XDR typhoid emerging from Pakistan is becoming global health challenge

An outbreak of extensively drug-resistant (XDR) typhoid in Sindh, including Karachi, is rapidly getting out of control, as over a dozen deaths have been reported from different parts of the province at the hands of the superbug that is resistant to most known antibiotics.

However, Dr Zafar Mehdi of the Sindh Health Department told The News on Wednesday that only four people — three children and an elderly person — have died due to XDR typhoid in the province since its outbreak was reported from Hyderabad in November 2016.

“We are taking all the measures to contain this outbreak, and in this regard international health bodies, including the World Health Organisation (WHO), are also on board.” Typhoid fever is a serious water-borne infection caused by the bacterium Salmonella Typhi that spreads through contaminated food and water. High-grade fever, weakness, stomach pain, nausea, vomiting, headache, cough and loss of appetite are some of the symptoms.

Some people may also experience diarrhoea or constipation. In rare cases typhoid fever can be fatal. Its treatment with antibiotics is essential. Vaccination helps protect people from contracting typhoid fever.

‘Over a dozen dead’

Experts associated with local health care facilities and international health agencies have claimed that over a dozen deaths have occurred in Sindh, including Karachi, mainly due to the inexperience of doctors treating the disease.

The experts said that the doctors did not know that the typhoid they were dealing with was resistant to most antibiotics traditionally prescribed for the treatment of water-borne diseases. “Daily dozens of typhoid cases, especially of school-going children, are reported from different parts of Karachi as well as its adjoining areas,” claimed a doctor associated with a leading private hospital in the city.

“In most cases, the patients do not respond to third-generation cephalosporins, which were the drugs of choice before the outbreak of XDR typhoid in Sindh.” He said that majority of the XDR typhoid patients are children who contracted the disease from their schools, where unchlorinated water is supplied by the institutions’ administrations, or by eating contaminated food sold by pushcart vendors, who use sewage-mixed tap water to prepare their products.

High alert

Sindh’s health officials have said that major international health bodies, including the WHO and the Centres for Disease Control and Prevention, are on high alert following the outbreak of the deadly disease.

The authorities said that the international bodies have started issuing unofficial travel advisories to people to either refrain from travelling to Pakistan, especially to Sindh, or take extraordinary precautionary measures for having safe food and water.

“XDR typhoid cases have surpassed the 8,000 figure, with most cases being reported from Karachi, followed by Hyderabad, Sanghar and the adjoining districts,” said Dr Mehdi.

“The Sindh Health Department is under tremendous pressure from the federal health authorities and the international health bodies, as XDR typhoid cases are being reported in the United Kingdom and the United States among travellers returning from Pakistan.”

WHO’s support

Acknowledging that XDR typhoid is spreading rapidly in Sindh, especially in Karachi, WHO representatives in the province said that they are keeping in touch with the health department and providing them with technical and material support to contain the outbreak, even though cases of the drug-resistant strain are being reported from the entire country.

“A national action plan has been formulated with the focus on Sindh, from where most of the XDR typhoid cases are being reported,” said Dr Sara Salman, a WHO representative in Sindh. “Being a technical body, the WHO is providing technical support, which includes trainings to contain this outbreak as quickly as possible.”

To a question regarding the absence of diagnostic facilities in Sindh’s public sector, she said that a private health facility, namely the Aga Khan University Hospital, had first identified and reported this outbreak, and now a public-private partnership has developed in the province to control and contain this disease by pooling all the resources at hand.

Availability of drugs

To ensure the availability of two major drugs that are required to treat XDR typhoid, the authorities have issued relevant orders to local and multinational pharmaceutical companies, suppliers and associations of chemists in the province so that the drugs are available in the market and hospitals.

“The provincial drug administration has written to all the pharmaceutical companies, pharmacies and suppliers to ensure the availability of the two major antibiotics, as cases of XDR typhoid are on the rise and they are not responding to third-generation cephalosporins,” said Sindh Chief Drug Inspector Adnan Rizvi.