(4) Prevention. The cholera vaccine consists of 2 injections of 0.5 and
1 ml. intramuscularly or subcutaneously 1-4 weeks apart, then a booster dose of 0.5 ml
is administered every 6 months when cholera is a hazard. Even so, the vaccine offers
only limited protection and has no value in controlling outbreaks. All water, other drinks,
food, and utensils must be boiled or avoided in endemic areas. When high standards of
sanitation and public health exist, there is rarely an outbreak of cholera of any
c. Typhoid Fever.
(1) General. The gram-negative rod Salmonella typhi causes typhoid fever
when it enters the victim's gastrointestinal tract, penetrates the intestinal wall, and
produces lesions and inflammation of the mesenteric lymph nodes, spleen, and small
intestines. The organisms can localize in the kidneys, central nervous system, the gall-
bladder, or the lungs with inflammation. The Salmonella typhi is transmitted by
consumption of food or drink contaminated by food handlers who are healthy carriers.
The chronic carriers with persistent gall-bladder or urinary tract infections are the main
source of most infections.
(2) Signs and symptoms. The onset of typhoid fever is insidious but can be
very abrupt (especially in children) with a sharp rise in temperature with chills. If
untreated, typhoid fever can be divided into three stages: the prodromal stage,
fastigium, and the stage of defervescence.
(a) Prodromal stage. The victim experiences increasing malaise,
headache, sore throat, diarrhea or constipation, abdominal pain, vomiting, and the fever
ascends in stepladder fashion with each day's maximum higher than the preceding day.
(b) Fastigium. The fever stabilizes after 7-10 days, and the victim
becomes quite sick. He is motionless and unresponsive, has half-shut eyes, and
appears wasted and exhausted. He has marked abdominal distention along with "pea
soup" diarrhea or severe constipation.
(c) Stage of defervescence. The victim surviving the fastigium stage
(with its severe toxemia) without complications may show improvements gradually. His
feverish temperature descends to normal in 7-10 days, and he becomes alert. Relapse
may occur as much as 1-2 weeks after the temperature returns to normal, but the
relapse is usually milder than the original illness. There is a possibility of having a
cardiac arrhythmia. In about 10 percent of the patients, rose spots (rounded, rose-
colored spots that blanch on pressure) appear between the 7th and 10th day of illness.
These spots last from 2 to 5 days and then disappear.