Typhoid and Paratyphoid in Grand Rapids, Michigan

Typhoid and paratyphoid (also called typhoid and paratyphoid fever) are serious bacterial infections that affect the intestinal tract and bloodstream. They are caused by:

  • Typhoid: Salmonella enterica serotype Typhi (often called Salmonella typhi)
  • Paratyphoid: Salmonella paratyphi (types A, B or C)

These infections are rare in the United States and in Grand Rapids, MI, but they are common in many parts of the world with unsafe drinking water and poor sanitation.

Areas with higher rates of typhoid and paratyphoid include:

  • India, Pakistan, Bangladesh
  • Many countries in Southeast Asia
  • Parts of the Southwest Pacific (including Papua New Guinea)
  • Central and South America
  • The Caribbean
  • Many African countries
  • Some countries in the Middle East

Most people diagnosed with typhoid or paratyphoid in the U.S. — including West Michigan — were infected while travelling overseas.

How Typhoid and Paratyphoid Spread

The bacteria that cause typhoid and paratyphoid are mainly carried by humans (and rarely domestic animals). The bacteria live in:

  • Feces (stool)
  • Sometimes urine of infected people

Transmission happens when:

  • An infected person does not wash their hands properly after using the bathroom and then:
    • Touches food that others eat
    • Touches surfaces (doorknobs, counters, utensils) that others then touch
  • A caregiver changes the diaper of an infected infant and does not wash hands well
  • Water sources become contaminated with infected feces and are used for:
    • Drinking
    • Making ice
    • Washing fruits and vegetables
    • Cooking

In many countries where typhoid is common, drinking water and irrigation water can be contaminated with sewage. This is why food and water safety is critical for travelers from Grand Rapids.

Carriers of Typhoid and Paratyphoid

Without proper treatment:

  • About 1 in 20 people who recover from typhoid become a “carrier”.
  • Carriers:
    • Have no symptoms
    • Still have bacteria in their stool and sometimes urine
    • Can spread infection to others for about 3 months, and sometimes up to 1 year
    • About 2–5% of carriers may remain permanently infectious

People who recover from paratyphoid can also become carriers, but this is less common.

Incubation Period (Time from Exposure to Symptoms)

  • Typhoid: usually 7–14 days, but can range from 3–60 days
  • Paratyphoid: usually 1–10 days

This means you could return home to Grand Rapids from an overseas trip and develop symptoms days or weeks later.

Who Is at Higher Risk in Grand Rapids, MI?

While local transmission in Grand Rapids is extremely rare, certain groups are at higher risk of catching typhoid or paratyphoid while travelling:

  • People travelling from Michigan to areas where typhoid and paratyphoid are common
  • People returning to their country of birth to visit friends and relatives (“VFR” travelers)
  • Children, especially young children, who are often at higher risk of infection than adults
  • Anyone who has close contact with a person infected with typhoid or paratyphoid

People who have been vaccinated against typhoid are at lower risk, but:

  • Typhoid vaccines are not 100% effective
  • About 20–50% of vaccinated people may still get typhoid if heavily exposed

Symptoms of Typhoid and Paratyphoid Fever

Symptoms can range from mild to severe and may develop slowly over 3–4 days. Without treatment, illness often lasts about 4 weeks, and complications usually occur in weeks 2–3.

Common symptoms include:

  • Fever, often high and persistent
  • Fatigue or tiredness
  • Malaise (general feeling of being unwell)
  • Headache
  • Sore throat
  • Persistent cough
  • Slower than usual heart rate (relative to the fever)
  • Sweating
  • Nausea (feeling sick)
  • Abdominal pain or cramping
  • Changes in bowel habits:
    • Constipation
    • Or diarrhea
  • Loss of appetite and weight loss
  • Reddish skin rash (“rose spots”) on the chest and stomach
  • Enlarged liver (hepatomegaly)
  • Enlarged spleen (splenomegaly)
  • Mental changes, such as confusion or irritability

In severe cases, there may also be:

  • Blood poisoning (sepsis)
  • Meningitis (inflammation of the membranes around the brain and spinal cord)
  • Inflammation of other organs, such as:
    • The heart (myocarditis)
    • The pancreas (pancreatitis)

Compared with typhoid, paratyphoid generally has:

