What Is Typhoid Fever?
A serious bacterial infection spread through contaminated food and water, causing prolonged fever and potentially life-threatening complications.
Pathogen: Salmonella enterica serovar Typhi (S. Typhi), a Gram-negative bacterium
Type: Bacterium
Transmission
Faecal-oral route through consumption of food or water contaminated by the faeces or urine of an infected person. Risk is highest where sanitation and hygiene are poor. Chronic carriers can shed bacteria for months or years.
Vector: No arthropod vector. Transmitted via contaminated food and water.
Symptoms
Gradual onset of sustained high fever (39-40°C) that worsens over days, headache, malaise, abdominal pain, constipation or diarrhoea, and a characteristic salmon-coloured 'rose spots' rash on the trunk. Without treatment, can progress to intestinal perforation, haemorrhage, or encephalopathy.
Incubation period: 6 – 30 days
Usually 8-14 days, depending on the size of the infectious dose. Shorter incubation with larger doses.
Timeline: Fever builds gradually over the first week. Second week: sustained high fever, abdominal symptoms, rose spots. Third week (without treatment): severe complications including intestinal perforation and haemorrhage. Recovery in the fourth week if uncomplicated.
Case fatality rate: Less than 1% with appropriate antibiotic treatment. 10-20% without treatment. Drug-resistant typhoid (including extensively drug-resistant strains) is an increasing concern in South Asia.
Diagnosis & Treatment
Diagnosis: Blood culture is the gold standard (positive in 60-80% of cases in the first week). Bone marrow culture is more sensitive but invasive. Stool and urine cultures. The Widal test is unreliable and no longer recommended. PCR-based tests are increasingly available.
Treatment: Antibiotics: azithromycin is the preferred first-line agent in many regions due to multidrug resistance. Fluoroquinolones (ciprofloxacin) where susceptibility is confirmed. Ceftriaxone for severe or resistant cases. Supportive care with fluids and electrolytes.
Prevention
- Typhoid vaccination before travel (injectable Vi polysaccharide or oral Ty21a)
- Drink only bottled, boiled, or treated water
- Avoid ice in drinks unless made from safe water
- Eat only freshly cooked, hot food
- Avoid raw salads, unpeeled fruit, and street food in high-risk areas
- Wash hands frequently with soap, especially before eating
💉 Vaccine Available
A vaccine is available for Typhoid Fever. View the Typhoid vaccine guide for details on schedule, cost, and availability in Australia.
Post-Exposure
If you develop a gradually worsening fever lasting more than 3 days during or after travel to an endemic area, seek medical attention and request blood cultures. Mention your travel history. Early antibiotic treatment prevents complications.
Long-Term Effects
Approximately 1-5% of patients become chronic carriers, shedding S. Typhi in their stool for months to years, often from the gallbladder. Intestinal perforation during acute illness can cause peritonitis requiring surgery. Relapse occurs in 5-10% of treated patients.
📋 Typhoid is a nationally notifiable disease in Australia. Around 80-100 cases are notified annually, almost all acquired during travel to endemic countries, particularly the Indian subcontinent.
Frequently Asked Questions
Do I need a typhoid vaccine for Bali?
Typhoid vaccination is recommended for travellers to Indonesia, including Bali, especially if you plan to eat local street food or visit rural areas. While the risk is lower in resort areas with good sanitation, the vaccine provides valuable protection given that typhoid is endemic in Indonesia.
Which typhoid vaccine is better — injection or oral?
Both are effective. The injectable Vi polysaccharide vaccine (Typhim Vi) is a single dose given at least 2 weeks before travel, with protection lasting about 3 years. The oral Ty21a vaccine (Vivotif) is 3 capsules taken on alternate days, completed at least 1 week before travel, with protection lasting about 5 years. The oral vaccine should not be taken concurrently with antibiotics. Neither provides 100% protection, so food and water precautions remain essential.
How is typhoid different from food poisoning?
Typical food poisoning (gastroenteritis) causes sudden vomiting and diarrhoea that resolves within 1-3 days. Typhoid develops gradually over a week with a high, sustained fever (often 39-40°C) that does not resolve on its own. Abdominal pain, headache, and constipation (more than diarrhoea initially) are characteristic. If you have a fever lasting more than 3 days after travel to a developing country, think typhoid and see a doctor.
Is typhoid a risk in India?
India has one of the highest rates of typhoid in the world, and it is a top destination for imported typhoid cases in Australia. Travellers visiting friends and relatives (VFR travellers) are at particularly high risk. Typhoid vaccination is strongly recommended for all travellers to India, along with strict food and water precautions. Be aware that drug-resistant typhoid, including extensively drug-resistant (XDR) strains, is an increasing concern in the subcontinent.
Can you get typhoid from drinking water?
Yes. Typhoid is transmitted through water contaminated with the faeces of an infected person. This includes tap water, ice made from tap water, and drinks diluted with local water. In endemic areas, drink only sealed bottled water, boiled water, or water treated with purification tablets or a filter rated for bacteria.
How effective is the typhoid vaccine?
Both typhoid vaccines are approximately 50-80% effective. This means vaccination significantly reduces your risk but does not eliminate it. Safe food and water practices are essential even if vaccinated. The vaccine does not protect against paratyphoid fever, caused by Salmonella Paratyphi, which has similar transmission.
What is the treatment for typhoid?
Typhoid is treated with antibiotics. Azithromycin is commonly used as first-line treatment due to increasing resistance to older antibiotics. Ciprofloxacin may be used where resistance patterns allow. Severe cases may require intravenous ceftriaxone and hospitalisation. Drug-resistant typhoid is an increasing problem, particularly in South Asia, making prevention even more important.
How long does typhoid fever last?
Without treatment, typhoid fever can last 3-4 weeks and may be life-threatening. With appropriate antibiotic treatment, fever typically resolves within 3-5 days, though a full course of antibiotics (usually 5-14 days depending on the drug) must be completed. Relapse can occur in 5-10% of treated patients.
Sources & References
Last updated: April 2026