XDR typhoid cases on the rise in Pakistan

ISLAMABAD: Following Karachi, a large number of XDR typhoid cases among adults and children are being reported at Pakistan Institute of Medical Sciences (PIMS) Islamabad from different areas of the federal capital as well as Rawalpindi, various cities of Khyber Pakhtunkhwa (KP) and even from Kashmir, officials said on Monday.

“We are seeing a large number of Extensively Drug Resistant (XDR) Typhoid cases at the Infectious Diseases Department of PIMS on daily basis. They include both adults and children. Of the 10 typhoid cases, 6-7 cases of the hard-to-treat XDR typhoid”, Dr. Nasim Akhtar, head of infectious diseases at PIMS Islamabad told The News. Experts in Karachi had earlier warned of a spike in XDR typhoid cases, particularly among children in the mega city as well as some other cities of Sindh including Hyderabad and Mirpurkhas, saying with the increase in temperature, they were expecting a further rise in the XDR typhoid cases.

But in Islamabad, cases of XDR typhoid were not only being reported from the capital Islamabad but also from Rawalpindi and other cities of Punjab, different cities of KP and even from Kashmir, Prof. Nasim Akhtar said, adding that mostly children were being found infected with the infectious disease.Prof. Akhtar maintained that XDR typhoid can only be treated with a few injectable antibiotic medicines, which are very expensive so the best option is to take precautionary measures which include drinking clean water and eating fresh and hygienic food.

“The complete course of injectable antibiotics for the treatment of XDR typhoid costs over Rs150,000. So, the best option is prevention, which is possible by drinking clean water and eating fresh, hygienic food”, Prof. Nasim Akhtar said.

She informed that uncontrolled use of antibiotic medicines, especially third-generation cephalosporins developed resistance in the bacteria against these antibiotics and deplored that excessive use of Azithromycin, effective for uncomplicated typhoid fever (bacteremia without secondary complications), could also become ineffective if its usage was not regulated and controlled. According to Center for Disease Control and Prevention (CDC) Atlanta, US In 2016, a large outbreak of XDR Salmonella Typhi infections began in Sindh province, Pakistan, and spread throughout the country.

The typhoid fever, caused by the strains (kinds) of Salmonella Typhi, does not respond to most antibiotics used to treat typhoid fever, officials said, adding that the disease has caused deaths of several people including children. According to a recent study by team of Pakistani and US researchers published in the American Journal of Tropical Medicine and Hygiene, genomic analysis of XDR typhoid isolates in Pakistan revealed that numerous XDR variants were circulating in the country.

More than 15,000 cases of XDR typhoid have been reported in Pakistan since 2016, authors of the study said, adding that XDR strains have also been identified in Southeast Asia and eastern and southern Africa, and have been introduced into the United Kingdom, Canada, and the United States by the travellers. Given the continued spread of XDR typhoid and the associated genomic diversity, experts say countries need to take steps to reduce the burden of typhoid, which is transmitted by contaminated food and water and person-to-person contact and tends to spread in areas with poor sanitation. Among the steps they recommend are improving vaccination rates and the quality of drinking water and promoting good hygiene.