  • Similar but milder symptoms
  • Faster recovery time
  • Fewer complications

Serious Complications

Without prompt medical treatment, typhoid and paratyphoid can be life-threatening. Possible complications include:

  • Intestinal hemorrhage (bleeding from the intestine)
    • Signs can include:
      • Sudden drop in blood pressure
      • Blood in the stool
  • Intestinal perforation (a hole in the intestine)
    • Intestinal contents and blood leak into the abdominal cavity
    • Can cause severe infection of the abdomen (peritonitis)
  • Lung infections such as pneumonia
  • Kidney infection
  • Bladder infection
  • Spinal infections
  • Sepsis (bloodstream infection)

Anyone in Grand Rapids who has recently travelled overseas and develops fever plus abdominal symptoms should seek medical care immediately.

How Typhoid and Paratyphoid Are Diagnosed

In Grand Rapids, typhoid and paratyphoid are usually diagnosed by:

  • Physical examination
  • Medical history, including:
    • Recent travel (especially to Asia, Africa, Latin America, Caribbean, Middle East)
    • Possible exposure to contaminated food or water
    • Contact with someone known to be infected
  • Laboratory tests:
    • Blood tests (blood cultures)
    • Stool (feces) tests
    • Urine tests
    • In some cases, a bone marrow test (very sensitive for detecting the bacteria)

Local testing can be arranged through:

  • Primary care clinics and urgent care centers in Grand Rapids
  • Major hospital systems such as Corewell Health (formerly Spectrum Health), Trinity Health Grand Rapids, Metro Health – University of Michigan Health, and Mercy Health

Treatment of Typhoid and Paratyphoid in Grand Rapids

Without prompt treatment, typhoid and paratyphoid fevers can be fatal.

Treatment usually includes:

  • Hospitalization (in moderate to severe cases)
    • Especially if there is high fever, dehydration, or concern for complications
    • Patients may need specialized and supportive care for a few days
  • Antibiotics
    • To kill the bacteria
    • Reduce the risk of complications
    • Shorten the length and severity of illness
  • Plenty of fluids
    • To prevent or treat dehydration from fever and diarrhea
    • May include oral fluids or IV fluids in the hospital
  • Fever control
    • Medications like acetaminophen may be used, as directed by a physician

In Grand Rapids, treatment is typically provided through:

  • Your primary care provider
  • Infectious disease specialists at hospitals such as Corewell Health or Trinity Health Grand Rapids
  • Emergency departments for severe cases

About 5–10% of people can relapse (get sick again) about 2–3 weeks after they appear to have recovered. Follow-up with your doctor is important.

When You Are Infectious

If you have typhoid or paratyphoid:

  • You are considered infectious until:
    • All of your symptoms have resolved, and
    • You have been well for at least 24 hours
  • You may need follow-up stool tests to confirm that you are no longer shedding the bacteria

Your doctor and Kent County Health Department may provide specific guidance, including work or school restrictions.

How to Avoid Spreading Typhoid and Paratyphoid

While you are infectious:

  • Do NOT go to work, school, or childcare until cleared by your healthcare provider and public health authorities.
  • Do NOT handle or prepare food for others in your household or workplace.
  • Avoid sharing:
    • Towels
    • Eating utensils
    • Cups, water bottles, or food
  • Wash your hands thoroughly with soap and water:
    • After using the toilet
    • After changing diapers
    • Before preparing food
    • Before eating
  • Use alcohol-based hand sanitizer if soap and clean water are not available, but use soap and water whenever possible.

Children with typhoid or paratyphoid should be kept out of school and childcare until they are cleared to return, in coordination with their doctor and public health officials.

Prevention: How Grand Rapids Travelers Can Reduce Risk

Because typhoid and paratyphoid are usually travel-related for people in Grand Rapids, prevention focuses on:

  • Vaccination (for typhoid)
  • Safe food and water practices while abroad
  • Good hand hygiene

Typhoid Vaccination

In the United States, including Michigan, three main types of typhoid vaccine are available, plus a combination vaccine that also protects against hepatitis A.

Key points:

  • Typhoid vaccination offers good protection, but is not 100% effective.
  • About 20–50% of vaccinated people may still get typhoid with heavy exposure.
  • There is currently no vaccine for paratyphoid.

