Extensive drug resistant typhoid is emerging as a global challenge for our country and our general physicians. The World Health Organization (WHO) and the Center for Disease Control and Prevention (CDC) have been on high alert following the outbreaks in Sindh, Hyderabad, Sanghar, Karachi and other areas of Sindh.
This bug is turning deadly—with over a dozen deaths reported, and incidence of over 2000 cases. Sindh’s Health Department is taking measures to control this outbreak, with the help of international bodies like WHO.
Typhoid is caused by a bacterium that spreads through contaminated food and water. Symptoms include stomach pain, nausea, vomiting, and loss of appetite. Of the 16 Asian countries with high typhoid prevalence, residents of Punjab and Sindh are at the highest risk of developing typhoid.
A single case of extensive drug resistant travel associated typhoid case has also emerged in the UK. Multi-drug resistant (MDR) typhoid shows resistance to fluoroquinolones, with sporadic cases of resistance towards other antibiotics like azithromycin and cephalosporins. Such cases were previously seen in parts of Africa and Asia. However, first large scale emergence of resistance to first line drugs—top three: ampicillin, TMP-SMX, chloramphenicol and fluoroquinolones, as well as third generation Cephalosporins—is seen in Sindh.
Causes of typhoid:
According to the World Health Organization, causes of typhoid fever in Pakistan include poor sanitation and hygiene practices, limited surveillance for typhoid and low vaccination coverage. Therefore, the WHO recommends the following: typhoid vaccine in endemic areas, access to clean water and adequate hygiene among the food handlers. Furthermore, surveillance of typhoid fever should be strengthened to monitor known and new resistance.
What is the drug option now?
As of now, Azithromycin remains the reliable and affordable option for oral drug to manage typhoid in low-resistance setting. A new typhoid conjugate vaccine, Typbar—TCV, has been qualified by WHO for use, and is currently in practice by health officials in Sindh.
Other measures regarding typhoid eradication include educating the local people, especially children, about hygiene and clean water. Both public health workers, and non-governmental organizations need to work on promoting hygiene campaigns and vaccination campaigns, and most importantly discouraging irrational use of antibiotics, to prevent antibiotic resistance. Strict typhoid monitoring and surveillance should also be done to identify and treat chronic carriers.
The provincial government of Sindh, has started dealing with water and sanitation issues, and revamping the Jamshoro, and Hyderabad filtration plant. The Supreme Court of Pakistan has ordered inquiry into the mixing of natural water ways with sewage water. Hopefully, the improvement of sanitation facilities will go a long way into eradicating disease.
One of the consequences of this X-drug resistant typhoid, is the travel alert issued by the United States government, following the incidence of resistant typhoid cases in travelers returning from Pakistan. CDC has asked travelers to South Asia, including Pakistan, to take measures to protect themselves from this bug, and get vaccinated against it.
To get a regular check-up and to get surveillance for typhoid, consult a healthcare provider, now. Book an appointment with top general physician in Lahore, Multan and Islamabad through oladoc.com, or call our helpline at 042-3890-0939 for assistance to find the RIGHT professional for your concerns.