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Mounting XDR typhoid cases in Karachi, Hyderabad

There is increasing number of ‘extensively-drug resistant’ (XDR) typhoid cases being reported in the Karachi city and public has been told to adopt good hygiene practices, drink boiled water and avoid eating raw food. Experts have called upon the government to initiate efforts for better sanitation and free vaccination campaigns against typhoid, a preventable disease. XDR typhoid has high risk of complications and is difficult to treat. It has become quite common now.

According to sources around 30 cases of this disease reported every week and these stats represent only one hospital. Surveys are under way to collect comprehensive data on the disease from various hospitals in Karachi after it was diagnosed in Hyderabad; the disease had also spread in Karachi. The world’s first outbreak of XDR typhoid was reported in Hyderabad between 2016 and 2017, affecting 800 people. Only six cases of drug-resistant typhoid, however, were reported in Pakistan between 2009 and 2014.

It was observed that on treatment, the disease did not respond to most antibiotics, leaving physicians with only a few costly choices. The treatment gets prolonged, compromising care of other patients, with high relapse rate, though the mortality rate is not high.

Physicians, emphasizes the need for creating public awareness of the disease. People should consume only boiled water, homemade food prepared and cooked in properly cleaned utensils. Food handlers and consumers must follow good hygiene practices, including washing hands after defecation.

A senior infectious diseases expert associated with the The Indus Hospital said drug-resistant typhoid had become a serious challenge and an exercise was under way to collect comprehensive data on XDR typhoid from various public and private sector hospitals in the city.

The disease is not being diagnosed early enough and patients often present complications. The misuse of antibiotics is very common in Pakistan. Physicians should know that every fever was not viral and opt for a blood culture if a fever persisted.

Vaccination provides 60 to 80 percent protection against typhoid depending upon the type of vaccine used. There is the need for testing water in each locality and ensuring supply of safe drinking water. It is unfortunate that preventable disease has taken a serious form. There is a much need to create awareness of misuse of antibiotics and good hygiene practices.

It is hard to know the exact data on such patients as they were often treated in the outpatient departments, generally of public-sector hospitals.

The Pakistan Medical Association (PMA), called upon the government to include typhoid vaccine in the immunization programme and provide it free at all public-sector hospitals. The government is responsible for the health problems people face due to supply of contaminated water and it has to compensate people for that. It is sad that there is no vision or government focus on preventive care that can help reduce health spending.

 

A recent health warning issued by the US Centres for Disease Control and Prevention that urged all travellers to “Pakistan or anywhere else in South Asia” to take extra care with food and water and get typhoid vaccination. It also stated that the level-two alert had been triggered by the observation that several travellers to Pakistan returned to their home countries with drug resistant typhoid fever.

Waterborne diseases claimed life of 250,000 children under the age of five years every year in Pakistan. Around three million people in the country fall ill due to illnesses, such as hepatitis A, hepatitis E and gastroenteritis, all caused by contaminated water and food.

Researchers from Britain’s Wellcome Sanger Institute, who analyzed the genetics of the typhoid strain, found it had mutated and acquired an extra piece of DNA to become resistant to multiple antibiotics.

Typhoid is a highly contagious infection caused by the Salmonella enterica serovar Typhi bacteria. It is contracted by consuming contaminated foods or drinks and symptoms include nausea, fever, abdominal pain and pink spots on the chest.

An outbreak of typhoid fever in Pakistan is being caused by an extensively drug resistant “superbug” strain, a sign that treatment options for the bacterial disease are running out, scientists said. Researchers from Britain’s Wellcome Sanger Institute who analyzed the genetics of the typhoid strain found it had mutated and acquired an extra piece of DNA to become resistant to multiple antibiotics.

Official data on case numbers and deaths are not available, but local media reports say health authorities detected more than 800 cases of drug-resistant typhoid in Hyderabad alone in a 10-month period between 2016 and 2017. The researcher found the bacterial strain causing the outbreak is now resistant to five antibiotics in total, more than seen in any outbreak before.

This outbreak was caused by a multidrug-resistant strain that had gone a step further and acquired an extra piece of DNA encoding additional genes for antibiotic resistance.

Typhoid is a highly contagious infection caused by the Salmonella enterica serovar Typhi bacteria. It is contracted by consuming contaminated foods or drinks and symptoms include nausea, fever, abdominal pain and pink spots on the chest.

A highly drug-resistant strain of typhoid is spreading in Pakistan, killing four and affecting around 850 others. The “extensively drug-resistant” bug was first identified in November 2016 in Hyderabad but has since spread to other parts of the country.

According to the Pakistani National Institute of Health Islamabad four people have died and 858 people have become infected with the resistant strain of the disease. Doctors are worried about the drug-resistant bug’s potential to threaten vast numbers of people in Pakistan and beyond.

In December, the strain was identified in a patient who came to the UK from Pakistan. The patient, who was isolated and treated successfully, was one of around 300 diagnosed with typhoid in the UK every year, the majority of whom are infected in India, Pakistan and Bangladesh.

Antibiotic resistance is a growing problem in lower and middle-income countries such as Pakistan and India, where drugs are poorly regulated and it is easy to buy antibiotics over the counter.

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