IN a country that can ill afford the outbreak of another preventable disease, multidrug resistant typhoid has spread in many parts of Karachi and certain districts in Hyderabad. To this effect, a study by the Aga Khan University uncovered over 800 cases of drug-resistant typhoid in Hyderabad between 2016 and 2017 — an alarming development since only six cases of drug-resistant typhoid were reported in Pakistan between 2009 and 2014. Possibly at the cusp of another public health crisis, the Sindh health department, in collaboration with AKU and international donor assistance, has launched a four-month emergency vaccination campaign in Hyderabad’s worst-hit areas of Latifabad and Qasimabad. Although typhoid vaccinations are not implemented as routine measure, despite the low price of the vaccine and the high cost of typhoid treatment, vaccination in high-risk areas is a WHO-recommended control strategy. To measure the efficacy of this vaccine, this campaign will vaccinate 250,000 children administering the new Typbar-TCV vaccine. Of concern is the fact that the cases in Hyderabad are the world’s first outbreak of typhoid that is resistant to standard antibiotics such as ceftriaxone used as treatment globally. It is shameful that the authorities failed to pay heed to obvious reasons for the prevalence of typhoid in Sindh, including the lack of potable water, unhygienic food, and unsanitary conditions.

To avoid serious social and economic long-term consequences, it is imperative our health authorities invest resources and expertise in disease-prevention strategies. Improved surveillance for drug-resistant bugs should also help public health officials figure out whether or not the typhoid vaccine should become part of the national immunisation programme and what type of antibiotics can treat local typhoid infections. It is because of overuse of antibiotics over decades that there is an urgent need to use frontline drugs wisely by placing strict controls on ad-hoc prescribing, and ensure diagnostic tests are done for such medicines.

Published in Dawn, February 13th, 2018