Typhoid prevention is better than typhoid treatment in saving lives. Typhoid vaccines, injections, awareness, and financial stability can help reduce typhoid prevalence.

The Do’s and Don’ts of Typhoid Prevention

The Do’s And Don’ts Of Typhoid Prevention

Introduction

<a href="https://www.merisehat.pk/disease/typhoid-fever">Typhoid fever</a> is a systemic illness caused by S. Typhi infections. It is responsible for causing 200,000 to 600,000 fatalities globally each year, resulting from an estimated 21 million new infections<a href="#accordion">[1]</a>. Typhoid fever is a significant health issue in areas with few resources. However, its increasing prevalence among foreign visitors has made it a more well-known condition on a global scale. Moreover, the Indian subcontinent accounts for 90% of typhoid fever cases across the world<a href="#accordion">[1]</a>.&nbsp; 
&nbsp;

Licensed vaccines only protect against some S. Typhi variants. Further research is required to develop advanced and broad-spectrum vaccines for some resistant variants. 
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Typhoid is caused by the bacteria part of the Salmonella enterica serotype Typhi family. It can grow in the 
&nbsp;

<ul>
	<li>Blood</li>
	<li>Spleen</li>
	<li>Liver</li>
	<li>Gallbladder</li>
	<li>Intestines</li>
	<li>Peyer&#39;s patches (lymphoid follicles of the intestine)</li>
	<li>Some lymph nodes 
	&nbsp;</li>
</ul>

Typhoid is simply transmitted by consuming food or water contaminated with an infected person&#39;s feces.

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Salmonella Typhi is a bacterium that causes the illness typhoid fever. Whereas paratyphoid fever results from the bacterium Salmonella Paratyphi. These diseases bring on identical symptoms. While typhoid infections are more common, paratyphoid infections are typically less severe. 
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Fever is not the only symptom of typhoid. It can become life-threatening if it is not treated appropriately under the supervision of healthcare professionals. If you suspect you may have typhoid fever, consult a doctor as soon as possible.&nbsp;

Let&#39;s have a look at the behavior of S. Typhi in the human body. 
&nbsp;

<h5>Transmission And Role Of The Human Stomach</h5>

<ul>
	<li>After entering the body via the mouth, S. Typhi travels to the acidic stomach where it can survive in pH levels as low as 1.5. Normally, a healthy person&#39;s stomach will start producing enough gastric acid for killing S. Typhi, but it only happens when there is an excessive amount of acid.</li>
</ul>

<ul>
	<li>The bacteria will remain active if the stomach cannot yield sufficient acid. This typically occurs in children, as they produce less acid than adults.</li>
</ul>

<ul>
	<li>As a result, S. Typhi passes through the stomach and enters the ileum in the small intestines. 
	&nbsp;</li>
</ul>

<h5>Incubation Period Of Typhi&nbsp; 
&nbsp;</h5>

<ul>
	<li>
	As the S. Typhi begins attacking intestinal epithelial cells, this causes an inflammatory reaction and the production of intestinal mononuclear phagocytes.&nbsp;
	</li>
	<li>They are responsible for recognising and killing invading pathogens by engulfing S. Typhi, but sadly they only engulf and do not kill it.&nbsp;</li>
</ul>

<ul>
	<li>The incubation period for typhoid fever is between 7 and 14 days. During this time S. Typhi survives in monocytes and reproduces inside them. 
	&nbsp;</li>
</ul>

<h5>Onset Of Symptoms 
&nbsp;</h5>

<ul>
	<li>The phagocytes finally rupture as a sufficient number of S. Typhi fill them up.</li>
</ul>

<ul>
	<li>Then they invade the Peyer&#39;s patches, a lymphoid tissue beneath the enterocytes, resulting in abdominal pain and ulceration (open sores).&nbsp;</li>
</ul>

<ul>
	<li>Later, S. Typhi enters the bloodstream and spreads to numerous organs, particularly the liver, spleen (which enlarges), and bone marrow. The symptoms typically manifest around this time. 
	&nbsp;</li>
</ul>

<h5>Diagnosis Procedures Of Typhoid 
&nbsp;</h5>

Any of the following methods can help to make a diagnosis of typhoid.

