• Number of patients may rise as weather gets warmer in coming weeks
• Experts say infection spreads through contaminated water or food

KARACHI: Cases of drug-resistant (XDR) typhoid, particularly among children, are on the rise in the metropolis and health experts warn of a further spike in the days to come, it emerged on Friday.

Currently, a number of cases of XDR typhoid are being reported at different healthcare facilities in the city on a monthly basis.

In 2019-20, an outbreak of XDR typhoid was reported in Sindh that affected hundreds and thousands of patients in Hyderabad, Karachi and other districts.

More than 200,000 cases of typhoid were reported in Sindh, including Karachi, in 2022.

The experts said as weather gets warmer in the coming weeks these cases might see a further spike.

“At the National Institute of Child Health (NICH), we have been seeing a rising trend in typhoid cases over the past two months. Most patients reporting with prolonged fever, diarrhoea, vomiting and abdominal pain, are being diagnosed with [dangerous] extensively-drug resistant (XDR) typhoid,” deputy director of NICH Dr Liaquat Ali Halo told Dawn.

According to him, the infection is usually spread through contaminated water or food and children are more vulnerable to the disease due to their low immunity levels.

“Besides, they eat food items being sold by street vendors who have no concept of health and hygiene,” he said.

About the treatment, he said it’s costly and painful in the case of drug-resistant typhoid.

“It’s a 14-day therapy during which a patient is administered with injections thrice a day, depending upon the body weight of the patient,” he said.

Efforts needed to tackle vaccine hesitancy

The experts also underscored the need for concerted efforts by the government to tackle vaccine hesitancy and increase routine immunisation coverage.

Dr Wasim Jamalvi of the Pakistan Paediatric Association (PPA) said the cases (of typhoid fever, drug-resistant typhoid and extensively-drug resistant typhoid) were rising, though their numbers were less as compared to those reported in 2019 and 2020.

“This is so because a lot of parents had opted for getting their children vaccinated against the disease after that outbreak.

“Unfortunately, however, the numbers of children getting vaccinated against the life-threatening infection is still too low despite the fact that the vaccine for typhoid is free and part of the routine immunisation programme,” he said.

Vaccine hesitancy, he pointed out, was a major barrier to increasing routine immunisation coverage.

“It’s very effective [against all forms of typhoid] and free. But, we don’t see encouraging trends for routine immunisation coverage,” he said, emphasising the need for concerted efforts to shatter the myths surrounding vaccines.

Asked about the current prevalence of typhoid in the adult population, Dr Abdul Ghafoor Shoro, senior general practitioner representing the Pakistan Medical Association, said their numbers weren’t worrisome right now. “But, people, especially the poor labourers working in the streets, are likely to get affected more in coming weeks when the weather gets warmer.”

In this respect, he said, the government’s failure to supply safe and clean drinking water to its citizenry posed the biggest threat.

“People, especially the poor, have no option but to risk their lives. The water they get through government lines is contaminated but they can’t afford to boil it.

“Sky-rocketing inflation has left the poor with barely any money to spend on transport that he needs to reach a hospital for getting vaccinated against typhoid,” he said, adding that this vaccine was only available at tertiary care hospitals.

He suggested linking routine immunisation programme with anti-polio campaigns.

According to experts, there are several ways to counter the threat posed by all variants of typhoid. Many of these are long term, such as improving health and sanitation facilities, as well as providing clean drinking water. But to tackle the disease immediately, it has been proposed that children under 15 be vaccinated against typhoid.

Moreover, they suggest that in order to contain the XDR strain, firm steps must be taken to curb the rampant overuse of antibiotics in the country.

Published in Dawn, May 20th, 2023