In this article, we will discuss the current situation of Typhoid in Pakistan and propose some recommendations for its prevention and control. Many factors contribute to the widespread nature of the disease in Pakistan, including lack of hygiene, lack of COVID-19 vaccination, and a broken healthcare system.
XDR typhoid strains
XDR typhoid is a new strain of Salmonella Typhi. The XDR typhoid outbreak in Pakistan is the first known outbreak of this strain in the world. Researchers sequenced 87 of the 339 XDR isolates from the Sindh province of Pakistan and the cities of Karachi and Hyderabad. The isolates all belong to the H58 clade of Salmonella Typhi and formed a distinct cluster on a phylogenetic tree. This means that the strains likely came from a single source.
Despite the increasing incidence of this disease in Pakistan, containing it has become extremely difficult. This is due to inadequate sanitation, a collapsing economy, and inadequate access to clean water. In addition, the limited use of antibiotics and the poor health system in the country have hindered effective disease control measures. XDR typhoid strains can be transmitted from person to person, which makes them a significant risk factor for the disease.
In July 2018, WHO and the US CDC mission in Pakistan established an XDR National Taskforce to address the problem. This taskforce is now translating recommendations into a draft national action plan for the country. In addition, updated surveillance tools were shared with provincial health departments in Pakistan on 7 September 2018.
The XDR typhoid outbreak is an emerging issue that requires immediate attention and international collaboration. While local and regional efforts have shown promising results, further progress is needed to contain the epidemic and prevent a return to the pre-antibiotic era.
A recent report found that an antibiotic-resistant typhoid strain is gaining ground in Pakistan. This new strain has the potential to spread throughout the country and replace the native strains. Moreover, there have been six reports of travel-associated transmission to the United States and the United Kingdom. A Canadian case has also been reported.
Pre-appointment restrictions
The increased use of antibiotics for the treatment of typhoid has become a problem in Pakistan. The lack of sanitation and clean water in the country have exacerbated the disease. Furthermore, the preferential use of antibiotics for treating the disease is hampering the provision of appropriate treatment. The socioeconomic disparities have also contributed to the spread of typhoid in the country. Self-medication with antibiotics is also a risk factor in the spread of the disease.
If you suspect that you may have typhoid, visit a doctor immediately. The fever can last for up to two weeks and can be contagious. It is best to see a doctor who specializes in infectious disease or international travel medicine. Specialized doctors will be able to diagnose your condition more quickly and prescribe the appropriate treatment.
The disease is highly contagious and can be transmitted to other people through contaminated water or food. It is usually fatal if treatment is not sought promptly. It can be prevented by vaccination. There are two types of typhoid vaccine: oral and intravenous.
Typhoid vaccine is available in Pakistan. Although there are restrictions and limitations, it is recommended that you get vaccinated before travelling. The vaccine is highly effective and protects against the disease in two out of three cases. If you’re traveling to Pakistan, it’s best to get vaccinated. This vaccine can help prevent typhoid infection, which can be fatal if it isn’t treated.
Gatifloxacin versus chloramphenicol for uncomplicated typhoid fever
Recent reviews have found that azithromycin, a common antibiotic for typhoid fever, is as effective as chloramphenicol against uncomplicated typhoidic fever. The Cochrane review of seven trials involving 773 patients concluded that azithromycin is more effective.
Two widely used treatments are currently recommended by WHO: fluoroquinolone, or a combination of it, and amoxicillin. Both treatments should be used for three to seven days and should render blood cultures negative. Ideally, the antimicrobial drug should have few side effects and low cost. It should also be effective at curing the disease in patients and prevent transmission of the infection to nearby people. This is important because up to 10 percent of untreated typhoid fever patients die.
In isolated strains of S. typhi, the rate of resistance to chloramphenicol is as high as 80%. In contrast, the prevalence of resistance is less than one percent in India and Indonesia. However, studies of large numbers of strains from South Asia found that about 23% of them had resistance to both chloramphenicol and trimethoprim-sulphamethoxazole. Moreover, resistance to both antibiotics differed from country to country. However, most patients with typhoid fever have infections caused by strains susceptible to chloramphenicol.