Timing:

  • Get vaccinated at least 2 weeks before travel to allow time for protection to build.
  • Protection does not last forever. Ask your doctor or a travel clinic in Grand Rapids if you need a booster before future trips.

Local options for travel vaccines and advice:

  • Primary care offices and family medicine clinics throughout Grand Rapids
  • Travel medicine services at:
    • Corewell Health (Spectrum Health)
    • Trinity Health Grand Rapids
    • Metro Health – University of Michigan Health
  • Kent County Health Department and Grand Rapids Public Health resources may also provide guidance or referrals.

Food and Water Safety While Travelling

Even if you think your destination is safe, disease outbreaks can occur unexpectedly. While travelling in areas with unsafe water or poor sanitation:

  • Avoid street food and food from vendors with poor hygiene.
  • Eat only hot, freshly cooked foods.
  • Avoid:
    • Foods served cold or at room temperature
    • Seafood, especially shellfish
    • Raw fruits or vegetables, including:
      • Fresh salads
      • Fresh fruit juices
    • Raw or runny eggs
    • Unpasteurized milk and dairy products, including some ice cream

Safer options:

  • Fruits and vegetables that can be peeled, and that you peel yourself.
  • Well-cooked foods served hot.

Safe Drinking Water

In many high-risk destinations:

  • Do NOT drink tap water.
  • Do NOT have ice in your drinks, as ice may be made from contaminated water.
  • Drink only:
    • Bottled water with an intact seal
    • Boiled water
    • Properly treated water (e.g., water purification tablets or filters rated for bacteria)

Also:

  • Use bottled or boiled water to brush your teeth.
  • Avoid swallowing water while swimming or showering in areas with poor sanitation.

Hand Hygiene While Travelling

  • Wash your hands with soap and clean water:
    • After using the bathroom
    • Before preparing or eating food
  • Carry a small bottle of alcohol-based hand sanitizer for times when soap and water are not available.
  • Keep your hands away from your face and mouth as much as possible.

Local Context: Typhoid, Paratyphoid, and Grand Rapids Health

Although typhoid and paratyphoid are rare in Grand Rapids:

  • West Michigan residents travel frequently for business, missions, tourism, and to visit family abroad.
  • Returning travelers can bring infections back to Kent County.
  • Cold Michigan winters and indoor crowding increase the spread of other infections (like flu and COVID-19), but typhoid is typically linked to travel and sanitation, not cold weather.

Local public health support:

  • Kent County Health Department and Grand Rapids Public Health monitor reportable diseases, including typhoid.
  • Healthcare professionals in Michigan are required to report cases of typhoid to public health authorities so that contacts can be traced, and further spread prevented.

When to Seek Medical Help in Grand Rapids

Seek medical care immediately if:

  • You have returned to Grand Rapids from a country where typhoid is common in the last 1–4 weeks, and
  • You develop:
    • Persistent fever
    • Abdominal pain or cramping
    • Headache, fatigue, or feeling very unwell
    • Diarrhea or constipation
    • Any blood in your stool

Where to Get Help

  • Your primary care provider or pediatrician
  • Urgent care clinics in Grand Rapids
  • Emergency department of your nearest hospital if you are very unwell:
    • Corewell Health (Spectrum Health) Butterworth Hospital
    • Trinity Health Grand Rapids
    • Metro Health – University of Michigan Health
    • Mercy Health facilities
  • Call 911 in a medical emergency (severe abdominal pain, confusion, difficulty breathing, signs of shock, or uncontrolled bleeding).

For travel-specific advice:

  • Travel clinics associated with Corewell Health, Trinity Health Grand Rapids, or other local health systems
  • Guidance from Kent County Health Department on vaccines and travel health

Key Points for Grand Rapids Residents

  • Typhoid and paratyphoid are rare in Grand Rapids, MI, but common in many parts of the world with unsafe water and poor sanitation.
  • Water contaminated with infected feces is a major source of infection.
  • Without treatment, about 1 in 20 people who recover from typhoid become carriers and can continue to spread the bacteria.
  • People who recover from paratyphoid can also become carriers, though this is less common.
  • Symptoms usually start gradually over 3–4 days and can last about a month without treatment.
  • Typhoid vaccination lowers risk but is not 100% effective; you still need safe food, water, and hygiene practices when travelling.
  • If you develop fever and digestive symptoms after travel, contact a Grand Rapids healthcare provider right away.