Typhoid Fever

Primary reference(s)

WHO, 2023. Typhoid. World Health Organization (WHO). Accessed 14 February 2025.

Annotations

Key relevant UN convention / multilateral treaty

International Health Regulations (2005), 3rd ed. (WHO, 2016).

Drivers

Typhoid fever is common in places with poor sanitation and a lack of safe drinking water (WHO, 2023). Typhoid risk is higher in populations that lack access to safe water and adequate sanitation, and children are at the highest risk (WHO, 2023).

Impacts

As of 2019, an estimated 9 million people get sick from typhoid and 110 000 people die from it every year (WHO, 2023). Symptoms include prolonged fever, fatigue, headache, nausea, abdominal pain, and constipation or diarrhoea. Some patients may have a rash. Severe cases may lead to serious complications or even death. Typhoid fever can be treated with antibiotics although increasing resistance to different types of antibiotics is making treatment more complicated (WHO, 2023).

Multi-hazard context

All travellers to endemic areas are at potential risk of typhoid fever, although the risk is generally low in tourist and business centres where standards of accommodation, sanitation and food hygiene are high (WHO, 2023).

Risk Management

Access to safe water and adequate sanitation, hygiene among food handlers and typhoid vaccination are all effective in preventing typhoid fever (WHO, 2023). 

Typhoid conjugate vaccine, consisting of the purified Vi antigen linked to a carrier protein, is given as a single injectable dose in children from 6 months of age and in adults up to 45 years or 65 years (depending on the vaccine). Two additional vaccines have been used for many years in older children and adults at risk of typhoid, including travellers. These vaccines do not provide long-lasting immunity (requiring repeat or booster doses) and are not approved for children younger than 2 years old: 

• an injectable vaccine based on the purified antigen for people aged 2 years and above; and
• a live attenuated oral vaccine in capsule formulation for people aged over 6 years (WHO, 2023).  

Two typhoid conjugate vaccines have been prequalified by WHO since December 2017 and are being introduced into childhood immunization programmes in typhoid-endemic countries. 

All travellers to endemic areas are at potential risk of typhoid fever, although the risk is generally low in tourist and business centres where standards of accommodation, sanitation and food hygiene are high. Typhoid fever vaccination should be offered to travellers to destinations where the risk of typhoid fever is high (WHO, 2023). 

The following recommendations will help ensure safety while travelling: ensure food is properly cooked and still hot when served; avoid raw milk and products made from raw milk – drink only pasteurized or boiled milk; avoid ice unless it is made from safe water; when the safety of drinking water is questionable, boil it or if this is not possible, disinfect it with a reliable, slow-release disinfectant agent (usually available at pharmacies); wash hands thoroughly and frequently using soap, especially after contact with pets or farm animals, or after having been to the toilet; and wash fruit and vegetables carefully, particularly if they are eaten raw. If possible, vegetables and fruits should be peeled (WHO, 2023). 

WHO response for typhoid: in October 2017, the Strategic Advisory Group of Experts on Immunization (SAGE), which advises the WHO, issued a recommendation for the typhoid conjugate vaccine to be added to routine childhood immunization programmes in typhoid-endemic countries SAGE also called for the introduction of typhoid conjugate vaccines to be prioritised for countries with the highest burden of typhoid disease or high levels of antibiotic resistance to Salmonella typhi. (WHO, 2023).  

Starting in 2019, Gavi, the Vaccine Alliance has provided funding to support typhoid conjugate vaccine use in eligible countries. As of March 2023, WHO has prequalified two conjugate vaccines for the prevention of typhoid. Typhoid conjugate vaccine has longer-lasting immunity than the older typhoid vaccines and can be given as a single dose to children from the age of 6 months. 

In addition to decreasing the disease burden in endemic countries and saving lives, widespread use of the typhoid conjugate vaccine in affected countries is expected to reduce the need for antibiotics for typhoid treatment and slow the increase in antibiotic resistance in Salmonella typhi (WHO, 2023).

Monitoring

WHO supports countries to conduct all-hazards strategic risk assessment in the contexts of health emergencies and disasters, which results in the development of a country's risk profile. Empowered with the country risk profile, inclusive of a seasonal risk calendar, countries can anticipate potential emergencies before they occur to trigger early alerts and inform early actions (WHO, 2021).

WHO's Early Warning, Alert and Response System (EWARS) has been designed to improve disease outbreak detection in emergency settings, such as in countries in conflict or following a natural disaster. It is a simple and cost-effective way to rapidly set up a disease surveillance system. EWARS is deployed during an emergency as an adjunct to the national disease surveillance system. WHO works with Ministries of Health and health sector partners to train local health workers to use the system. After the emergency, EWARS should re-integrate back into the national system (WHO, no date).