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Pakistan: Outbreak of multi-drug resistant Typhoid in Hyderabad/Karachi

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  • Pakistan: Outbreak of multi-drug resistant Typhoid in Hyderabad/Karachi

    Source: https://www.geo.tv/latest/149448-mul...ggest-outbreak

    Friday Jul 14 2017
    Khawar Khan
    Multi-drug resistance typhoid: Experts warn about 'world?s biggest outbreak'

    KARACHI: More than 250 children have been affected by Multi-drug resistant typhoid (MDR) typhoid in Hyderabad, said Dr Farah Qamar, the Assistant Professor of Pediatric at the Aga Khan University Hospital.

    Qamar, who conducted a survey in different areas of Hyderabad and Karachi, warns that it is ?typhoid at its worst?, adding that the two cities are seeing the biggest outbreak of MDR.

    In Karachi, 15 children have been affected by the outbreak, Dr Qamar added.

    The worst affected areas of Karachi, where an antibiotic-resistant strain of typhoid is circulating, were found to be Lyari, North Karachi, Gulshan-e-Hadeed, Gulistan-e-Jauhar, Malir and Ibrahim Haydri.

    Areas in Hyderabad affected by the outbreak include Bhittai Colony, Qasimabad, Wehdat colony, where the affectees include children under the age of two to five years.

    According to Dr Qamar, the primary reason for the outbreak is un-chlorinated water, contaminated water and poor sanitation and sewerage conditions, which have contributed to an increase in MDR germs in the environment...


  • #2
    Pakistan Is Racing to Combat the World?s First Extensively Drug-Resistant Typhoid Outbreak
    ...

    By Meher Ahmad on March 14, 2018
    ...
    Infectious disease experts say Pakistan is in the grip of the world?s first outbreak of XDR typhoid, and they suspect the country?s abysmal sewage and water systems are the root cause for its spread. In most poor neighborhoods sewage lines do not exist, and where they do they are often faulty or broken, leaving potable water supplies vulnerable to contamination. Open sewage pools in areas throughout Hyderabad, even in the poshest neighborhoods in this sprawling city of six million people.

    The XDR typhoid outbreak has crept across southern Pakistan and reached its largest city, Karachi. At first, government officials hoped it would remain small and burn out on its own. But it soon became clear they would need to launch an extensive vaccination campaign to battle the spread of the mutated strain.

    A new typhoid vaccine, produced in neighboring India, was approved by the World Health Organization last year. It is more effective than its earlier counterparts and only requires a single dose. Health care workers have rushed to bring it to Hyderabad. Last month they kicked off a long-awaited campaign to vaccinate all children under age five in the city?s hardest-hit neighborhoods; the disease most often kills young kids who have not developed immunological defenses against it.

    At the same time, researchers have been racing to understand the biological underpinnings of the XDR typhoid pathogen in the hopes of unraveling how it became so drug-resistant. A team of scientists from A.K.U. and colleagues from the Wellcome Sanger Institute in England have pored over Hyderabad?s typhoid-causing bacterium, and recently reported it developed its ?superbug? powers by picking up DNA from another microbe?likely Escherichia coli. The team mapped cases and found the biggest clusters around the city?s sewage lines. Sadia Shakoor, an A.K.U. microbiology professor and co-author of the study, believes the pathogen likely mutated in those lines and spread when it seeped into the water supply.
    ...
    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
    -Nelson Mandela

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    • #3
      Source: https://www.dawn.com/news/1418058

      US warns Pakistan against outbreak of drug-resistant typhoid fever
      The Newspaper's CorrespondentUpdated July 05, 2018

      WASHINGTON: The United States issued a health warning for Pakistan on Wednesday, alerting people against an ongoing outbreak of ?extensively drug-resistant? typhoid fever that does not respond to most antibiotics.

      In a statement issued in Washington, the US Centres for Disease Control and Prevention (CDC) urged all travellers to ?Pakistan or anywhere else in South Asia? to take extra care with food and water and get a typhoid vaccination.