While typhoid fever continues to be widespread in the region, the number of documented cases is declining. Currently, accurate diagnosis is based on blood culture or bone marrow culture. However, there are a number of limitations to blood culture. For example, it is not sensitive enough for infants or toddlers. Further, bacterial levels must be low and the patient should have received at least one course of antibiotics. In some countries, laboratory facilities are lacking. However, despite these limitations, accurate diagnosis of the disease will result in better management of the disease.
In Pakistan, recent outbreaks of a particularly resistant typhoid strain have raised the alarm. Although the emergence of a new resistant strain in the country is concerning, the emergence of an effective antibacterial treatment for the condition is essential for the overall health of the population. This is especially important in the country with the highest number of people who have poor access to safe water and sanitation.
Vaccination
In Pakistan, typhoid vaccination has helped to reduce the number of cases. However, it has not completely eliminated the XDR type of the disease. XDR accounted for about 60 to 70% of the typhoid cases before the vaccination campaign began. Despite the widespread vaccination campaign, XDR infection rates remain high in the country. In Pakistan, Dr. Farah Qamar, who has studied typhoid for more than a decade, expects the XDR rate to go down once the vaccination campaign is completed. Vaccination will also cut down on the use of antibiotics as the number of typhoid cases decreases.
To increase the acceptance of the vaccine, PATH collaborated with PHC Global in Sindh province to engage with civil society organizations. It organized typhoid “walks” in the community and conducted discussions with teachers, parents, and religious leaders. The team also facilitated media outreach for parents and conducted interviews with local community members. Vaccination teams are now available in schools and other public places throughout Sindh.
The government recently launched a 13-day vaccination campaign to give children the typhoid conjugate vaccine (TCV). The campaign will target children in 22 districts of Sindh province. During the campaign, 2.8 million children will receive a free vaccine jab. Additionally, the government is rebuilding health facilities that were damaged in the recent monsoon.
The Typbar-TCV vaccine has demonstrated efficacy against culture-confirmed and culture-negative S Typhi in children. This vaccine can also reduce the number of S Typhi infections among children, regardless of antimicrobial resistance.
Treatment
Treatment of typhoid in the country is an ongoing challenge and has led to an increasing burden on healthcare. Poor sanitation and water quality are some of the main contributors to the spread of this disease, which is often difficult to contain. Furthermore, socioeconomic disparities and limited access to proper healthcare are limiting the availability of effective treatment. As a result, there is a need for more effective vaccination programs to help reduce the incidence of the disease and to prevent its spread.
Poor sanitation and hygiene practices have resulted in a poor water supply, and more than 20% of Pakistanis live without access to clean water. This contaminated water contains various pathogens and heavy traces of arsenic. It is also laced with a high concentration of bacteria, including Salmonella typhi.
Treatment of typhoid in the country has been compromised by antimicrobial resistance, which makes most first-line antibiotics ineffective. Third-generation cephalosporins have emerged as the main antibiotic of choice. In 2016, a particularly resistant strain of S. typhi was detected in Karachi. This strain was resistant to ceftriaxone and fluoroquinolones. In extreme cases, patients may require intravenous hydration, blood transfusions, and even surgery.
Treatment of typhoid in the country is important due to the endemic nature of the disease and drug-resistant strains of Salmonella Typhi. In this regard, physicians should be knowledgeable about typhoid prevention and treatment and implement strategies to combat the threat.
The ongoing typhoid outbreak in Pakistan is causing concern among healthcare providers and public health officials. The disease is affecting over 11,000 Pakistanis, with the majority of cases occurring in the southern Sindh province. More than 120 people have died from this infection. The outbreak started in 2016 and despite its four-year containment, the virus has not yet completely gone away.
