It is easy in the UK to take for granted our access to drinking water straight from the tap, for cooking, washing and drinking. When travelling abroad, UK travellers are often advised to drink bottled water over tap water and avoid street food.
One reason for this is that various bacteria can be present in untreated tap water and the food prepared with it. And one of the infections those bacteria could cause is typhoid fever, a disease which could do more than just ruin your holiday plans.
What is typhoid fever?
Typhoid fever is a bacterial infection spread through contaminated water, food and poor hygiene. It causes several symptoms of varying intensity, and some, such as the infamous Typhoid Mary, are asymptomatic carriers.
The infection can be fatal at a rate of up to 20 per cent, although with correct treatment it is less than one per cent.
Common symptoms can include:
- Fever or high temperature, including aches and pains
- Cough
- Headache
- Fatigue
- Sickness and loss of appetite
- Constipation, although some infected people have diarrhoea
A brief history of Typhoid Fever
Typhoid fever has been around for millennia, with suspected outbreaks that wiped out communities in ancient Greece and Jamestown colonists in the current United States.
For centuries, the fever was blamed on poor living conditions or ‘bad air’ without knowing the exact method of transmission and what caused the disease. Carl Liebermeister, a 19th-century physician, was one of the first to suggest that it might be a microorganism in contaminated water.
It was William Budd, in 1973, who proved that it was a toxin from human faeces in water that spread the disease. Finally, in 1880, doctors and scientists put a name to the bacteria that caused it – Salmonella typhi.
However, it wasn’t until 1948 that a treatment was found in the form of chloramphenicol. Improvements to personal hygiene, access to clean water and sanitation helped to reduce the risks.
More recently, there has been concern over drug-resistant typhoid strains, for which researchers are working on a solution.
Where is typhoid fever a risk to travellers?
High-risk areas for typhoid continue to be in South Asian countries such as India, Pakistan and Bangladesh. However, it is also a risk in South and Central America, and sub-Saharan Africa, where there are drug-resistant strains.
Since typhoid is spread through contaminated food and water, travelling to areas with low levels of sanitation will increase your risk. This is more likely to be in lower-income areas or rural areas where there is less access to clean water.
How is the typhoid vaccine given?
Treatment for Typhoid is via antibiotics and medicine to combat a high temperature. However, the best treatment is prevention, and there is a vaccination available along with other ways you can prevent infection.
Vaccinations can be given in intramuscular injections in a single dose or oral tablets over four days. Intervals of three years if at continued risk are recommended. They are available from pharmacy travel health services such as Royston Pharmacy.
Other ways to prevent infection
- Attention to personal hygiene, particularly washing hands before making food or after using the toilet. If water is unavailable, use hand sanitiser.
- Drink bottled or canned drinks, or drinks made with boiled water
- Use bottled water or boiled (and cooled) water for brushing teeth
- Eat hot food that is properly cooked through and served fresh
Remember that even if you get infected and don’t have symptoms, you could be putting others around you at risk, just like Typhoid Mary.