Typhoid Fever in Children: Symptoms, Treatment, and Prevention

Typhoid fever — caused by Salmonella typhi — remains one of the most common bacterial infections in Indian children. Despite being preventable by vaccine and treatable with antibiotics, it continues to cause significant illness, largely because of contaminated water and food.

How Does Typhoid Spread?

Typhoid is spread through contaminated food and water — the faecal-oral route. Infected stool contaminating drinking water or food preparation is the main mechanism. Street food, unfiltered water, raw vegetables washed with tap water, and contaminated ice are common sources.

Symptoms in Children

Typhoid in children often presents differently from the "classic" adult presentation:

• Persistent fever for more than 5 days — often rising gradually over days
• The fever is characteristically "step-ladder" (rises each day)
• Headache, malaise, and general aches
• Abdominal pain (typically around the navel)
• Either constipation OR diarrhoea — either can occur
• Reduced appetite
• Mild liver enlargement
• In younger children, presentation may be more non-specific — just high fever and poor feeding

Diagnosis

• Blood culture: The gold standard — most accurate in the first week of illness
• Widal test: Widely used in India but has significant limitations — many false positives and false negatives; should not be used alone for diagnosis
• Typhidot test and ELISA: More specific antibody tests

Treatment

Typhoid is treated with appropriate antibiotics — usually for 14 days. Antibiotic choice depends on local sensitivity patterns, as drug-resistant typhoid (ESBL-producing Salmonella) is increasingly common. Ceftriaxone (IV) for hospitalised children, or azithromycin/cefixime for outpatient management in mild cases. Always complete the full course.

Complications (intestinal perforation, haemorrhage) are serious but uncommon with early treatment.

Prevention: Vaccine Available

Typhoid vaccines are available and recommended by IAP:

• Typhoid Conjugate Vaccine (TCV) — Typbar TCV: Recommended from 9 months of age. Single dose, licensed for children from 9 months. Preferred vaccine due to long-lasting immunity.
• Polysaccharide vaccine (Typherix/Typhim Vi): From 2 years, requires repeat every 3 years

"Safe drinking water and good hand hygiene are the most powerful tools against typhoid. Until infrastructure guarantees this for everyone, vaccination provides crucial individual protection."

Dr. Sushma B provides typhoid management and vaccination counselling at Sri Anand Child and Neuro Center, Chanda Nagar. Call +91 90633 66983.