PESHAWAR: Health experts have said that unsanitary conditions, lack of proper waste disposal, contamination of water by sewage, shortage of clean drinking water and public ignorance are main causes of rise in cases of typhoid fever.

“We will go 100 years back when typhoid would kill 40 per cent of the infected people. It used to be the case prior to invention of antibiotic but now despite of so many antibiotics we would be left with no effective antibiotic against the disease,” Prof Mohammad Noor Wazir of Hayatabad Medical Complex told Dawn.

According to him, more than 40 cases have been detected during the last few months only in one ward of the hospital. All the cases have extensively drug resistant (XDR) salmonella isolated from their blood. The superbug is only sensitive to costly antibiotics including Meropenem, Azithromycin and Imipenem.

Salmonella was once easy to treat with simple antibiotics like Septran, Ampicillin and Chloramphenicol. With the passing of time and use of haphazard antibiotics without any prescription by the people themselves, the organism became resistant even to Ceftriaxone and Fluroquinolones. “Now we have reached to a stage that it responds to Meropenem, Imipenem and Azithromycin. The average cost of treating one case with these antibiotics is almost Rs100,000,” said Prof Noor.

Experts call for public health measures to control situation

Physicians at the local hospitals say that they have written several letters to the directorate-general health services to issue directives to the public health section to take concrete steps for controlling the situation. Without public health measures like vaccination, sewage disposal, availability of safe drinking water, public awareness on print electronic and social media and monitoring hotels, restaurants and sellers of cold beverages in the bazaars, the situation can’t be controlled, they add.

It is strange that government has established culture facilities at the public health laboratory in Khyber Medical University Peshawar where there is no patient flow. These facilities should be available at the doorsteps as most of the doctors are sending tests to Shaukat Khanum, which is inconvenient and very expensive.

Prof Khalid Mahmood, a former physician at Lady Reading Hospital, said the ailment was endemic in that part of the globe. He added that treatment of the multi-drug resistant (MDR) typhoid was very expensive and beyond the reach of common people, therefore, the days were not far when patients would be dying of it in a large number.

He said that typhoid bacteria were transmitted through fecal contamination of food stuff or water or sometimes from the typhoid carrier. He said that it was of utmost importance to observe personal hygiene in the form of frequent hand washing with soap (especially after using the toilet), avoid eating uncooked items in bazaars and drinking bottled or post boiling water.

“It is absolutely necessary to discourage the children from eating ice cream and other food stuff from street vendors,” said Prof Khalid. He said that proper disposal of waste was of paramount importance in prevention of infectious diseases.

“In our posh locality of Hayatabad, sewerage water is directly flowing into the canal without prior treatment thereby exposing the downstream population to diseases like cholera, dysentery and typhoid. So it is very important to stop this practice forthwith,” he said.

Prof Amjad Taqweem of Health Net Hospital said the problem of poor hygiene, sanitation and unclean water were rampant in poor overcrowded area. Extended drug resistant strains were common in Asia and were resistant to five classes of antibiotics.

“To prevent it, regular sampling of food and water plus checking restaurant and personal staff for carrier state is important. Without that it is impossible to control the disease. Till government implements it, the best thing is to drink water after boiling and avoid restaurant and hotel foods,” he said.

Prof Amjad said that Centre for Disease Control (CDC), US, had already issued warning to travellers visiting Pakistan. “It is likely that if we do not take it seriously and don’t control the epidemic, the WHO may impose a travel ban on us,” he added.

Published in Dawn,June 17th, 2022