Typhoid and hepatitis A in Vietnam: how they spread and what vaccination changes

These two share a route into the body and almost nothing else. Both come in through food and water contaminated by human waste. One is a bacterial illness that builds over a week and can perforate a bowel. The other is a virus that goes for the liver, and then takes its time leaving. Both are preventable by vaccination, which is the main reason to read about them before a trip rather than during one.

What they also share is being misfiled. Travellers who develop either one usually assume food poisoning, because that is the familiar explanation for feeling ill after a meal somewhere unfamiliar. The clue is duration: a fever still climbing on day four or five is not the gastroenteritis you were expecting. Nothing on this page identifies what you have — both need blood tests to confirm.

When either becomes an emergency

Most cases of both illnesses are managed without drama. These are the developments that are not. Ring 115 or go to the nearest hospital emergency department at once:

• Severe abdominal pain with a belly that has become rigid or tender all over — a typhoid bowel perforation presents this way
• Black tarry stools, or blood passed from the bowel
• Confusion, agitation, a flat unresponsive stare, or being difficult to rouse
• Yellow eyes together with drowsiness, confusion, or bruising and bleeding gums — that combination suggests the liver is failing rather than merely inflamed
• Vomiting that has made fluids impossible across a day, with very little urine passed
• A very high fever with shaking chills and a racing pulse
• Any seizure
• Jaundice in a pregnant traveller, which is assessed urgently rather than routinely

Typhoid perforation and acute liver failure are both uncommon and both time-critical. Each is a reason to go in directly rather than to arrange an examination where you are staying.

Typhoid does not behave like food poisoning

Salmonella Typhi takes roughly one to three weeks to make itself felt after it is swallowed, so the meal responsible is long forgotten. Then, instead of the sudden vomiting and cramps of ordinary food poisoning, it builds.

The classic course is a fever that steps up a little each day across a week, a dull persistent headache, aching, profound tiredness, and abdominal discomfort. The bowels often do the opposite of what people expect: constipation is as common as diarrhoea in adults, particularly early. A slow pulse in someone with a high fever is a traditional clue. Appetite goes completely, and some patients develop a faint rash of small pink spots on the trunk that is easy to miss on anything other than pale skin.

Untreated, the second and third weeks are where complications sit — bleeding or perforation of the bowel being the serious ones. Treated, people improve over days. The reason to be seen rather than wait it out is simple. The diagnosis needs a blood culture and the treatment needs choosing, and both get harder the longer it runs.

Why buying antibiotics over the counter backfires here

Pharmacies in Vietnam will sell antibiotics without a prescription, and a traveller with a week-long fever frequently tries a course before seeing anybody. It is an understandable decision with two specific costs.

The first is diagnostic. A blood culture taken after antibiotics have started is far more likely to come back negative, so the illness becomes unprovable precisely when knowing matters. The second is resistance. Typhoid in South and Southeast Asia has developed extensive resistance, and the choice of drug now depends on local patterns and, ideally, on what grows in the culture. A partially treated typhoid can quieten down, relapse, and arrive at hospital later and harder to treat.

So the order that works is: get the blood test, then treat. A fever on its fourth day is worth a consultation and a needle, not a pharmacy counter.

Hepatitis A: the long, dull one

Hepatitis A incubates for two to six weeks. It opens with something that feels like flu without the cough. Fever, exhaustion, aching, nausea, no appetite, and often a distinctive aversion to fatty food and to cigarette smoke in people who smoke. Discomfort under the ribs on the right is common.

Then, in adults, the colour changes: urine darkens to the shade of strong tea, stools go pale, and the whites of the eyes and then the skin turn yellow. Oddly, people often feel somewhat better once the jaundice appears, even while they look far worse.

The thing travellers are least prepared for is the length. The fatigue commonly runs for weeks, sometimes a couple of months, and it can relapse mildly before it finally goes. There is no medicine that shortens the illness, and no antiviral for it. The liver recovers on its own. Management is rest, fluid, food that stays down, and avoiding anything that gives the liver extra work.

Severity rises sharply with age. Young children frequently have it without jaundice or without noticing at all, which is also how adults around them catch it. Adults over about forty, and anyone with existing liver disease, have a harder time, and that group is where the rare severe cases occur.

Alcohol, paracetamol and the recovering liver

Two practical points that come up in every consultation about hepatitis.

Alcohol goes, completely, until liver blood tests have returned to normal — which is often well after the person feels able to go out. This is the part people negotiate about and the part worth not negotiating.

Paracetamol is processed by the liver, which worries patients who have read the label. It is not forbidden in hepatitis, but the safe amount is lower than usual and that is a decision for the clinician looking after you, not for a packet. Mention everything else you are taking as well. Herbal supplements, bodybuilding products and some traditional preparations are a recognised cause of liver injury — the last thing an inflamed liver needs.

The vaccines, and what they actually do

Both illnesses are vaccine-preventable, and this is the sensible part of the conversation.

The hepatitis A vaccine is highly effective, is given as a course rather than a single shot for long-term protection, and the protection it gives lasts years. The typhoid vaccines — an injected one and an oral one — are useful but noticeably less complete, which is the detail travellers mishear. A typhoid vaccination reduces the risk substantially; it does not remove it, so food and water care still matters after one.

Which vaccines you need, in what order, and whether a dose given after you have already arrived is worthwhile, all depend on your age, your history and how long you are staying. That is a travel clinic's job. It belongs in a conversation with a clinician who can see your records. This page deliberately does not set out schedules — a timetable written for nobody in particular is the wrong way to plan an injection. If you are already in Vietnam and unvaccinated, starting is still often worth it for a long stay.

Where the risk actually sits

Both organisms travel the same way, so the precautions overlap, and both are more about the handling than the ingredient.

• Food that has been cooked and is still hot is the safest category. Busy street stalls with high turnover are often a better bet than a lukewarm buffet
• Raw salads, herb plates and anything washed in untreated water carry the realistic risk, and they are everywhere in Vietnamese food
• Shellfish — particularly oysters and clams from estuarine water — concentrate hepatitis A virus and are a classic source
• Fruit you peel yourself is fine. Fruit cut up hours earlier on a tray is a different proposition
• Hands are an underrated route. Soap and water before eating catches the exposures nobody notices

Getting a diagnosis in Vietnam

Both diagnoses are straightforward once someone orders the right test. Typhoid is confirmed by blood culture, which takes days to grow and must be taken before antibiotics to be reliable. Hepatitis A is confirmed by a blood test for IgM antibodies alongside liver enzymes, and the enzyme levels are also what track recovery.

What we can do where you are staying

• Take a proper history of the fever by day, which is what separates a long bacterial illness from a short viral one
• Draw blood at your accommodation and send it to a laboratory, including a culture taken before any antibiotic is given
• Review everything already swallowed, including anything bought at a pharmacy counter, and say frankly what it has done to the picture
• Arrange admission with a referral letter in English if the signs point that way
• Repeat liver blood tests across the following weeks for hepatitis A, since the trend is what matters, and advise on when flying is reasonable
• Provide an itemised invoice and a medical report for a claim, with the dates a policy will ask about

If you take three things from this

A fever that is still climbing after four or five days is not food poisoning and needs a blood test, taken before any antibiotic. Yellow eyes mean liver blood tests and no alcohol for a good while after you feel better. And both illnesses are far easier to vaccinate against beforehand than to sit through here.