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WASHINGTON: The United States issued a health warning for Pakistan on Wednesday, alerting people against an ongoing outbreak of “extensively drug-resistant” typhoid fever that does not respond to most antibiotics.

In a statement issued in Washington, the US Centres for Disease Control and Prevention (CDC) urged all travellers to “Pakistan or anywhere else in South Asia” to take extra care with food and water and get a typhoid vaccination.

The CDC said the level-two alert had been triggered by the observation that several travellers to Pakistan returned to their home countries with the disease.

“All travellers to Pakistan are at risk of getting XDR typhoid fever. Those who are visiting friends or relatives are at higher risk than are tourists and business travellers,” CDC warned.

It also urged travellers to these areas to take extra care to follow safe food and water guidelines. The guidelines include information that can be useful for those living in Pakistan as well.

What is the current situation: The outbreak of XDR typhoid fever began in Hyderabad in November 2016. This strain of Salmonella Typhi does not respond to most antibiotics used to treat typhoid fever.

The outbreak has spread to the city of Karachi and to multiple districts, and several deaths have been reported.

Public health authorities in Pakistan are identifying possible typhoid fever cases, starting typhoid vaccination campaigns in the most affected districts, and spreading educational messages about proper hand-washing and safe food and water practices.

In the United States, public health officials have increased efforts to quickly interview and test samples from patients with suspected typhoid fever.

The guidelines that could be useful for both travellers and citizens of Pakistan: Get the typhoid vaccine: Two typhoid fever vaccines are easily available - an oral vaccine and an injectable vaccine. The oral vaccine can be given to those at least six years old and should be given at least one week before travel. The injectable vaccine can be given to those at least two years old and should be given at least two weeks before travel.

Safe eating and drinking habits: Because the bacteria that cause typhoid fever are spread through contaminated food and water, risk of infection can be reduced in several ways: Wash your hands often, especially before eating; avoid eating food prepared by anyone who is sick or has recently been sick; if you get sick, immediately seek medical care. If you get sick after returning from Pakistan seek medical care and tell your healthcare provider where and when you travelled. Learn more about typhoid fever, how to prevent it, and what to do if you think you have it. The information is available on various health website.

Published in Dawn, July 5th, 2018