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Typhoid Fever and Paratyphoid Fever
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Clinical Guidance for Typhoid Fever and Paratyphoid Fever


Purpose
 This page provides information healthcare providers can use to identify, diagnose, and treat typhoid fever and paratyphoid fever.
It also provides information that can be useful for counseling patients who travel to places where these diseases are common.
 A diverse group of healthcare providers standing together for a photo, representing different ages, races, and ethnicities.
 Evaluation Clinical features Typhoid fever and paratyphoid fever are systemic illnesses caused by *Salmonella*Typhi and *Salmonella*Paratyphi, respectively. Both diseases have an insidious onset characterized by some or all of the following symptoms: Fever
Headache
Constipation or diarrhea
Malaise
Chills
Myalgias
Emesis A transient, maculopapular rash of rose spots may be present on the trunk. Severe cases may have encephalopathy, gastrointestinal bleeding, or intestinal perforation, which typically occur after 2–3 weeks of illness. Few clinical features reliably distinguish these illnesses from a variety of other infectious diseases. Diagnosis Blood culture is the mainstay of diagnosis. Bone marrow cultures have sensitivity of 80% in some studies and can remain positive despite antibiotic therapy. Stool and urine cultures are positive less frequently. Usually, multiple cultures are needed to identify the pathogen. Serologic tests, such as the Widal test, are not recommended because of the high rate of false positives. CDC offers testing for ***Salmonella*Typhi and *Salmonella*Paratyphi. CDC accepts specimens for analysis only from state public health laboratories and other federal agencies. Private healthcare providers and institutions must submit specimens to their state public health laboratory for processing.
 Prevention Vaccination The Advisory Committee on Immunization Practices (ACIP) recommends vaccination for people 2 years and older traveling to areas where the diseases are endemic or an outbreak is occurring. Two typhoid fever vaccines are available in the United States. Basic Information on Typhoid Vaccines Available in the United States
Vaccine
Administration method
Recommended dosage
How long to complete immunization before travel
Minimum age for vaccination
Booster neededTy21a (Vivotif, Emergent BioSolutions)
Oral capsules
4 capsules, 1 taken every other day
1 week
6 years
Every 5 yearsViCPS (Typhim Vi, Sanofi Pasteur)
Intramuscular injection
Single injection of 0.5 mL
2 weeks
2 years
Every 2 years
 Additional resources Typhoid vaccination: Information for healthcare providers
  Sept. 29, 2010
 Typhoid vaccine information statement (VIS): Information for patients
  Oct. 29, 2019
 Typhoid VIS in languages other than English
 Food and water safety **Typhoid vaccines are not 100% effective.**All travelers should follow recommended food and water precautions to prevent infections during travel. Safe eating and drinking habits also help protect travelers from other illnesses, including travelers' diarrhea, cholera, dysentery (severe diarrhea), and hepatitis A.
 Handwashing Travelers should wash hands thoroughly with soap and water, especially after using the bathroom and before preparing food or eating.
Use hand sanitizer with at least 60% alcohol if soap and water are not available.
 Treatment Antibiotic use Antibiotic use helps patients recover faster and lowers the risk of complications and death. High rates of antimicrobial resistance can limit treatment options. Antimicrobial susceptibility testing can help guide treatment decisions.
 Empiric treatment While waiting for culture results, obtain a thorough travel history to inform empiric treatment. Ceftriaxone resistance is now common among travelers returning from Iraq and Pakistan. It has been observed less frequently in travelers returning from neighboring countries, including India and Afghanistan. For patients who **traveled to Iraq or Pakistan** and patients **who did not travel** internationally:Uncomplicated illness may be treated empirically with azithromycin.
Complicated illness may be treated empirically with a carbapenem.
Ceftriaxone and azithromycin remain appropriate empiric treatment options for patients returning from most countries other than Iraq and Pakistan.
Most typhoid fever and paratyphoid fever infections diagnosed in the United States are caused by strains that are not susceptible to fluoroquinolones. **Do not use fluoroquinolones for empiric treatment.**
 Complications Without treatment, typhoid fever and paratyphoid fever can last for about a month. Before widespread antibiotic use, the case fatality rate for typhoid fever was higher than 10%. With appropriate treatment, the fatality rate of typhoid fever is lower than 1%. Paratyphoid fever is usually less severe and has a lower case fatality rate than typhoid fever. About 10% of inadequately treated patients experience relapse, with an illness that is often milder than the initial one. Relapse can happen 1–3 weeks after recovery from the initial illness. About 1%–4% of people with typhoid fever become chronic carriers and remain positive for *Salmonella*Typhi for more than one year.
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  April 24, 2024 Sources Print Share
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 National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)


Typhoid Fever Typhoid fever and paratyphoid fever are life-threatening illnesses. Learn about how they spread, risk factors, and how you can prevent infections. View All
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													Prevention
													Treatment
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 Public Health Surveillance
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																													Laboratory Information
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Contact Us Contact Us  Call 800-232-4636
						Contact CDC
 About CDC Mission & Organization
						Budget & Funding
						Careers & Jobs
						About CDC
 Policies Accessibility
						External Links
						Privacy
						Web Policies FOIA
						OIG
						No Fear Act
						Nondiscrimination
						Vulnerability Disclosure Policy
 Languages Languages Español
						Multilingual Content Language Assistance Español
						繁體中文
						Tiếng Việt
						한국어
						Tagalog
						Русский
						العربية
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