      The CDC said the level-two alert had been triggered by the observation that several travellers to Pakistan returned to their home countries with the disease...

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      • #4
        Source: https://www.thenews.com.pk/print/347...ing-in-karachi

        Typhoid cases rising in Karachi
        PPI
        July 29, 2018

        KARACHI: Eminent paediatrician, Prof Dr Jamal Raza has revealed that the multi-drug resistant typhoid (MDRT) cases are on the rise in Karachi as well as in Hyderabad city as thousands of children have been infected from the disease in Karachi so far.

        Prof Jamal Raza, who is also President of Pakistan Paediatric Association, Sindh, while talking to PPI, said MDR typhoid outbreak had gripped parts of North Nazimabad, Gulshan-e-Iqbal and its adjoining areas...

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        • #5
          Source: https://nation.com.pk/31-Jan-2019/ty...-water-sa-told



          Typhoid spreading due to contaminated water, SA told
          MUHAMMAD SABIH
          January 31, 2019

          KARACHI - Sindh Minister for Health Dr Azra Fazal Pechuho has said that typhoid has consistently been spreading in the province owing to contaminated water, fearing that the situation could become worst if not controlled.

          Replying queries during question hour in Sindh Assembly, Dr Azra said that water distribution system was very old and not up to the mark as sewerage water gets mixed with drinking water due to which typhoid and other diseases were spreading. She added that Hyderabad and localities of Karachi?Saddar, Lyari and North Karachi? were hit more than other parts of the province...

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          • #6
            Source: https://www.thenews.com.pk/print/428...alth-challenge


            XDR typhoid emerging from Pakistan is becoming global health challenge
            M. Waqar Bhatti
            February 7, 2019

            An outbreak of extensively drug-resistant (XDR) typhoid in Sindh, including Karachi, is rapidly getting out of control, as over a dozen deaths have been reported from different parts of the province at the hands of the superbug that is resistant to most known antibiotics.

            However, Dr Zafar Mehdi of the Sindh Health Department told The News on Wednesday that only four people ? three children and an elderly person ? have died due to XDR typhoid in the province since its outbreak was reported from Hyderabad in November 2016.

            ?We are taking all the measures to contain this outbreak, and in this regard international health bodies, including the World Health Organisation (WHO), are also on board.? Typhoid fever is a serious water-borne infection caused by the bacterium Salmonella Typhi that spreads through contaminated food and water. High-grade fever, weakness, stomach pain, nausea, vomiting, headache, cough and loss of appetite are some of the symptoms.

            Some people may also experience diarrhoea or constipation. In rare cases typhoid fever can be fatal. Its treatment with antibiotics is essential. Vaccination helps protect people from contracting typhoid fever.

            ?Over a dozen dead?

            Experts associated with local health care facilities and international health agencies have claimed that over a dozen deaths have occurred in Sindh, including Karachi, mainly due to the inexperience of doctors treating the disease.

            The experts said that the doctors did not know that the typhoid they were dealing with was resistant to most antibiotics traditionally prescribed for the treatment of water-borne diseases. ?Daily dozens of typhoid cases, especially of school-going children, are reported from different parts of Karachi as well as its adjoining areas,? claimed a doctor associated with a leading private hospital in the city.

            ?In most cases, the patients do not respond to third-generation cephalosporins, which were the drugs of choice before the outbreak of XDR typhoid in Sindh.? He said that majority of the XDR typhoid patients are children who contracted the disease from their schools, where unchlorinated water is supplied by the institutions? administrations, or by eating contaminated food sold by pushcart vendors, who use sewage-mixed tap water to prepare their products...

            Comment


            • #7
              Source: https://reliefweb.int/report/pakista...-february-2019

              WHO EMRO Weekly Epidemiological Monitor: Volume 12, Issue 6 (10 February 2019)
              Report from World Health Organization
              Published on 10 Feb 2019


              Current major event

              Knowledge gaps: Multiple drug-resistant typhoid fever in Pakistan

              Cases of multiple drug-resistant Salmonella typhoid (MDR S. Typhi) fever continue to report from Pakistan. Between November 2016 to February 2019, a total of 5 853 MDR typhoid fever cases were reported from different districts of Sindh province. Currently, there are a number of knowledge gaps which is hindering effective control of this out-break.

