Hyderabad facing world’s first outbreak of drug-resistant typhoid: AKU

Dozens of children have died in Hyderabad as a result of what has been termed the “world’s first outbreak of drug-resistant typhoid”. The Aga Khan University (AKU) has blamed contaminated water for the lethal disease, but the Sindh Health Department has ruled it out.

Two regions of Hyderabad are in the grip of a drug-resistant strain of typhoid caused by “poor sanitation and contaminated drinking water”, said the AKU in a statement on Tuesday and announced the launch of an emergency vaccination drive to protect children from the lethal disease.

Although no confirmed number of deaths due to the drug-resistant typhoid was provided to the media, the health department and local gastroenterologists said that over a hundred cases of the lethal bacterial disease had been reported to date since November-December 2016, as compared to only six cases across the country between 2009 and 2014.

“Typhoid cases resistant to third-generation antibiotic Ceftriaxone have been reported from different areas of Hyderabad, but so far we’re unable to find its source,” Health Services Sindh Director General Dr Muhammad Akhlaq Khan told The News.

“Children in the age group of 2-10 years are being affected by this type of disease, but so far we don’t have any exact data on the deaths caused by this lethal disease.”

Dr Khan confirmed that the AKU’s researchers and paediatricians had identified the drug-resistant typhoid in Hyderabad, but he said that so far they had not shared the data on the deaths caused by it. He, however, claimed that it was not the contaminated water that was causing the disease.

“It’s not the water-borne typhoid, otherwise the entire population of Hyderabad would’ve suffered from the lethal disease,” he said, adding that the health department, in collaboration with the AKU, was launching a mass immunisation campaign to vaccinate 250,000 children in the district.

But paediatricians and gastroenterologists serving at different public and private hospitals in Hyderabad said typhoid cases were on the rise in the city and resulting in several deaths on a daily basis, deploring that even third-generation antibiotics were not working against the lethal disease.

“Several children have died in front of my eyes during the past few weeks due to typhoid and its related complications, as they didn’t respond to antibiotics available in the market,” said Dr Abbas Tunio, a paediatrician serving at a private clinic in Hyderabad’s Qasimabad area.

Even the AKU’s experts and researchers who detected the drug-resistant typhoid cases during the past 14 months confirmed that the newer type of water-borne disease was not responding to third-generation antibiotic Ceftriaxone, which was a serious cause of concern for them and international health agencies.

“This is the world’s first outbreak of typhoid that is resistant to the antibiotic Ceftriaxone, which is a standard treatment for the disease around the world,” said Dr Farah Qamar, an associate professor at the AKU’s Department of Paediatrics and Child Health.

“Our research has pinpointed the areas of Hyderabad district with the greatest need and shows that children represent the majority of those affected by the disease. We’re glad to partner with the government on this important initiative which would save lives and stop new cases of this preventable disease.”

Around 250,000 children in Latifabad and Qasimabad, the worst-hit talukas in Hyderabad district, will receive doses of the new Typbar TCV vaccine, which is the only solution to preventing cases of this type of typhoid.

Researchers and laboratory staff from the AKU have detected over 800 cases of drug-resistant typhoid in Hyderabad alone in a 10-month period between 2016 and 2017. This is an alarming development since only six cases of drug-resistant typhoid were found in the entire country between 2009 and 2014.

“We recently completed a pilot programme in the affected areas that saw high demand for the vaccine from the community and proved that the vaccine could be safely administered,” said Dr Khan.

“The pilot provided us with valuable insights on how to effectively scale up the campaign and we look forward to working with our private sector partners so that we can reach every child in the affected areas.”

The vaccination drive will be conducted over a three- to four-month period by 15 teams of vaccinators from Hyderabad’s health department. They will be working alongside officials from the district health department, the provincial disease surveillance unit, the district administration and local government officials.

Private partners such as the AKU and staff from the Field Epidemiology & Laboratory Training Programme of the Centres for Disease Control & Prevention will also be part of the emergency campaign.

Doses of the vaccine were purchased through funding from the Bill & Melinda Gates Foundation’s Emergency Response programme after the AKU’s researchers presented data on the outbreak – gathered from its extensive laboratory network in Hyderabad – at an international summit in Uganda in April 2017.

The control and prevention of neglected tropical diseases such as typhoid is a global health priority, with targets under Goal 3 of the Sustainable Development Goals calling for the eradication of such diseases by 2030.

Dr Anita Zaidi, director of vaccine development, surveillance and enteric and diarrhoeal diseases at the Bill & Melinda Gates Foundation, supported global efforts to generate evidence of the efficacy of this vaccine against typhoid fever.

“It is unconscionable that children are still dying by the thousands every year from diseases like typhoid that are completely preventable,” said Dr Anita, an AKU alumnus and former chair of the AKU’s Department of Paediatrics and Child Health.

“We are pleased to support the Sindh government’s initiative as part of our overall strategy to combat typhoid through an integrated approach including access to clean water, improved sanitation and immunisation.”

Researchers from the AKU will be collecting data during the four-month vaccination drive to assess the impact of the typhoid conjugate vaccine in an outbreak setting.

Findings from the study will inform efforts to tackle outbreaks of typhoid in other parts of the world and to investigate if the vaccine should be made part of Pakistan’s national immunisation programme.

Prof Rumina Hasan and Asst Prof Sadia Shakoor of the AKU’s Department of Pathology and Laboratory Medicine and Dr Mohammad Tahir Yousafzai, senior instructor (research) at the Department of Paediatrics and Child Health, were also involved in the research and advocacy efforts to generate evidence on the prevalence of drug-resistant typhoid in Hyderabad.