<ul>
	<li>Blood test</li>
	<li>Bone marrow</li>
	<li>Stool cultures</li>
	<li>The Widal test (antibodies against Salmonella)&nbsp; 
	&nbsp;</li>
</ul>

In epidemics, and in less developed nations, a therapeutic trial period with chloramphenicol is typically started while awaiting the results of the various laboratory tests. 
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Understanding Dos And Don'ts Of  Typhoid Prevention

Yes, there is no debate that typhoid is a communicable illness. It typically results from the consumption of food or water. Interaction with a freshly infected relative, inadequate sanitation and hygiene infrastructure, especially geographical linkages with polluted public water sources, have all been linked to increased risk of infections. 
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<h5>Lack Of Well-Equipped Healthcare Systems</h5>

Diagnostic tools in typhoid-prevalent regions are quite limited for test accuracy and specificity. The time required for a proper diagnosis, the increasing spread of antibiotic resistance, and the cost of testing are some of the challenges faced by under-resourced healthcare systems. 
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<h5>Lack Of Hygiene Awareness</h5>

Unhygienic food, contaminated water, and poor sanitation are the main causes of typhoid. Due to poor hygiene habits, poverty, water scarcity, fecal pollution of water sources, and overcrowding, salmonella typhi infection has become more common in South Asian countries. According to current reports, typhoid annually affects 21 million people and kills approximately 161,000 people every year<a href="#accordion">[3]</a>. 
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Untreated typhoid fever often progresses in three separate stages, each lasting a week or so. In contrast to normal fever, typhoid fever starts in the late afternoon, or evening, and typically peaks in the morning. Typhoid fever is correlated to the symptoms listed below. 
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<h5>In the First Week</h5>

1. A gradual increase in body temperature

2. Relative bradycardia&nbsp;

3. Headache and cough

4. General discomfort

5. Abdominal pain

6. Sweating 
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<h5>In the Second Week</h5>

1. Feeling of tiredness

2. High fever (approx. 104 degrees Fahrenheit)

3. Bradycardia

4. Difficulty in focus

5. Diarrhea&nbsp; 
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<h5>In The Third Week &ndash; Complicated Week</h5>

1. Relatively high fever with minimal 24-hour fluctuation

2. Bleeding in GIT

3. Pneumonia and inflammation of the lungs

4. Inflammation of brain

5. Inflammation of bone

6. Low platelet count

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Despite our long-standing knowledge and fear of typhoid fever, there are still numerous obstacles to overcome. When trying to control enteric fever in susceptible human populations, one should focus on all possible ways the infection can spread further.&nbsp; 
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<h5>Financial Instability</h5>

A deteriorating economic growth, low-quality public services, inadequate infrastructure, corruption, fiscal traps, and among other problems, a lack of innovation have inevitably contributed to the emergence of diseases like typhoid fever.&nbsp; 
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<h5>Hygiene Awareness</h5>

Typhoid fever cases tend to cluster in less affluent, densely populated areas with inadequate sanitation and a scarcity of clean water. People who have typhoid are frequently unaware of their condition and continue to conduct various unsanitary habits which helps the infamous disease thrive and spread even more quickly.&nbsp; &nbsp; 
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<h5>Healthy Water Resources</h5>

In the 1950s, Pakistan had an annual water supply of about 5000 cubic meters per person.&nbsp; Owing to population increase, inadequate water policies, inadequate infrastructures, as well as water pollution, the water availability level has substantially decreased below 1000 cubic meters. A clean drinking water system for everyone is a crucial step in eradicating typhoid. 
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<h5>Appropriate Sanitation</h5>

Currently, 22 million people in low-income countries still defecate in the open, and 79 million lack access to toilets. Open defecation exposes a large population, particularly vulnerable children, to diseases like typhoid by polluting the environment and contaminating water sources like streams. 
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<h5>Self-treatment Control&nbsp;</h5>

