Typhoid travel guide for travelers to India

This post is aimed at providing the travelers to India, all the information they need to know to  prevent contacting Typhoid and identifying and managing the illness if contracted. Note that Typhoid is widespread in other countries as well - like Africa and countries in the Indian subcontinent. I'm not sure what the exact sources of contamination there would be, but the following details would still be relevant.  

 

Step 1: Get vaccinated before your trip to India

It takes a week for the vaccine to build immunity against Typhoid, so make sure you take the shot atleast 1 week in advance. In India, Typhoid vaccine can be given to infants as old as 9 months, so it's a good idea to get your baby vaccinated once you arrive in India. Note that in other countries, Typhoid vaccine is not available for children under 3, so you may not be able to get your baby vaccinated before you arrive in India. Once you do, visit any children hospital and check with the local pediatrician. More details about vaccination in this post - Typhoid Vaccine - Oral and Injectable.

Step2: Know the sources of infection to avoid getting infected during your visit

Efficacy of Typhoid vaccine, like any other vaccine is limited. So in addition to taking the shot, you need to avoid ingesting anything that increases your chances to get infected by Salmonella S Typhi. Following is a list of sources most likely to cause the illness. 

1. Street food - Avoid eating food that is not cooked thoroughly and may have water in uncooked form. If the water used by the vendor is contaminated, and the dish is not cooked - water added as part of chutneys, curd, buttermilk, Sweet lime water, juices or the all time favorite panipuri, there's a high chance to get sick with any kind of food poisoning. Ice added to drinks served on the street is also known to be a source of all sorts of bacteria and needs to be strictly avoided. In India, water is almost always contaminated. So best is to refrain from street food that does not involve all the components being cooked at high temperatures.

2. Swimming   - Salmonella Typhi can get passed on to the swimming pool water through a carrier, fecal matter washes from the bodies of swimmers into the water. Chlorine is supposed to kill Salmonella but it would take time. Also effectiveness of chlorine also depends on when the pool was chlorinated. while swimming, take care to avoid intake of pool water.

3. Untreated drinking water - Water travels a long way before finding its way through the taps in our houses. There are chances that the water is contaminated at various sources before reaching us. In some places, local tankers deliver water to the communities. This water is seldom contaminated It is therefore very important to boil water sufficiently before consuming. The drinking water served from tap at restaurants and Hotels must also be avoided. Stick to mineral water always.

4. Typhoid carrier handling eatables - It is advised that Typhoid patients take extra care in maintain hygiene as there are chanced that the bacteria gets into the finger nails if hands are not washed thoroughly after vising the toilet. In India, Typhoid is widespread and 1 in 10 people would have had Typhoid at some point in their lives. Some of them get into the carrier state and the Salmonella Typhi would continue to shed in the stools. It is important that people handling food maintain a good degree of hygiene. The famous tale of Typhoid Mary is also associated with Salmonella transmission through incorrect food handling.

5. Contamination through insects: flies and other insects can carry the bacteria along (usually from public Toilets or open grounds used as Toilets) and contaminate the eatables they sit upon.Stay away from consuming food that is kept uncovered.

 

Step3: Know the Symptoms

Refer to the symptoms in the post on Typhoid symptoms . If the fever and diarrhea are accompanied with severe headache, don’t rule Typhoid out. Additionally, if you suspect Typhoid, don’t feel shy to let your doctor know and get the Widal test done.

Step: Know how to find help

The incubation period for Salmonella Typhi is anywhere from 3 to 21 days. So you may come down with the sickness while you are still in India or after you return. In both cases, it is important to let your doctor know your travel history, and where you ate. All internal medicine doctors are well equipped to handle Typhoid patients. Though some doctors (In US and Europe where the disease is not prevalent), may not suspect Typhoid. I’ve seen several people from US, that contracted the disease on their trips to India and Mexico, complain that the disease was not diagnosed correctly and that they were treated by their doctors in the US for regular food poisoning, when the underlying cause was Typhoid.