EEIP RIDRM Typhoid-Paratyphoid Fever
Typhoid fever and Paratyphoid fever are illnesses caused by the bacteria Salmonella typhi and Salmonella paratyphi respecively. These illnesses are life-threatening and include fevers as high as 104° F (40° C), weakness, stomach pain, headache and gastrointestinal symptoms. Although these infections are not common in the United States, people traveling to countries including India, Bangladesh, and Pakistan can get vaccinated against typhoid fever. Antibiotics are used as a treatment, and as many as 30% of people who are not treated die from complications. Paratyphoid is common in many other countries and unfortunately there is no vaccine. People become infected by ingesting contaminated water and food rinsed with contaminated water. People infected with Salmonella typhi and paratyphi will continue to shed the bacteria for weeks after symptoms end.
About Typhoid Fever and Paratyphoid Fever
Actions Required and Control Measures
Reporting Requirements - Category 2
Salmonellosis is physician reportable by mail within 12 hours of recognition or strong suspicion to both the Connecticut Department of Public Health (DPH) and the local health department (LHD). The director of any clinical laboratory must also report laboratory evidence of Salmonella to both the DPH and the LHD. Additional laboratory requirements: Isolates of Salmonella must be submitted to the DPH State Public Health Laboratory for confirmation and should include the serogroup and type. To assure you have the most up-to-date information concerning reportable diseases, please visit the Reporting of Diseases, Emergency Illnesses, Health Conditions, and Laboratory Findings page.
Case Investigation
LHD Responsibility: Unless deferring Salmonella interviews to FoodCORE, interview the case using the GEDIF specific to Salmonella and Campylobacter, being sure to ask about a 30-day incubation period rather than the typical 7-day incubation. If the case reports travel to a country where S. typhi/ paratyphi is common during any part of their incubation, the food history section can be skipped. Otherwise please complete the food history section. Additionally, complete the CDC “Typhoid and Paratyphoid Fever Surveillance Report form." Identify individuals in high-risk occupations or settings (see below). Completed forms should be scanned and uploaded to CTEDSS or faxed to the DPH at 860-509-7910. They will also provide information and educational materials that describe the nature of the disease and preventive measures. Proper hand hygiene should be stressed for all cases and contacts. Encourage a physician visit if symptoms persist.
DPH Responsibility: DPH is available to the LHD for assistance, consultation, and guidance and to ensure that appropriate investigative and control actions are being taken.
Control Measures
Food handler:
Refer to DPH Food Protection Program at 860-509-7297.
Health care provider, day care attendee or staff member:
Exclude from patient care, or day care center until the following are met:
Three consecutive negative stool cultures that are:
- taken not earlier than 1 month after onset, and
- taken at least 24 hours apart, and
- taken at least 48 hours after any antibiotic treatment.
When S. Typhi infection is identified in a symptomatic child care attendee or staff member, stool cultures should be collected from other attendees and staff members, and all infected people should be excluded.
Comment: Even with antibiotic treatment, infected persons may continue to shed the infectious organism. Shedding is highest during the month following onset of illness; thus, it is recommended to begin culturing one month following onset of illness.
Household contact that is a health care provider, or day care attendee or staff member:
Exclude from patient care, and day care center until the following are met:
Two consecutive negative stool cultures that are:
- taken at least 24 hours apart, and
- taken at least 48 hours after any antibiotic treatment.
Typhoid carrier who is a health care provider
Exclude typhoid carriers from providing patient care until the following are met:
Three consecutive negative stool cultures that are:
- taken at least 1 month apart, and
- taken at least 48 hours after any antibiotic treatment.
Culturing of household contacts
Ideally, all household contacts should be cultured to identify additional cases or carriers. If this is not possible, then culture household contacts meeting the following criteria:
- persons who traveled with the confirmed case, or persons who are in high-risk occupations (food handlers, health care providers, day care attendee or staff member).
This page last updated 9/16/2019.