Drug-Resistant Typhoid in Pakistan

10 Oct 2019

The European Centre for Disease Prevention and Control reports an increase in drug-resistant typhoid imported into Europe (Denmark and the United Kingdom) and also into countries outside Europe (Australia, Canada, Taiwan and USA).

Most recently, Ireland has reported an increase in typhoid in travellers returning from Pakistan: as of 22 September 2019, there have been 12 cases with recent travel to Pakistan and 7 of these were below 15 years of age. Three of these 12 cases were infected with extensively drug-resistant (XDR) Salmonella typhi which is resistant to a number of commonly used antibiotics.

Pakistan has been reporting XDR S. Typhi since 2016. As of August 2019, there have been 10 365 cases in Sindh province, with the Karachi district most affected.

Advice to travellers

Vaccination against typhoid is usually recommended for travellers to Pakistan.

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.

When to consider vaccination

Vaccination is recommended for travellers to high risk areas where food and water may be contaminated.

Travel to low risk areas - vaccination may be recommended only to those staying in conditions with poor sanitation and unable to maintain their own hygiene precautions e.g. hand hygiene and water purification.

For further information see Typhoid.