Typhoid fever is one of the life threatening illnesses that are caused by bacteria named Salmonella typhi. The mode of transmission of this illness is mostly contaminated food and water.

Pakistan comes under the list of countries where typhoid is endemic. A recent study has been conducted which showed that Pakistan is under attack of extensively drug resistant (XDR) typhoid fever. It is the world’s first outbreak of XDR that Pakistan is experiencing. The CDC has reported that the strain of XDR typhoid in Pakistan is very much strong and shows resistance to most of the antibiotics. XDR typhoid is becoming untreatable and it is the quite alarming situation.

The symptoms often include cough, loss of appetite, diarrhea, fever, stomach pain, weakness and headache. The various reasons for this outbreak includes low health infrastructure, lack of proper hygienic and sanitation conditions. The potential cause of XDR strain is also the misuse of antibiotics.

Reported Cases in Pakistan and Areas Attacked

Extensively drug resistant typhoid fever began as an outbreak in November 2016 from Hyderabad and has become an ongoing outbreak until now. From Hyderabad alone, 800 cases were reported. It has spread to many regions of Pakistan including Karachi. Before this outbreak four of them are known with no transmission capability but outbreak of 2016 depicted strong transmission capability. From 2009 to 2014, six cases were reported all over Pakistan. Up to 3 cases has been reported in resent year 2018 among travelers. Two travelers returning to US and one returning to UK were reported to be affected by XDR typhoid.  According to some studies, in recent year 339 cases has been reported in east of Karachi. According to a microbiologist at Aga Khan University and senior author of microbiology study, she had found XDR strains in 1/3 of her patient’s samples of blood. One of the recent report suggests that about eighty percent patients affected were under the age group of 10 years.  

Precautions and Government Initiatives

The warning alert for travelers has been announced by US CDC (centers for diseases) and prevention, mentioning those who are planning to travel to Pakistan must take precautionary measures including extra care in food and water moreover, to get vaccinated against typhoid.

The drastic outbreak of typhoid in Hyderabad, which results in more than 800 cases of patients affected by typhoid results in an emergency campaign for typhoid in specifically two regions of Hyderabad. The whole campaign was launched by Sindh health department reported by Pakistan Press International (PPI). After the successful awareness of the campaign almost 250,000 children have received doses of the Typbar-TCV vaccine. This is a type of conjugative vaccine which has been recently shortlisted by World Health Organization (WHO).

Various public health authorities in Pakistan are now actively working on this emerging issue by spreading the awareness messages through campaigns and alarming people through educational messages about hygiene, proper washing of hands, safe food and drinking of clean water.

This article is jointly written by Nimra Murtaza, Aqsa Babar and Taiyyaba Noor from Kinnaird College for Women, Lahore, BSc. (Hons) Biotechnology Department.