              Editorial note

              This multidrug resistance type of S. Typhi has been prevalent across South and Southeast Asia and parts of Africa as well. In Pakistan, the district of Hyderabad of Sindh province witnessed the emergence of MDR S. Typhi cases during November 2016. Currently, the outbreak has spread to a total of 19 districts in the province. The most affected district is Karachi which has reported 68% (3 994) of the total reported MDR cases till date (See table)...

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              • #8
                Source: http://outbreaknewstoday.com/cdc-iss...d-fever-49606/


                CDC issues travel alert for Pakistan due to XDR typhoid fever
                by News Desk
                October 5, 2019

                The Centers for Disease Control and Prevention (CDC) issued a travel notice this week for Pakistan due to the ongoing outbreak of extensively drug-resistant (XDR) typhoid fever.

                Health officials in Pakistan have reported an ongoing outbreak of extensively drug-resistant (XDR) typhoid fever that began in Hyderabad in November 2016.

                The strain of Salmonella Typhi does not respond to most antibiotics used to treat typhoid fever. The outbreak has spread to provinces throughout the country, and several deaths have been reported. XDR typhoid associated with travel to Pakistan has been reported in the United States, Canada, the United Kingdom, Denmark, and Australia.

                All travelers to Pakistan are at risk of getting XDR typhoid fever. Those visiting friends or relatives are at a greater risk than tourists or business travelers...

                Comment


                • #9
                  Extensively Drug-Resistant Typhoid Fever in Pakistan



                  Watch - Level 1, Practice Usual Precautions


                  Key Points
                  • There is an ongoing outbreak of extensively drug-resistant (XDR) typhoid fever in Pakistan. Extensively drug-resistant infections do not respond to most antibiotics.
                  • XDR typhoid infections in people with a history of travel to Pakistan have been reported in North America (United States and Canada), Europe (United Kingdom and Denmark), and Australia.
                  • All travelers to Pakistan are at risk of getting XDR typhoid fever. Those visiting friends or relatives are at a greater risk than tourists or business travelers.
                  • If you are going to South Asia, including Pakistan, protect yourself against typhoid infection by getting a typhoid fever vaccination, and take extra care to follow safe food and water guidelines.
                  What is the current situation?


                  Health officials in Pakistan have reported an ongoing outbreak of extensively drug-resistant (XDR) typhoid fever that began in Hyderabad in November 2016. The strain of Salmonella Typhi does not respond to most antibiotics used to treat typhoid fever. The outbreak has spread to provinces throughout the country, and several deaths have been reported. XDR typhoid associated with travel to Pakistan has been reported in the United States, Canada, the United Kingdom, Denmark, and Australia.

                  Public health authorities in Pakistan are identifying possible typhoid fever cases, starting typhoid vaccination campaigns in the most affected areas, and spreading educational messages about proper handwashing and safe food and water practices.

                  In the United States, public health officials have increased efforts to quickly interview and test samples from patients with suspected typhoid fever. What can travelers do to prevent typhoid fever?

                  Get the typhoid vaccine


                  The CDC recommends that all travelers (even short-term travelers) to South Asia, including Pakistan, be vaccinated against typhoid fever before travel. Two typhoid fever vaccines are available in the United States—an oral vaccine and an injectable vaccine. Travelers should take one or the other. The oral vaccine, approved for people 6 years old or older, should be taken as directed, at least 1 week before departure. The injectable vaccine is approved for people 2 years old or older; travelers should receive the injectable vaccine at least 2 weeks before departure. Neither vaccine is 100% effective, so travelers should also practice safe eating and drinking. Practice safe eating and drinking habits


