Dear Doctor: How common -- and dangerous -- is typhoid fever? I read that a day care center was recently shut down because a student there was sick with it. I thought typhoid was a thing of the past.

Dear Reader: Of the 5,700 cases of typhoid fever reported each year in the United States, the majority -- about 75 percent, according to the federal Centers for Disease Control and Prevention -- are contracted while traveling abroad. That turned out to be the case with the story you're referring to. The day care facility, located in Quincy, Massachusetts, was shut down after a child was diagnosed with the disease. People who had contact with the sick child underwent testing and no other cases of the disease were found. The child who became ill received treatment and recovered.

Typhoid fever is a life-threatening illness caused by Salmonella typhi, a type of bacterium. It's contracted by an estimated 21 million people worldwide each year and kills more than 220,000 of them. Symptoms include nausea, abdominal cramps, fatigue, headache, vomiting, loss of appetite and a dangerously high fever. These are similar to symptoms of the flu, which can sometimes delay an accurate diagnosis in areas where typhoid is not common. What distinguishes the illness, however, is the severity of these symptoms and the length of time for which they persist.

A diagnosis of typhoid fever is suspected when a patient has recently traveled internationally to an area where the disease is common. The diagnosis is confirmed via a sample of stool, urine, blood or bone marrow. The sample is placed in a special medium that allows the bacterium to flourish. The resulting culture is then visualized under a microscope to see whether the bacterium responsible for typhoid is indeed present. A typhoid fever diagnosis may also be confirmed with a test that detects the antibodies the immune system sends out in response to the typhoid bacterium, or a test that identifies typhoid DNA in the blood. The sole treatment for typhoid fever is antibiotics.

Someone is considered to be a typhoid carrier whether or not the bacterium has caused them to become ill. (Not everyone who is a typhoid carrier gets sick.) However, the bacterium is present in the feces, and sometimes the urine, of all carriers. You can contract the disease if you eat food prepared by an infected individual who has not washed his or her hands properly after using the bathroom. It can also be passed along in contaminated water. Before the sanitation infrastructure in the U.S. was built out, including our public sewer and water treatment systems, typhoid fever was widespread. In the decades between 1920 and 1950, when many of the public sanitation utilities we now rely on were built, cases of typhoid fever dropped from 100 cases per 100,000 people, to fewer than two cases per 100,000.

Although there are typhoid vaccines that can help prevent infection, they are not 100 percent effective. For that reason, even when they have been vaccinated, travelers to regions where the disease is common should take precautions. Never drink untreated water, avoid raw or undercooked foods, and be sure to wash hands often.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Readers, this will be my 250th column over the past two years. Writing for you has been a great opportunity, and I thank all of you for the questions you have given me. In trying to convey the best information possible, I have learned a great deal. I have pored through multiple articles in my attempt to glean the truth buried within the scientific evidence and to explain how it applies to our everyday life. Now, however, other duties beckon, and so this is my last article for you. My colleagues, Dr. Eve Glazier and Dr. Elizabeth Ko, will continue writing the column and addressing your medical queries.

I feel both a sense of satisfaction in helping so many people, as well as a great deal of regret that I may not have the frequent opportunity to unearth what remains a wealth of untapped knowledge.

There remains a great deal of confusion and much misinformation about health and disease. Even I cling to notions that may be incorrect and, when confronted with studies that are contrary to my beliefs, I must overcome my hubris and admit when I'm wrong. It would be nice if we could all do that.

In one last salvo, I would like to give you my hope for a healthier society:

-- A healthy society is one that provides access to vegetables, fruits and animal protein and rejects the multiple processed foods and desserts that have flooded our markets.

-- A healthy society is one that decreases pollutants that contaminate the air we breathe and the water we drink.

-- A healthy society should have open spaces for its people to hike, walk, saunter or just sit reading a book or taking time to watch the sun set.

-- A healthy society has compassion for its individual members and a reverence to the Earth that harbors them.

I hope that my efforts have provided insight and guidance about your health, even as I hope that each person can commit to contributing in some way to make our world a better place.

To do that, each of us has to take responsibility for our own health. Succumbing to the plethora of unhealthy foods, drugs, alcohol and tobacco available to us, or using one's nonwork time glued to some form of visual entertainment, will not make a healthy individual. Instead, poor health habits lead to disease, the taking of multiple medications with side effects and the inability to live life fully. Our consumer industries feed off our unhealthy habits and, in concordance, our health care becomes ever more expensive. These choices are up to us.

I'd like to thank my wife and kids for being patient with me while I worked on these articles on the weekends. As for me, my first weekend endeavor will be to clean up my garage. It's a mess. I will continue to write medical articles for UCLA Health and will be promoting my novel, "Beautifully Absurd." And I will continue my work as a primary care physician, where I will continue to learn about medicine and the everyday lives of human existence. Thank you.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I just read that some parts of the medical community may finally be taking the idea of fecal transplants seriously. What are the latest advances? And what's taking so long?

Dear Reader: We think you may be referring to a study about fecal transplants that made quite a few headlines when the results were published in the New England Journal of Medicine in June. Researchers from Norway assessed the efficacy of various treatments on patients with a dangerous and potentially deadly intestinal infection caused by a type of bacteria called Clostridium difficile, also referred to as C. diff. The bacterium causes symptoms that include frequent diarrhea, high fever, nausea and dehydration that can adversely affect heart rate, blood pressure, kidney function and overall health. In the most severe cases, C. diff causes a type of inflammation of the colon that can lead to death.

In the study, 20 patients with C. diff infections were randomly assigned to either undergo standard treatment with antibiotics or to receive a fecal transplant. For those unfamiliar with the concept, that's the process by which specially prepared stool from a healthy individual is transferred into the colon of the sick person. The idea is that the "good" bacteria from the healthy individual will populate the colon of the patient and vanquish the C. diff bacteria. People who donate stool for a fecal transplant undergo extensive testing be sure no pathogens, such as bacteria, fungi, viruses or parasites, get transferred to the recipient.

Of the nine C. diff. patients in the study who received the fecal transplant, five were cured immediately. Five of the 11 patients who received antibiotics were also cured. In this particular study, fecal transplants were shown to be as effective as antibiotics for the treatment of C. diff. In a time of increasing antibiotic resistance, this is an important development. However, the study, with just 20 patients, is too small to use to draw definitive conclusions. The researchers have announced plans to repeat their work with 200 patients in the near future.

As to why progress in the arena of fecal transplants appears to be slow, we think it's a combination of things. Any new approaches in medicine have to undergo comprehensive testing, studies and clinical trials to be sure that they are safe, and to fine-tune the specifics of treatments, dosage and procedures. Compared to how quickly information gets shared these days, the bench-to-bedside process may appear to move at a glacial pace. It's also true that new ideas can face resistance in the medical community. We're thinking of how, in the early 1980s, the idea that peptic ulcers and gastric cancers were caused by certain bacteria was thought to be ludicrous. Two decades later, though, the Australian doctor who came up with the theory, which was eventually proven to be correct, won the Nobel Prize.

At this time, although fecal transplants are permitted by the FDA, they are to be used only when treatment with antibiotics has failed. This new study, despite its small size, may offer a persuasive argument for more extensive research with an eye toward revisiting treatment priorities.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)