Health: Infectious Disease Epidemiology & Prevention Division: Typhoid and Paratyphoid Fever

Typhoid and Paratyphoid Fever

Typhoid fever and paratyphoid fever are caused by Salmonella serotype Typhi and Salmonella serotype Paratyphi. These serotypes are specific types of the Salmonella bacterium. Typically, these diseases are spread through untreated water. They are ingested by people who drink untreated water and eat foods that may have been contaminated. It also may be spread from person to person.

Typhoid and paratyphoid fever are rare in Indiana (and within the U.S. overall); however people traveling to countries where these diseases are common are at an increased risk. These illnesses are most common in parts of the world where water and food may be unsafe and sanitation is poor, particularly South Asian countries such as Pakistan, India, and Bangladesh. Travelers from the U.S. to these countries should be aware of measures to take to prevent infection.

How do people get sick with typhoid and paratyphoid fever?

Most people become sick when they have contact with untreated water or sewage. This sewage or untreated water can contaminate food or drinking water. A sick person can spread the bacteria to others through person to person contact. Someone may spread the illness if they are sick and prepare food for others or do not wash their hands properly after using the restroom. Drinking water contaminated with sewage is another common way that typhoid and paratyphoid fever spreads. Sometimes contaminated water that is used to rinse foods that will be eaten raw (such as fruits or vegetables) can cause people to get sick when they eat these foods. It can easily spread from person to person, including household members who are sick. You can become ill if a sick individual with typhoid or paratyphoid fever prepares your food or drink, or if they do not wash their hands after using the bathroom.
What are the symptoms of typhoid and paratyphoid fever?
Symptoms of typhoid fever normally begin around six to 30 days following exposure. Symptoms of paratyphoid fever begin within one to 10 days of exposure. People who are exposed to typhoid fever and paratyphoid fever may experience the following symptoms:
- High fever (103-104 degrees F)
- Weakness
- Chills
- Stomach pain
- Headache
- Diarrhea or constipation
- Cough
- Loss of appetite
Some people will develop a rash that is flat with rose-colored spots.
Severe illness may occur, including sepsis, when an individual gets a bloodstream infection. Some severe cases can lead to death.
How is typhoid and paratyphoid fever diagnosed and treated?

Diagnosis
Typhoid or paratyphoid fever infections are normally diagnosed through laboratory testing of a feces sample for Salmonella bacteria. Salmonella positive specimens must be sent to the Indiana Department of Health Laboratory for confirmation and additional testing for the Typhi or Paratyphi strain.
Treatment
Typhoid and paratyphoid infections should be treated with supportive therapy, such as hydration. Antibiotics can also be given depending on how sick the person is.
How can typhoid and paratyphoid fever be prevented?
- Follow food safety guidelines
  - Be careful when consuming raw or undercooked seafood
  - Consider consuming only fully cooked seafood
- People with diarrhea and/or vomiting should not prepare food or provide health care for others and should limit direct contact with others as much as possible
- Avoid swallowing water when swimming or playin gin lakes, ponds, streams, swimming pools, or other bodies of water
- Do not enter bodies of water when you have open cuts (or cover them up fully)
What should I do if I am sick with typhoid and paratyphoid fever?

Once you or your child start having symptoms of the illness, such as diarrhea, do not attend work (specifically for food handlers, healthcare workers, daycare workers) or attend daycare or school until a healthcare provider or someone from your local health department says you are clear to go back.
If you believe you have typhoid or paratyphoid fever and have not yet been treated by or spoken with a doctor, please be sure to do so. You should be evaluated by a doctor to confirm that you have typhoid or paratyphoid fever and that you get the correct treatment. You should also respond to requests to be interviewed by your local or state public health department. An investigation will take place for every confirmed case of typhoid or paratyphoid fever. It is important that you answer the call from your local or state health department so that other people in your home or near you are not at risk of getting typhoid or paratyphoid fever as well. An investigation may also look into your exposures to check if other people are at risk.
More Information
- CDC Typhoid and Paratyphoid Fever Information
- Vaccine and Travel Information

Page last reviewed/updated: December 2024