A DISEASE that notoriously claimed the life of Queen Victoria’s husband Prince Albert — and may, more recently, have put The Greatest Showman actor Zac Efron in hospital — has hit record levels in Britain.
Typhoid fever may sound like something that belongs in history books, but new research suggests it is rapidly evolving into a 21st-century threat as it becomes increasingly immune to the drugs used to treat it.
Some 702 imported cases of typhoid and paratyphoid fever, deadly bacterial infections that can kill one in five if untreated, were reported in 2024, according to the UK Health Security Agency (UKHSA).
This marks an eight per cent increase from 645 cases the previous year, and the highest ever recorded.
Most new cases were linked to travellers returning to the UK, so health officials are urging Brits to get vaccinated when visiting countries where the disease is rife.
It comes as cases of typhoid have increased worldwide over the last decade, due in large part to the rise of antibiotic-resistance – where bacteria develops the ability to fight the medicine used to treat them because of repeated exposure.
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In South Asia, where the bug is endemic, new strains of typhoid that can resist the strongest available antibiotic have emerged.
A gene capable of breaking down carbapenems, a class of powerful antibiotics seen as a drug of “last resort”, was discovered among 32 samples collected from hospitals across western and southern India.
The discovery, published in Frontiers in Microbiology in December, is the latest in a series of setbacks for efforts to contain the spread of typhoid.
Typhoid is a bacterial illness that, without swift treatment, can lead to fatal complications, such as internal bleeding, brain swelling or ruptured organs.
It is caused by salmonella bacteria, typically spread through food or water contaminated with infected urine or faeces. Paratyphoid fever, a close cousin of typhoid, is caused by a different strain of Salmonella and can be harder to treat.
Most British cases are linked to travel to South Asia, including India, Bangladesh, or Pakistan, which has poor sanitation and limited access to clean water.
Strains resistant to the antibiotic azithromycin, used as a first-line treatment, have also appeared in Bangladesh, India and Nepal.
Extensively drug-resistant typhoid, known as XDR, has been spreading since 2016 in Pakistan.
Dr Malick Gibani, Clinical Lecturer in Infectious Diseases at Imperial College London warned that drug resistant typhoid strains could emerge and establish themselves outside South Asia.
“If historical trends are any guide, XDR strains can emerge in one part of the world and then take hold elsewhere,” said Dr Gibani told The Telegraph.
“The open question is where they might establish themselves.”
Globally, around a fifth of typhoid cases are fatal, though deaths are less common in countries like the UK.
Symptoms of typhoid infection typically appear one to two weeks after exposure.
Early signs include flu-like symptoms such as fever, headache, body aches, fatigue, cough, and constipation.
As the illness progresses, symptoms worsen, with nausea, diarrhoea, and occasionally a pink dotty rash.
At this stage, the risk of life-threatening complications increases significantly.
‘Typhoid Mary’
It’s most infamous carrier, Irish cook Mary Mallon, infected hundreds when she emigrated to the United States in 1884 and settled in New York.
She was detained after unknowingly infecting the American families she cooked for through the food she served them.
It was believed she carried the disease silently, with no symptoms, infecting between 51 and 122 people with the disease – three of which died.
Dubbed “Typhoid Mary,” she spent 26 years in quarantine until her death.
The nickname has since become a term for someone who spreads disease or other misfortune.
While the NHS offers a free typhoid vaccine for travellers to high-risk countries, no vaccine exists for paratyphoid, which is caused by a related but distinct bacteria.
People should visit the Government’s Travel Health Pro website for information on what vaccines or medications tourists may need before travelling to an overseas destination.
This is especially important for pregnant people or those hoping to have one in the near future as they could be at heightened risk.
Though most cases are now imported, typhoid was a serious public health crisis in 1800s Britain, claiming around 16,000 lives annually.
The disease struck people from all walks of life, from overcrowded slums to royal palaces. Prince Albert, Queen Victoria’s husband, succumbed to typhoid fever at just 42 years old.
Though modern analysis suggests his chronic ill health may have been caused by underlying conditions like Crohn’s disease or stomach cancer, which may have contributed to his death.
In 2019, US actor Zac Efron has confirmed he fell ill while filming a survival reality TV show in Papua New Guinea.
At the time, Australian media reported that the now 38-year-old was flown by helicopter for treatment in Australia after contracting a bacterial infection, possibly typhoid, while shooting the Killing Zac Efron series.
How to avoid typhoid fever
TO protect yourself from typhoid, make sure to see your GP or visit the TravelHealthPro website at least eight weeks before travelling to find out if you need a vaccine.
Even if you were born or raised in countries like Pakistan, Bangladesh, or India, or have travelled there before, you may still need a vaccination. The vaccine offers protection for around three years.
As there’s no vaccine for paratyphoid, be cautious with food and drink.
Follow the rule: Boil it, cook it, peel it, or forget it!
Eat only freshly prepared, piping hot food, or fruit you’ve peeled yourself, like bananas or mangoes.
Stick to bottled or cooled boiled water, ensuring bottles are sealed or opt for sparkling water to avoid refills.
Use bottled or boiled water to brush your teeth, and avoid tap water entirely.
Wash your hands regularly with soap and water, especially before eating, drinking, or preparing food, and after using the toilet.
Avoid uncooked foods, including:
- Salads
- Raw or undercooked shellfish
- Buffets (unless dishes are steaming hot)
- Unpasteurised milk and cheese
- Ice cubes
- Tap water
- Ice cream
- Cold desserts in restaurants
- Leftovers
Taking these precautions can significantly reduce your risk of infection.
Source: UKHSA