S. products are Typhim Vi, a single injectable polysaccharide dose for people age 2 or older given at least two weeks before exposure with boosters every two years, and Vivotif, four live oral capsules for people age 6 or older completed at least one week before exposure with boosters every five years. Neither vaccine is fully protective.
Cost note: Patient cost varies by product, provider, insurance, location, and eligibility. Many recommended vaccines are covered in network without cost sharing, and qualifying children may use the Vaccines for Children program.
Trusted source
Patient cost varies by insurance, provider, location, and eligibility. Coverage and public-health access differ, so listed prices are examples rather than guaranteed patient prices. This page is for general education and does not replace individualized medical advice, diagnosis, vaccination assessment, or treatment.
Typhoid Fever: Symptoms, Causes, Treatment, Prevention, and Vaccine Information
Typhoid fever is uncommon within the United States but remains a major risk in parts of South Asia and other regions with unsafe water and sanitation. U.S. cases are usually travel-associated. Vaccination reduces risk but cannot replace careful food and water choices because protection is incomplete and vaccines do not cover paratyphoid fever.
Important: This page is for general education. It does not replace diagnosis, treatment, vaccination advice, or emergency care from a qualified healthcare professional.
Quick Facts
| Topic | Current information |
|---|---|
| Cause | Typhoid fever is caused by Salmonella enterica serotype Typhi. It spreads by the fecal-oral route through contaminated food or water and occurs where sanitation and safe-water systems are inadequate. |
| Main symptoms | Prolonged fever, weakness, headache, abdominal pain, loss of appetite, constipation or diarrhea, cough, and sometimes a faint rose-colored rash. |
| Typical course | Symptoms usually begin 6 to 30 days after exposure. Untreated illness can last weeks and relapse. Some people continue carrying and shedding bacteria after recovery. |
| Treatment | Antibiotics are selected using travel history and susceptibility results; ceftriaxone, azithromycin, or other agents may be used, while extensively drug-resistant infection requires expert guidance. Hydration and monitoring for intestinal complications are essential. |
| Vaccine status | U.S. products are Typhim Vi, a single injectable polysaccharide dose for people age 2 or older given at least two weeks before exposure with boosters every two years, and Vivotif, four live oral capsules for people age 6 or older completed at least one week before exposure with boosters every five years. Neither vaccine is fully protective. |
History and Public-Health Importance
Typhoid shaped modern sanitation and public-health practice. Chronic carriers, including the famous early twentieth-century case Mary Mallon, showed that healthy-appearing people can shed bacteria. Clean water, sewage systems, food safety, antibiotics, and vaccination greatly reduced U.S. disease, while antimicrobial resistance now threatens treatment globally.
What Causes Typhoid Fever?
Typhoid fever is caused by Salmonella enterica serotype Typhi. It spreads by the fecal-oral route through contaminated food or water and occurs where sanitation and safe-water systems are inadequate.
Only humans carry Salmonella Typhi. Bacteria from stool, and less often urine, contaminate food or water. Raw produce, street food, unsafe ice, and contaminated drinking water are common travel risks. A recovered person can become a chronic carrier and continue transmitting infection.
Symptoms and Typical Course
Prolonged fever, weakness, headache, abdominal pain, loss of appetite, constipation or diarrhea, cough, and sometimes a faint rose-colored rash.
Fever often rises over several days and is accompanied by headache, malaise, abdominal symptoms, and appetite loss. Diarrhea is not universal; constipation can occur. Without effective antibiotics, illness may persist three to four weeks. Relapse can occur after apparent recovery.
Complications and Who Is at Higher Risk
Intestinal bleeding or perforation, encephalopathy, shock, liver or heart complications, and death can occur. Antimicrobial resistance complicates treatment.
Intestinal hemorrhage or ileal perforation often appears later in untreated disease and requires urgent surgery. Encephalopathy, myocarditis, hepatitis, shock, bone infection, or chronic gallbladder carriage can occur. Resistant strains increase treatment failure risk.
How It Is Diagnosed
Blood culture is most useful early, and multiple cultures improve yield. Stool or urine culture may help later or assess carriage. Bone-marrow culture is more sensitive but invasive. Travel history and susceptibility testing are essential because resistance patterns influence empiric therapy.
Treatment and Recovery
Antibiotics are selected using travel history and susceptibility results; ceftriaxone, azithromycin, or other agents may be used, while extensively drug-resistant infection requires expert guidance. Hydration and monitoring for intestinal complications are essential.
Treatment should follow current travel-associated resistance patterns and culture results. Fluoroquinolone resistance is common, and extensively drug-resistant strains have emerged. Patients should complete the full course, practice meticulous hand hygiene, and follow public-health restrictions for food handling or high-risk work. Persistent carriage may require additional treatment.
Vaccine Information
U.S. products are Typhim Vi, a single injectable polysaccharide dose for people age 2 or older given at least two weeks before exposure with boosters every two years, and Vivotif, four live oral capsules for people age 6 or older completed at least one week before exposure with boosters every five years. Neither vaccine is fully protective.
Typhim Vi is an inactivated polysaccharide injection; Vivotif is a live attenuated oral vaccine kept refrigerated and taken on alternate days. Vivotif is avoided in pregnancy and significant immunosuppression. Injectable dose is given at least two weeks before exposure; oral series finishes at least one week before. Boosters are needed while risk continues.
Prevention
Get vaccinated for recommended travel, drink sealed or properly treated water, avoid unsafe ice, eat food thoroughly cooked and hot, peel produce yourself, wash hands, and avoid raw dairy. Vaccination does not permit relaxed food and water precautions.
When to Seek Medical Care
Seek prompt care for persistent fever after travel, severe abdominal pain, bloody or black stool, confusion, fainting, or signs of dehydration. Tell the clinician every country and date of travel.
Frequently Asked Questions
Do typhoid vaccines provide complete protection?
No. Food and water precautions remain essential.
What are the U.S. products?
Typhim Vi is an injectable vaccine and Vivotif is a four-capsule live oral series.
Do the vaccines prevent paratyphoid?
No. Current U.S. typhoid vaccines do not reliably protect against paratyphoid fever.
Can recovered people still spread bacteria?
Yes. Some become chronic carriers and require public-health follow-up.
Key Takeaway
Typhoid is a travel-associated systemic infection complicated by resistance. Vaccination, strict food and water precautions, prompt cultures, and susceptibility-guided antibiotics work together.
Medical, treatment, and vaccine information was reviewed against official U.S. public-health guidance available through September 2026.