                  Because the bacteria that cause typhoid fever are spread through contaminated food and water, you can reduce your risk of infection in several ways:
                  • Follow safe food and water guidelines.
                  • Wash your hands often, especially before eating.
                  • Avoid eating food prepared by anyone who is sick or has recently been sick.
                  If you get sick during or after travel


                  If you travel abroad and get sick while traveling, seek medical care. If you get sick after returning to the United States, seek medical care and tell your health care provider where and when you traveled. Do not prepare food for other people. Learn more about typhoid fever, how to prevent it, and what to do if you think you have it at CDC’s typhoid fever page for travelers. Information for Health Care Professionals


                  The XDR strain of Salmonella Typhi is resistant to most antibiotics (ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, ciprofloxacin, and ceftriaxone) used to treat typhoid fever. Health care providers should:
                  • Obtain a complete travel history (asking about travel to South Asia, including Pakistan) from patients with suspected typhoid fever.
                  • Collect stool and blood cultures from patients with suspected typhoid fever and request antimicrobial susceptibility testing on isolates.
                  • Be aware that the Pakistan outbreak strain remains susceptible to azithromycin and carbapenems:
                    • Azithromycin is effective for uncomplicated (diarrhea or bacteremia without secondary complications) typhoid fever and should be used to treat patients with suspected uncomplicated typhoid fever who have traveled to Pakistan. When culture and sensitivity results are available, adjust treatment accordingly. Adult azithromycin dosage is usually 1,000 mg orally once, then 500 mg orally daily; OR 1,000 mg orally once daily for at least 5 days. Pediatric azithromycin dose is 20 mg/kg orally once, then 10–20 mg/kg orally once per day (maximum 1,000 mg per day) for at least 5–7 days.
                  • Carbapenems should be used for patients with suspected severe or complicated typhoid fever who have traveled to Pakistan. Severe or complicated typhoid fever could include for example, gastrointestinal complications (such as typhoid-related intestinal perforation, peritonitis, intestinal hemorrhage, hepatitis), neurologic complications (such as typhoid encephalopathy, including altered consciousness, delirium, confusion), or bacteremia with sepsis or shock. When culture and sensitivity results are available, adjust treatment accordingly. Consider getting an infectious diseases consultation for these patients.
                  • Be aware that relapses can occur, often 1–3 weeks after clinical improvement.
                  • Be aware that most (90%) Salmonella Typhi isolates from patients coming from South Asia have decreased susceptibility or resistance to fluoroquinolones, including ciprofloxacin; therefore, fluoroquinolones should not be used as empiric treatment for suspected typhoid fever in patients who have traveled to this area.
                  • Report all cases of confirmed typhoid fever to the appropriate local or state health departments. Clinical laboratories should also submit all Salmonella Typhi isolates to their state or local public health laboratory for submission to the Centers for Disease Control and Prevention.
                  Traveler InformationClinician Information
                  https://wwwnc.cdc.gov/travel/notices...fever-pakistan

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                  • #10
                    Source: https://www.ndtv.com/world-news/paki...-a-dru-2137058

                    Pakistan Grapples With Drug-Resistant Typhoid Outbreak
                    "Typhoid is a nightmare in countries like Pakistan because the hygienic situation is not good," says Muhammad Khalid Shafi-a paediatrician in Karachi.
                    World | Reuters | Updated: November 23, 2019 01:43 IST


                    KARACHI, Pakistan:

                    Early this year Muhammad Haider Sajjad, a thin bespectacled boy of 15, was hospitalised in Karachi, Pakistan's commercial capital.

                    Doctors suspected typhoid, but when the most common antibiotics failed to work, the boy's family began to panic.

                    Sajjad is one of more than 11,000 people, mostly children, to have contracted a drug-resistant strain of the infection in the country since 2016, and which experts say risks spreading internationally.

                    He survived, but hundreds have died, predominantly in the southern province of Sindh.

                    In response Pakistan's government, already battling outbreaks of polio and dengue, has launched a huge foreign-funded vaccination drive that began on Nov 15...

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