The World Health Organization (WHO) has updated its report on the ongoing outbreak of extensively-drug resistant (XDR) typhoid in Sindh province in Pakistan. The outbreak began in November 2016 and since then until December 2018, there have been 5,274 cases of XDR typhoid out of 8,188 cases of typhoid reported within Sindh province. Of these cases:
- 69% were reported in Karachi
- 27% in Hyderabad district
- 4% in other districts of Sindh province
The increasing trend of typhoid fever caused by antimicrobial resistant strains of Salmonella enterica serovar typhi poses a public health concern. The risk of XDR S. typhi at national level is considered high in Pakistan due to insufficient water, poor sanitation and hygiene practices, and low vaccination coverage. Globally, the risk is considered low, although there is potential for travellers from Pakistan to spread disease.
There have been six travel-associated cases of XDR typhoid in travellers:
- one in the UK
- one in Northern Ireland
- four in the USA
The full report, including case definitions, is available on the WHO website.
Advice for travellers
Typhoid is spread by the faecal oral route, therefore precautionary measures should be taken to avoid consumption of potentially contaminated drinks, drinking water and ice and to ensure food is uncontaminated or cooked thoroughly. Personal hygiene when eating and drinking is also important including hand washing prior to eating and using clean plates, cups and utensils.
It is recommended that all travellers to Pakistan should be vaccinated.
Further information and advice is available on the Travax (for health professionals) and fitfortravel (for the general public) websites.