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Drug-Resistant Typhoid in Pakistan

10 October 2019

The European Centre for Disease Prevention and Control reports an increase in drug-resistant typhoid imported into Europe (Denmark and the United Kingdom) and also into countries outside Europe (Australia, Canada, Taiwan and USA).

Most recently, Ireland has reported an increase in typhoid in travellers returning from Pakistan: as of 22 September 2019, there have been 12 cases with recent travel to Pakistan and 7 of these were below 15 years of age. Three of these 12 cases were infected with extensively drug-resistant (XDR) Salmonella typhi which is resistant to a number of commonly used antibiotics.

Pakistan has been reporting XDR S. Typhi since 2016. As of August 2019, there have been 10 365 cases in Sindh province, with the Karachi district most affected.

Advice to travellers

  • Vaccination against typhoid should be considered for all travellers to Pakistan.
  • As with all other illnesses spread by the faecal oral route, precautionary measures should be taken to avoid consumption of potentially contaminated drinks, drinking water and ice and to ensure food is uncontaminated or cooked thoroughly.
  • Personal hygiene when eating and drinking is also important including hand washing prior to eating and using clean plates, cups and utensils.

When to consider vaccination

Vaccination should be considered under the following circumstances and is dependent on the individual risk assessment.

  • Vaccination is usually advised for travellers to high risk areas where food and water may be contaminated.
  • Vaccination is sometimes advised for travel to lower risk areas if the individual is:
    • Venturing off the usual tourist routes to visit smaller villages, cities and rural areas where access to adequate sanitation and safe water may be limited.
    • Visiting friends and relatives.
    • Unable to take sufficient care with food and drink, including children.
    • Increased susceptibility to infection or to severe outcome, i.e. travellers with achlorhydria or immunocompromise.
    • Long stay travellers.
  • A previous typhoid illness does not confer reliable immunity and, when indicated, vaccine should still be used.

For more information see Typhoid.