With 13,727 XDR typhoid cases reported, Sindh plans to reach 10.1m children

Following the emergence of 95 per cent of all the typhoid cases as XDR (Extensively Drug Resistant) Typhoid in Sindh, health officials in the province have decided to vaccinate around 10.1 million children against the lethal, waterborne disease for which millions of vials of Typhoid Conjugated Vaccine (TCV) are being imported from an Indian Biotechnology firm, officials said on Friday.

“With the help of GAVI Alliance and Unicef, we have imported millions of vials of Typhoid Conjugated Vaccine from an Indian Biotechnology firm, Bharat Biotech, which produces clinically proven and effective vaccine against typhoid in the world,” an official of the Sindh health department told The News on Friday.

Health department officials said the decision to import the Indian vaccine was taken after XDR Typhoid cases reached the figure of 13,727 since it was first reported in 2016, saying now every second child in Karachi and Hyderabad was affected with the XDR typhoid, which was resistant to third generation antibiotics.

“This year, 8,241 children have tested positive for XDR Typhoid since January 1 till November 4, of which 5,839 cases have been reported from Karachi alone, while 1,491 cases have been reported from Hyderabad,” the officials said, adding that 911 cases of the drug-resistant microbial disease were reported from the remaining districts of Sindh.

According to officials of the Centre for Disease Control and Prevention (CDC) United States, Pakistan is facing an ongoing outbreak of extensively drug-resistant (XDR) typhoid fever that began in Hyderabad in November 2016.

The strain of Salmonella Typhi does not respond to most antibiotics used to treat typhoid fever. The outbreak has spread to other provinces, and several deaths have been reported. XDR typhoid associated with travel to Pakistan has been reported in the United States, Canada, the United Kingdom, Denmark, and Australia, CDC officials said.

Health experts say the XDR strain of Salmonella Typhi is resistant to most antibiotics (ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, ciprofloxacin, and ceftriaxone) used to treat typhoid fever. At the moment, they say, only two antibiotics, including Azithromycin and Carbapenems, are effective against the XDR typhoid, which are extremely costly and last line of treatment.

Prof Jamal Raza, the director of the National Institute of Child (NICH) Karachi, said XDR typhoid was emerging as a serious threat to public health in Sindh and people should get their children vaccinated against it from November 18 when a mass immunisation campaign would be launched in the province.

“This year, we had 887 children tested positive for XDR typhoid till October 2019, of which 830 were cases of extensively drug resistant typhoid while only 57 were of the strain that was responding to the third generation or prevailing class of antibiotic medicines,” Prof Raza said and urged the parents to vaccinate their children against XDR typhoid from November 18 to 30, 2019.

He said children aging between nine months and 15 years would be vaccinated against XDR typhoid during this period.