PESHAWAR: Health department has issued guidelines to hospitals regarding management of typhoid fever amid calls by laboratory scientists for rapid diagnosis of the ailment to ensure effective and timely treatment with low cost antibiotics to protect patients against developing complications.

Khyber Pakhtunkhwa has recorded a total of 10,070 typhoid fever cases including 51 extensively Drug-Resistant Salmonella Typhi (XDR typhoid) cases in 2024 so far. Last year, the province reported 47,929 cases including 31 XDR typhoid cases.

Issued by the director of public health to all district health officers, medical superintendents and medical teaching institutions on the directives of National Institute of Health Islamabad, the letter said that keeping in view the seasonal trend of XDR typhoid, it was imperative to take necessary measures to limit its transmission through prevention, early detection, using recommended diagnostic tools and prompt treatment.

“It is meant to alert health authorities for timely action and preparedness for prevention and control of typhoid fever including XDR typhoid due to which we want to enlist support of line departments such as water and sanitation, public health engineering, district and local administration for preparedness and response,” it said.

KP records 10,070 cases of infection in the current year

The letter said that lack of access to safe drinking water, inadequate sanitation, poor hygiene practices, low immunisation coverage and limited disease surveillance increased the risk of a higher disease burden, especially during the summer and monsoon seasons that could be prevented.

Typhoid fever is a bacterial infection caused by Salmonella Typhi and Salmonella Paratyphi pathogens. If not treated properly, it may be a life-threatening infection. Any person with a history of fever of at least 38°C for three or more days with symptoms like diarrhoea or constipation, abdominal tenderness and prostration can be subjected to blood, stool or urine culture tests.

“The treatment options for typhoid are becoming more limited. Preventive measures including improved sanitation and vaccination campaigns, raising community awareness regarding hand washing with soap and water after changing baby’s diaper, using toilet and before and after attending patient, handling, cooking and eating are needed,” said the letter.

Vaccination is recommended for all age groups, especially high risk group of people and those, who are exposed to the disease. Typhoid fever vaccines do not provide 100 per cent protection, however, these will reduce severity of the illness.

Laboratory scientists, meanwhile, recommended culture test to prevent complications and treat patients effectively.

“Culture test will show if any of the cheaper and low dose antibiotics are useful. If they are, doctors will prescribe this instead of high dose of fourth generation antibiotics. This will not only reduce resistance to fourth generation antibiotics but will also be cheaper for the patient,” said Dr Yasar Yousafzai, the director of Public Health Reference Laboratory.

According to him, through early diagnosis, health teams can identify source of infection including water, sewerage, soft drink and food. It can help to stop outbreak of the disease. It will reduce the use of antibiotics, leading to less risk of resistance.

“If doctors suspect bacterial infection, they should send a culture (blood culture, throat culture, urine culture) to laboratory. If they suspect viral infection (like Covid-19, flu, dengue) then PCR should be conducted instead of culture. In case of malaria, rapid antigen or blood smear is conducted,” he said.

Dr Yasar said that if a test was conducted, they would know which antibiotics would work and therefore they would not give high dose of any antibiotic to patient.

“Patients will not require expensive but very cheap antibiotics for treatment. Prescribing high dose antibiotics leads to antibiotic resistance due to which drug resistant typhoid is going to become a huge problem in Pakistan,” he said.

Published in Dawn, July 31st, 2024