Preschoolers, caregivers highly vulnerable to XDR typhoid

ISLAMABAD: Warning preschoolers aged 3-5 are highly vulnerable to typhoid fever, including drug resistant typhoid, the National Institute of Health has underlined the need for limiting the transmission of the life-threatening bacterial infection through preventive measures and early detection and treatment.

In an advisory, the NIH, the country's leading medical research centre, said typhoid fever was endemic in the country, while outbreaks of the Extensively Drug Resistant Salmonella Typhi (XDR S. Typhi) had been reported in different parts of the country since 2016, especially during summer and monsoon seasons. “This XDR S. Typhi is resistant to commonly used antibiotics such as ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, fluoroquinolones and third generation cephalosporins. The XDR S. Typhi is sensitive only to carbapenem (meropenem) and macrolide (azithromycin). In view of the seasonal trend of XDR typhoid, it is important to take necessary measures to limit its transmission through preventive measures, early detection, use of recommended diagnostic tools, and prompt treatment,” it said.

According to the institute, typhoid occurs through feco-oral route and infection spreads through contaminated food, milk, frozen fruits and water or through close contact with the already infected persons.

It warned that preschool children were at greater risk of developing the disease and they usually had milder symptoms than the adults had, while visitors to or those working in endemic areas and caregivers of the patient infected with S. Typhi were also at higher risk.

According to the NIH, since the outbreak of novel coronavirus, health professionals are found to be frequently prescribing azithromycin for both suspected and confirmed COVID-19 cases.

“Such patients may develop resistance against azithromycin due to its overuse leading to resistance strains whose spread will limit out treatment options in XDR typhoid cases. This practice should immediately be addressed and azithromycin should be prescribed carefully for COVlD-19 cases in line with local and international recommendations.”

The NIH said with the treatment options for typhoid becoming more limited, preventive measures, including improved sanitation and vaccination campaigns, were urgently needed.

“The use of azithromycin and meropenem should be restricted and it should given to XDR cases based on prescription by registered medical practitioners. In case of upper and lower respiratory tract infections, other available drug options should be used instead of oral azithromycin, which should be spared for lab-confirmed XDR typhoid cases and other serious medical conditions.”

According to the NIH, thorough washing of hands with soap and water is highly recommended after using toilet, before and after attending patient, before handling, cooking and eating.

The people should drink treated, boiled or bottled water, wash fruits and vegetable properly before eating, use freshly cooked, hot served and homemade food, avoid eating raw fruits or vegetables, market prepared or leftover food, and use pasteurised milk. Visitors to and from endemic areas, high-risk group of people, and those exposed to the infection should be vaccinated.

“Typhoid fever vaccines do not provide 100 per cent protection from typhoid fever. However, they reduce the severity of the illness. Typhoid conjugate vaccine (Typbar—TCV@) is a new conjugate vaccine with longer immunity,” it said. Advocating immediate medical advice for suspected cases, the institute said doctors should avoid unnecessary use of antimicrobial agents to treat patients and prescribe them in light of the results of culture and sensitivity test.

It asked health authorities to involve water and sanitation agencies, public health engineering department and district and local administrations for effective anti-typhoid preparedness and response.