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February 8, 2018

After Hyderabad, drug-resistant typhoid emerges in Karachi


February 8, 2018

Following two sub-districts of Hyderabad, drug-resistant typhoid in children has emerged in Karachi where cases of patients not responding to antibiotics commonly used to treat the enteric fever have been reported, leading gastroenterologists and paediatricians have told The News.

Cases have been reported from across Karachi where patients, particularly children, are not responding to third-generation antibiotics Cephalosporins, including Cefixime and Ceftriaxone, which are the drugs of choice to deal with typhoid, said eminent paediatrician and former president of the Pakistan Paediatric Association Dr Iqbal Memon on Wednesday.

Aga Khan University (AKU) first reported in January that it was launching a mass vaccination drive in collaboration with Sindh government in Latifabad and Qasimabad areas of Hyderabad where they had recorded the “world’s first outbreak of drug-resistant typhoid”. It said that 250,000 children would be vaccinated in the second largest city of Sindh to prevent them from contracting the lethal disease.

The emergence of drug-resistant illnesses, especially typhoid, is a cause of serious concern among international health associations including WHO, Unicef, the Bill and Melinda Gates Foundation as well as the US government as the disease spreads through contaminated water and food and has the potential to infect thousands of people, especially children and elderly people who have weak immune systems.

Confirming the emergence of drug-resistant typhoid in Karachi, Dr Memon said such cases had not only shown up at his clinic but several other paediatricians and gastroenterologists were also reporting such patients who had typhoid which is not responding to third-generation antibiotics.

According to him, the Sindh health department was aware of the threat in Hyderabad where AKU officials and researchers were vaccinating children against the lethal disease, but now the data of Karachi’s suspected cases was also available with them. He said more accurate cases could only be verified through laboratory tests where the blood and bone marrow of the infected patient is cultured to ascertain if he or she is infected with a drug-resistant strain of Salmonella typhi or not.

To a query, Dr Memon said sewage-mixed water was the main cause of typhoid among people in Karachi but added that people were becoming resistant to third-generation antibiotics because of overuse of antibiotics, which were being prescribed by doctors and consumed by the patients as if they were food.

“Third-generation antibiotics, including Cefixime, are being used as if they are plain water and biscuits. So when a patient requires treatment against any serious illness like typhoid, their body does not respond to the medicine as they have overused it [in the past] without any need,” he said, claiming that these antibiotics were being used even in the case of a simple common cold and cough.

Associate Professor of Gastroenterology at Darul Sehat Hospital Dr Shahid Ahmed said typhoid cases resistant to Cefixime and Ceftriaxone had become quite common where patients were not responding to these drugs for an extended period of time and doctors are compelled to use other drugs to save their lives.

He also spoke out against the excessive antibiotic prescriptions by physicians and use by patients, warning that if the practice continues, the menace of drug-resistant diseases will grip the country and claim thousands of lives.

When contacted, Sindh Health Director General Muhammad Akhlaq Khan said he was aware of the drug-resistant typhoid cases being reported from different areas of Karachi by senior paediatricians and added that he had directed the concerned department in Karachi to investigate the issue and report it to the health department. He said that if it was needed a vaccination drive like the one in Hyderabad would be launched in other parts of the provinces as well

USAID offers help

The United States Agency for International Development (USAID) is partnering with the Government of Sindh on a children’s anti-typhoid campaign by donating 250,000 syringes, News Desk adds.

After the Sindh Department of Health noticed a recent rise in the number of drug-resistant typhoid cases, it reached out to USAID for assistance. The syringes will help immunise over 250,000 children against a drug-resistant strain of typhoid reported in Latifabad and Qasimabad, two sub-districts of Hyderabad, Sindh, said a press release issued by the US Consulate General on Tuesday.

Oghale Oddo, USAID’s acting deputy mission director for Sindh and Balochistan, said, “Our support for the government’s anti-typhoid campaign exemplifies the strength of our ongoing partnership. USAID will continue to support the Government of Sindh in their efforts to institutionalize evidence based care.”

The US government, through USAID, has supported the Sindh government for over five years to save the lives of children by ensuring that they have access to basic health services. Since its inception, USAID has partnered with the Government of Pakistan to save lives, strengthen families and communities, and develop a healthier workforce.

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