Their names are “Salmonella typhi” and “Salmonella enteridis” and they are always at the top of the list of the usual suspects when an epidemic breaks out. This is because the pathogens that cause typhoid fever abdominalis and the weakened form of paratyphoid fever prefer to live in feces – typhoid fever and paratyphoid fever can then spread in places where hygiene conditions leave much to be desired. The disease is transmitted through food and drink contaminated with feces: regular hand washing with clean water is therefore the best way to avoid infection.
Typhoid fever: illnesses are becoming rarer
Every year, about 17 million people contract typhoid fever, of which about 600,000 die. In industrialized nations, typhoid fever has become rather rare. Only a few of the permanent sufferers who acquired their disease during the typhoid outbreaks immediately after World War 2 and in the 1950s are still alive. Typhoid fever cases are frequently and repeatedly reported, especially from countries with inadequate hygienic and sanitary conditions.
Caution when traveling abroad
80 to 90 percent of all typhoid and paratyphoid cases in Germany today are now imported from travel regions with inadequate hygiene standards, according to estimates by travel medicine experts. These include Pakistan, India, Thailand, Indonesia, Egypt, Turkey and Morocco. According to estimates, one in 30,000 long-distance travelers imports a typhoid disease. The increasing antibiotic resistance of the pathogens, which makes successful treatment difficult, is becoming problematic.
Symptoms and course of typhoid fever
Typhoid fever (Greek typhos haze, mist, dizziness) and paratyphoid fever are bacterial infectious diseases caused by Salmonella. It is a severe general infection with high fever around 40 degrees Celsius, lasting about three weeks. However, the fever can also last longer. In addition to fever, the typical initial symptoms include severe headache. In addition, there is diarrhea, dizziness, and a swollen spleen or liver. Because the symptoms of the disease are relatively unspecific, typhoid fever is often only recognized late. With complications such as intestinal bleeding or pulmonary typhus, the disease can also be fatal. About two to five percent of typhoid and paratyphoid patients become so-called “permanent excretors” after they have contracted the disease, i.e. they continue to excrete the pathogens in their stools for weeks after the illness and can remain contagious for the rest of their lives. However, not everyone who ingests typhoid bacteria necessarily falls ill. The outbreak of the disease depends on the infectious dose and the general state of health of the patient. This constellation is also true of other salmonella illnesses, which often lead to epidemics of diarrhea during the summer months, especially in facilities with commercial kitchens.
Treatment of typhoid fever
During the first and often the second week of illness, the pathogens can be detected in the blood. However, blood culture results are not available for at least 48 hours, so patients with suspected typhoid or paratyphoid fever must be isolated immediately because the pathogens may be excreted during this phase. From the second week of illness, the pathogens can also be detected in the stool, and high antibody levels are detectable in the patient’s serum as the disease progresses.
Typhoid fever: vaccination for prevention
Typhoid and paratyphoid fever can be treated with antibiotics; in addition, the high fluid and electrolyte losses due to diarrhea and vomiting must usually be compensated. Without treatment with antibiotics, about 10 to 15 percent of those who contract the disease die; with treatment, about one to two percent die. Anyone planning a long-distance trip should be vaccinated against typhoid fever. This applies not only to trekking or adventure vacationers: Package tourists can also become infected with the pathogen through contaminated food in the hotel. The vaccination can be given as an oral vaccine or as an injection. Both vaccines can be used for adults and children over the age of two. The typhoid vaccine can be given at the same time as other protective vaccines. The oral vaccines contain essentially harmless live typhoid bacteria. For the vaccine to be fully effective, malaria prophylaxis, laxatives or antibiotics should not be taken until three days after complete typhoid immunization has been completed.Since oral vaccination involves taking three capsules two days apart, vaccination planning here should be done in a timely manner and with foresight so as not to jeopardize the success of this and other vaccinations.
Do not vaccinate: pregnant women and children under two years of age.
Booster vaccinations are recommended after three years, possibly more often if you are constantly in a danger zone after consulting with your doctor. Those suffering from an acute infection should postpone vaccination until the infection has resolved. Children under two years of age and pregnant women should avoid vaccination and travel. During breastfeeding, oral vaccination can be given because salmonella does not pass into breast milk.
