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The World Health Organisation have updated their report on the ongoing outbreak of extensively-drug resistant (XDR) typhoid in Sindh province in Pakistan. The outbreak began in November 2016 and since then until December 2018 there have been 5 274 cases of XDR typhoid out of 8 188 cases of typhoid reported within Sindh province. 69% of cases were reported in Karachi, 27% in Hyderabad district and 4% in other districts of Sindh province.
The increasing trend of typhoid fever caused by antimicrobial resistant strains of Salmonella enterica serovar Typhi poses a public health concern. The risk of XDR S. typhi at national level is considered high in Pakistan due to insufficient water, poor sanitation and hygiene practices and low vaccination coverage. Globally, the risk is considered low, although there is potential for travellers from Pakistan to spread disease.
There have been 6 travel-associated cases of XDR typhoid in travellers: 1 in the UK, 1 in Northern Ireland and 4 in the USA.
The full report, including case definitions, can be found here.
Advice to travellers
Typhoid is spread by the faecal oral route, precautionary measures should therefore be taken to avoid consumption of potentially contaminated drinks, drinking water and ice and to ensure food is uncontaminated or cooked thoroughly.
Personal hygiene when eating and drinking is also important including hand washing prior to eating and using clean plates, cups and utensils.
Vaccination is recommended for all travellers to Pakistan.
For further information see Typhoid.
