Typhoid fever

<B>Typhoid fever:</B> An acute illness with fever caused by infection with the Salmonella typhi bacteria contracted from contaminated water and food.

The disease has an insidious onset characterized by fever, headache, constipation, malaise, chills, and myalgia (muscle pain).

Diarrhea is uncommon, and vomiting is not usually severe.

Confusion, delirium, intestinal perforation, and death may occur in severe cases.

Without therapy, the illness may last for 3 to 4 weeks and death rates range between 12% and 30%.

The disease is transmitted through contaminated drinking water or food.

Large epidemics are most often related to fecal contamination of water supplies or street vended foods.

A chronic carrier state -- excretion of the organism for more than 1 year -- occurs in approximately 5% of cases.

Typhoid Mary was a chronic carrier.

About 16 million cases of typhoid fever and 600,000 deaths occur yearly worldwide.

There are about 400 cases a year in the US, mostly among travelers.

For people traveling to high risk areas, vaccines are recommended.

One needs to complete the vaccination at least a week before travel so that the vaccine has time to take effect.

The risk of typhoid is greatest for travelers to the Indian subcontinent and to developing countries in Asia, Africa, and Central and South America where there is prolonged exposure to potentially contaminated food and drink.

Vaccination is particularly recommended for anyone traveling to smaller cities, villages, and rural areas off the usual tourist itineraries.

Typhoid vaccination is not 100% effective and is not a substitute for careful selection of food and drink.

According to the World Health Organization (WHO), as of May 30, 2003, 200 cases of typhoid fever, including 40 deaths, had occurred in remote villages of the Grand Bois Area of Haiti.

Three of the cases were laboratory confirmed.

The residents of the affected villages lack access to health care facilities and safe water.

All water points in the area showed E.coli bacterial contamination.

Deaths occurred primarily among people who did not receive medical attention.

Treatment is with antibiotics but taking antibiotics does not prevent typhoid fever There is still 1-2% mortality (risk of death).