Typhoid fever is an illness caused by the bacterium Salmonella typhi. Very common worldwide, it is transmitted by food or water contaminated with feces from an infected person.

Symptoms

After infection, symptoms include:

a high fever from 103° to 104°F (39° to 40°C) that rises slowly
chills
slow pulse rate (bradycardia)
weakness
diarrhea
headaches
myalgia
lack of appetite
constipation
stomach pains
in some cases, a rash of flat, rose-colored spots called "rose spots"

Extreme symptoms such as intestinal perforation or hemorrhage, delusions, and confusion also are possible

Diagnosis

Diagnosis is made by blood, bone marrow or stool cultures and with the Widal test (demonstration of salmonella antibodies against antigens O-somatic and H-flagellar) or, in less affluent countries with the urine diazo test. In epidemics and less wealthy countries, after excluding malaria, dysentery or pneumonia, a therapeutic trial with chloramphenicol is generally undertaken while awaiting the results of Widal test and blood cultures.

Treatment

Typhoid fever can be fatal. Antibiotics, such as ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, and ciprofloxacin are commonly used in treating typhoid fever in the west.

When untreated, typhoid fever persists for three weeks to a month. Death occurs in between 10% and 30% of untreated cases. Vaccines for typhoid fever are available and are advised for persons traveling in regions where the disease is common (especially Asia, Africa, and Latin America).

Transmission

A person may become an asymptomatic carrier of typhoid fever, suffering no symptoms, but capable of infecting others. According to the Centers for Disease Control approximately 5% of people who contract typhoid continue to carry the disease after they recover.

The most notorious carrier of typhoid fever, but by no means the most destructive, was Mary Mallon, also known as Typhoid Mary. In 1907 she became the first American carrier to be identified and traced. She was a cook in New York at the beginning of the 20th Century. Some believe she was the source of infection for several hundred people. She is closely associated with fifty cases and five deaths. Public health authorities told Mary to give up working as a cook or have her gall bladder removed. Mary quit her job, but returned later under a false name. She was detained and quarantined after another typhoid outbreak. She died of a stroke after 23 years in quarantine.

Famous victims

Typhoid fever has touched the lives of several famous people.

Read more at Wikipedia.org

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Infants Losing Only Typhoid Vaccine Product - Brief Article
From Family Pratice News, 4/1/01 by Miriam E. Tucker

ATLANTA -- Two traveler's vaccines have been discontinued: the only licensed typhoid fever vaccine for children aged 6 months-2 years and the only licensed cholera vaccine in the United States.

Both vaccines were made by Wyeth-Lederle, Dr. Eric Mintz said at the winter meeting of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.

The loss of this typhoid vaccine will leave unprotected infants and children under age 2 who travel to typhoid-endemic areas, said Dr. Mintz, a medical epidemiologist at CDC's National Center for Infectious Diseases, Atlanta.

The typhoid vaccine being discontinued was one of three on the U.S. market, but the only one licensed for children as young as 6 months of age. It was 51%-77% effective in preventing typhoid fever over a 2-3 year period--about the same as the other two typhoid vaccines in older populations.

Data from the manufacturer suggest that as many as 3 million people were immunized with the vaccine between 1994 and 1999, but it is not known how many of those were aged 6 months-2 years.

However, it is known that this age group comprises a significant proportion of typhoid fever cases diagnosed in the United States. Between 1994 and 1999, 33 of 491 (6.7%) culture-confirmed cases of typhoid fever in travelers were children aged 6 months-2 years, who could only have received the now-with drawn vaccine.

Alternative vaccines that may prove immunogenic in children under 2 years of age are currently under development. Until they become available, physicians must emphasize that parents pay careful attention to food and beverages consumed by children under 2 years of age who travel to typhoid-endemic areas, Dr. Mintz advised.

Immunization against typhoid fever is recommended for "travelers to areas where there is a recognized risk of exposure to Salmonella typhi (countries in Latin America, Asia, and Africa), who have prolonged exposure to potentially contaminated food or drink, persons with intimate exposure (such as household contact) to a documented S. typhi carrier, and laboratory personnel who work with S. typhi."

Withdrawal of the cholera vaccine may not have a huge impact. The vaccine was only about 50% effective in reducing the incidence of clinical illness for 3-6 months. The CDC had recommended it only to "satisfy entry requirements for persons who anticipate travel to countries [that require it]" and for "special high-risk groups that work and live in highly endemic areas under less than sanitary conditions." No country has officially required evidence of cholera vaccination for entry in several years.

"We have no evidence that the withdrawal of this [cholera] vaccine from the U.S. market has caused or will cause any significant public health problems," Dr. Mintz said.

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