The World Health Organization is reporting a Typhoid Fever Outbreak in Pakistan,

Typhoid fever – Islamic Republic of Pakistan

27 December 2018

  • Pakistan Health Authorities have reported an ongoing outbreak of extensively drug resistant (XDR) typhoid fever (WHO, 2018)
  • An increasing trend of typhoid fever cases caused by antimicrobial resistant (AMR) strains of Salmonella enterica serovar Typhi (or S. Typhi) poses a notable public health concern (WHO, 2018)
  • The circulating XDR strain of S. Typhi haplotype 58 was resistant to first and second-line antibiotics as well as third generation cephalosporins (WHO, 2018)


WHO risk assessment

  • The risk of XDR S. Typhi at the national level is considered high in Pakistan due to insufficient water, poor sanitation and hygiene (WASH) practices, low vaccination coverage and limited surveillance for typhoid fever
  • The risk at regional level is considered moderate due to the similar environments and approaches to treatment of typhoid fever, as well as the widespread over-use of anti-microbials which is compounded by considerable levels of migration within the region
  • Globally, the risk is considered low due to the availability of antimicrobials and rational prescribing practices. However, S. Typhi has a global distribution and the potential for travelers to spread this resistant clone, especially in countries with poor WASH infrastructure, cannot be eliminated. The high level of resistance to traditional first-line antibiotics in the H58 clonal strain identified to be circulating in parts of Pakistan increases the potential risk at all three levels (WHO, 2018)


WHO Recommendations

  • WHO recommends typhoid vaccination in response to confirmed outbreaks of typhoid fever, and travelers to typhoid-endemic areas should consider vaccination. Further, where the TCV is licensed, WHO recommends TCV as the preferred typhoid vaccine. Typhoid vaccination should be implemented in combination with other efforts to control the disease
  • Currently, azithromycin is the only remaining reliable and affordable first-line oral therapeutic option to manage patients with XDR typhoid in low-resource settings


What is Typhoid?

  • Typhoid fever is a life-threatening illness caused by the bacterium Salmonella Typhi. Typhoid fever is not common in the United States, Canada, Western Europe, Australia, or Japan, but it is common in many other countries (CDC, 2018)


How are typhoid fever and paratyphoid fever spread?

  • People who are actively ill with typhoid fever or paratyphoid fever and people who are carriers of Salmonella Typhi or Salmonella Paratyphi bacteria can both spread the bacteria to other people. Carriers are people who have recovered from typhoid fever or paratyphoid fever but continue to carry the bacteria. About 1 in 20 people remain carriers after they’ve recovered. Both groups of people shed (excrete) Salmonella Typhi or Salmonella Paratyphi in their feces (CDC, 2018)
  • Typhoid fever and paratyphoid fever are more common in areas of the world where water is more likely to be contaminated with sewage (CDC, 2018)


You can get typhoid fever or paratyphoid fever if

  • You eat food or drink a beverage that has been touched by a person who is shedding Salmonella Typhi or Salmonella Paratyphi and who has not washed their hands thoroughly after going to the bathroom
  • Sewage contaminated with Salmonella Typhi or Salmonella Paratyphi gets into water you drink
  • Sewage contaminated with Salmonella Typhi or Salmonella Paratyphi gets into water used to rinse food you eat raw (CDC, 2018)


Can typhoid fever and paratyphoid fever be prevented?

Yes. Typhoid fever and paratyphoid fever can be prevented. If you are planning to travel outside the United States, you should

  • Get vaccinated against typhoid fever (there is no vaccine against paratyphoid fever)
  • Find out how to avoid getting sick from food and drinks (CDC, 2018)


WHO website,


CDC website,