Due to a lack of awareness, many locals frequently self-medicate, which leads to excessive antibiotic use. Thus, increasing the likelihood of antibiotic resistance. This raises the emergence of multi-drug resistant typhoid strains. Moreover, treatment options are becoming more limited in many endemic regions due to rising antimicrobial resistance and the emergence of multi-drug resistant pathogens. 
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<h5>Vaccine Availability</h5>

The use of vaccines is an efficient way to stop the spread of the illness, but many children, particularly those living in rural areas, lack the necessary protection. This is partially brought on by the negative cultural and religious perceptions of vaccines that prevent universal immunization. Moreover, inadequate infrastructure, low-income levels, and a lack of healthcare services in remote areas also contribute to the low vaccination rates. 
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Although the price of the TCV typhoid vaccine ($1.4- 1.5 USD per dose) is comparatively low, mass immunization is not cost-effective. The typhoid vaccine must be maintained at a temperature of 2-8 degrees Celsius. Therefore, it is difficult to distribute the vaccine to remote and rural areas, while keeping the doses at the required temperatures.&nbsp;

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The ongoing global epidemic has added to the strain on the already failing hospital sector; the resources are being diverted to stop the spread of COVID-19. Blood cultures, the most accurate test for typhoid, are rarely utilized because so many laboratories have become COVID-19 testing facilities.&nbsp; 
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Furthermore, a number of symptoms, such as fever and headache, are shared by COVID-19 and typhoid, along with other illnesses, such as dengue and measles. Thus, making a conclusive diagnosis difficult. Moreover, using azithromycin for COVID-19 and typhoid might raise the possibility of resistance over time.&nbsp;

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The majority of cases of typhoid and paratyphoid fever occur in places with low hygienic control. Such areas include:&nbsp;<ul><li>Africa</li><li>The Caribbean</li><li>Central and South America</li><li>The Middle East</li><li>Some sections of Asia (particularly Pakistan, India, and Bangladesh)</li></ul>People who are visiting friends or family have a higher probability than other tourists of catching typhoid fever. Since they could remain in the country, they may be less careful with the food and drinks they consume because they eat local cuisine cooked in the homes of people. Moreover, they may not believe in getting vaccinated prior to travelling.

The best defense against typhoid is vaccination, caution for food, and hand washing.

Verify whether the typhoid vaccination is advised for the area where you want to travel.&nbsp;

There are two typhoid vaccinations available: 
&nbsp;

<h5>1. Oral Vaccine In The Form Of Tablets</h5>

The tablet vaccine is suitable for individuals above the age of six. Complete the four pills (one daily) a minimum of one week before your trip. 
&nbsp;

<h5>2. Injectable Vaccines</h5>

Anyone above the age of two can receive the vaccine shot. At least two weeks before your trip, get one shot (or a booster shot).

The tablet and the shot for typhoid do not provide 100% protection against infection (50-80%), and both become less effective with time. Additionally, there is no vaccine to prevent paratyphoid fever. Because of these factors, it&#39;s crucial that you also follow the recommendations below to prevent typhoid. 
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<h5>Pick Your Foods And Beverages Wisely</h5>

<ul>
	<li>Consume only hot, freshly prepared dishes.</li>
	<li>Eliminate food that has been on a buffet for some time.</li>
	<li>Only consume unpeeled or raw vegetables and fruits rinsed in drinkable water.</li>
	<li>Drink only from bottles that have been factory sealed.</li>
	<li>Avoid ice as it may have been made with contaminated water.</li>
	<li>Drink only pasteurized milk. 
	&nbsp;</li>
</ul>

<h5>Clean Your Hands</h5>

<ul>
	<li>Wash your hands frequently for approximately 20-25 seconds with medicated soap and clean water, particularly after going to the toilet and prior to eating.</li>
	<li>If hand-washing&nbsp;is not an option, apply an alcohol-based antibacterial hand sanitizer&nbsp;with at least 60% alcohol.</li>
	<li>Avoid putting your hands near your face or mouth.</li>
</ul>

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S. Typhi should be confirmed with a blood test before starting treatment. Following antibiotics are used to treat typhoid: 
&nbsp;

