KARACHI, Feb 7: Over 200 national and international delegates attending the fifth International Symposium on Typhoid Fever and other Salmonelloses wrapped up their deliberations on Thursday.

They strongly recommended policy shifts to increase public health spending on preventive strategies such as provision of clean water, sanitation and inclusion of typhoid in the national vaccination programmes.

The four-day symposium was organized by the Aga Khan University Hospital in collaboration with the World Health Organization.

At the symposium, leading national and international speakers repeatedly highlighted the need for greater indigenous research into this disease and international collaboration in improving the understanding of the pathogenesis, spread, increasing drug resistance and effective vaccination strategies against typhoid.

For that purpose, it was also suggested that the WHO and other major international funding organizations should place greater emphasis on typhoid research.

In the opening plenary session, Dr Chris Parry from Oxford discussed prevailing treatment strategies for typhoid and talked about increasing drug resistance to typhoid treatment in different parts of the world.

He said that although fluoroquinolones was still a drug of choice in the treatment of typhoid fever, resistance to it was common.

Chairman of the Symposium Organizing Committee, Prof Zulfiqar A. Bhutta, in his presentation on ‘Clinical and therapeutic aspects of typhoid fever in children’ stressed the growing importance of typhoid as a public health problem in Pakistan.

He said that as delay in institution of appropriate therapy could prove fatal or cause severe morbidity in patients with typhoid fever, it was important that facilities for detection, diagnosis and management of typhoid were provided in community- settings to avoid such situations.

He stressed that the capability of a physician to make appropriate decision at the very onset regarding initiation of drug therapy on case-to-case basis was crucial in preventing deaths, complications and relapses due to typhoid fever.

He added that as typhoid was a predominantly paediatric disorder with almost 70 per cent of all proven cases occurring among children, the severity of the disease and rate of hospitalization were also higher among this group of population.

He also stressed that nutrition also played a key role in fighting this disease and grossly malnourished children were at a greater risk of falling prey to disease complications

Citing from a surveillance report of two urban slum dwellings in Karachi conducted by the AKU department of Paediatrics, he said that by using a simple system of screening and decision making, investigators were able to recognise about 75 per cent of typhoid cases and treat 85 per cent of them with the right choice of antibiotics. In a session on diagnosis Dr John Wain from the London Imperial College skimmed through available options for microbiological detection of typhoid and highlighted the need for quality control and more effective culture methods.

Dr Tariq Mehmood from the Jinnah Post-graduate Medical Centre recommended the use of ultrasound technique in diagnosis and monitoring of typhoid patients.

Dr Rumina Hasan of the AKU in her presentation discussed the increasing quinolone-resistance among typhoid isolates in Karachi.