What is Typhoid and how does it spread?

Typhoid fever is a serious systemic infection caused by enteric pathogen Salmonella typhi. Typhoid is transmitted by the consumption  of food or water contaminated with feces from a person infected with Salmonella typhi. Low hygiene and poor sanitation are the main reasons for the spread of Typhoid.  After ingestion, bacteria starts multiplying inside the intestine, after which, they enter the blood and spread throughout the body.  Some people are not able to evict Salmonella typhi from their intestinal tract and gallbladder. They become asymptomatic carriers capable of spreading the disease.

Symptoms of Typhoid disease:

After 5-21 days of incubation, Typhoid disease is suspected when a patient has recurrent  fever as high as 40 degree centigrade (104 degree Fahrenheit), excessive sweating, weakness, loss of appetite, abdominal discomfort such as constipation in adults and diarrhea in young children. Rose spots  appear on the chest of a patient with typhoid fever, indicating the infection by the bacterium Salmonella Salmonellatyphi typhi. Typhoid, if left untreated, can become serious  and lead to  intestinal bleeding and infection of the brain, gall bladder, heart and bones. It can also cause death.  Symptoms of Typhoid are often confused with the symptoms of Malaria, Dengue fever or Influenza diseases. Blood culture  and occasionally, more accurate, bone marrow culture tests are advisable to confirm the disease.

Treatment of Typhoid:

Typhoid can be controlled by  antibiotics such as Chloramphenicol, Ampicillin and Co-trimoxazole provided, the medication starts soon after timely diagnosis. The  rise of multidrug resistant (MDR) strains of S. Typhi, makes it almost impossible to treat the Typhoid fever caused by them, as the antibiotics don’t act on them. Also, MDR  S. Typhi infection gives rise to the 10-fold higher, post-treatment, asymptomatic carriers.

Is Typhoid serious & should we consider vaccination?

Normally, Typhoid fever results in lifelong immunity, in cases where primary infection is not treated with antibiotics. This natural immunity comes with a huge risk of fatal complications.

As per WHO conservative calculation, the annual global cases of typhoid fever are 21 million, out of which 1–4%  patients die. Alarmingly,  90% of these deaths occur in Asia. Children, under 5 years of age, are mostly affected with Typhoid. Timely diagnosis of Typhoid is difficult, because of its confusing symptoms. This poses a challenge in treatment, on the correct stage of the disease, with available antibiotics. Emergence of MDR  S. typhi, further makes the  treatment difficult and, give rise to serious complications. This also increases the cost of treatment due to hospitalizations. Hence, prevention becomes a better choice than cure, in case of Typhoid.

Improving the hygiene and living conditions in the developing world, is one way to stop the spread of Typhoid. Another approachable path to prevent Typhoid, is vaccination. Routine Immunization, of school-age and/or preschool-age children, is recommended by WHO  in areas, where typhoid fever in these age groups is shown to be a significant public health problem.  The latest Vi conjugate vaccine can be safely given to infants, older than 6 months along with routine childhood vaccines. It provides longer lasting immunity. After looking at all the scenarios, it is a wise decision to use the available vaccines; which are safe, efficient and affordable.