<ul>
	<li>Ceftriaxone</li>
	<li>Azithromycin</li>
	<li>Fluoroquinolone 
	&nbsp;</li>
</ul>

Even if you feel better, it&#39;s crucial to take all recommended antibiotics exactly as prescribed. If you want to confirm whether you still have S. Typhi or not, get a stool culture done to identify it accurately. 
&nbsp;

People who have received typhoid treatment may still carry the bacterium. They are classified as &quot;chronic carriers&quot; of typhoid. The bacteria from typhoid can be excreted by a chronic carrier in their feces or urine, as well as from wounds or tissues. They are mostly asymptomatic. 
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Some typhoid-causing strains are becoming more resistant to antibiotics. One newly-emerging strain in Pakistan, known as XDR, is now resistant to all but two of the antibiotic classes typically used to treat drug-resistant typhoid. Healthcare professionals may request tests to identify the strain of bacteria causing typhoid due to the rising rates of antibiotic resistance. As a result, the type of antibiotics may change.

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1. Typhoid should be taken seriously, and proper treatment methods should be used to reduce its effect on public health worldwide. 2. Standardized laboratory testing guidelines are required for S.Typhi azithromycin and ciprofloxacin susceptibility testing. Most of this argues that the antibiotic stewardship program (ASP) must be strictly implemented nationwide in low and middle-income countries. The implementation of such a program has faced many challenges, particularly in India. These barriers include:<ul><li>A limited number of highly trained pharmacists</li><li>Few physicians and specialist&nbsp;</li><li>Improper electronic medical data</li><li>Physically hidden stewardship practices</li><li>Few microbiological professionals</li><li>High rates of antibiotic use among people</li></ul>Therefore, the use of antibiotics in hospitals and physician prescribing practices are crucial areas of focus for antibiotic stewardship programs. Furthermore, low-income countries need to introduce antibiotic limitations as a crucial element of ASP. 3. The public health burden of multi drug-resistant (MDR) and extensive drug-resistant (XDR) typhoid must be reduced through:&nbsp;<ul><li>Antibiotics culture sensitivity test&nbsp;</li><li>Proper sanitary procedures</li><li>Community hygiene</li><li>Carrier surveillance and treatment</li><li>Immunization </li><li>Effective oral antibiotics for disease prevention</li></ul>Furthermore, healthcare organizations must anticipate the extent of the epidemics in order to implement appropriate countermeasures. It is crucial to identify an efficient oral antibiotic against XDR typhoid. In order to decrease the financial and health burden of the disease, particularly in low-income countries like India where the condition is endemic, adopting preventative measures should be our first line of action.

Conclusion

The germs of typhoid fever can be transferred by infected individuals. This frequently occurs when a sick person uses the restroom and, without washing their hands, touches everything, including food and beverages. As they may still carry the bacteria on their hands, they ultimately contaminate everything they touch. 
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These bacteria can also be found in the water used to cook meals and beverages. Moreover, in places where dishes are rinsed with inadequate hygiene, this can also lead to the transmission of typhoid bacteria.&nbsp; 
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Typhoid fever has more occurrence probability in travellers and children. Travellers may become ill if they consume food or drinks tainted with certain microorganisms. Therefore, the World Health Organization (WHO) advises vaccination for all visitors to nations where enteric fever is prevalent, irrespective of the scheduled duration of the visit.&nbsp;

Further research is required on the mechanism of action of S. Typhi and the biomechanics of host-pathogen interactions. 
&nbsp;

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Key Points

<ul>
	<li>Salmonella Typhi is a bacterium that causes the deadly illness typhoid.</li>
	<li>Typically, fever in typhoid might reach up to 103&ndash;104&deg;F (39&ndash;40&deg;C).</li>
	<li>People might also have weakness, headaches, stomach aches, constipation or diarrhoea, coughing, and appetite loss.</li>
	<li>Typhoid is spread by consuming food or liquids contaminated with an infected person&#39;s faeces.</li>
	<li>Typhoid fever can be prevented with highly effective immunisations.</li>
	<li>Travellers are at high risk of contracting typhoid fever, especially when travelling to endemic regions.&nbsp;</li>
</ul>

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