KARACHI: Cases of typhoid are on the rise, particularly among children who are not vaccinated against the bacterial infection. Most of these cases are of extensively drug-resistant typhoid (XDR), emphasising the need for clean drinking water and hygienic living conditions.

“There has been a 50 per cent increase in typhoid cases compared to the situation three months back. I am seeing around 100 to 150 typhoid patients weekly at my clinics that I do in Korangi, FB Area and Keamari,” said Dr Abdul Ghafoor Shoro, a senior general physician, while speaking to this reporter.

A majority of these cases were of XDR typhoid and involved teenagers and children, he added.

According to Dr Shoro, dengue cases are also being reported at healthcare facilities these days. Unfortunately, however, these common diseases are not getting the official attention they deserve.

‘It seems that there is no disease left in the country except the coronavirus’

“It seems that there is no disease left in the country except the coronavirus. Nobody would disagree that it’s a pandemic and national emergency, but you can’t continue to ignore other public health issues,” said Dr Shoro while warning against self-medication that might lead to antibiotic resistance and make XDR typhoid treatment more difficult.

According to experts, a person can test positive for both Covid-19 (a viral infection) and typhoid while there is no direct relation between the two. Also, Covid-19 makes the body’s immune system weak and makes it vulnerable to other infections, including typhoid.

Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract. Symptoms include prolonged high fever, fatigue, headache, nausea, abdominal pain, and constipation or diarrhoea. Some patients may have a rash. Severe cases may lead to serious complications or even death. Typhoid fever can be confirmed through blood testing.

XDR typhoid is caused by a strain of the bacterium Salmonella enterica serotype Typhi that is resistant to at least five antibiotic classes recommended for treating typhoid fever. In 2016, its outbreak occurred in Sindh and later it spread throughout the country.

Unvaccinated children

Dr Khalid Shafi, a senior paediatrician associated with the Dow University of Health Sciences, also representing Pakistan Paediatric Association, said though the situation was not alarming, there had been a recent increase in typhoid cases.

“These children now reporting with typhoid are those who couldn’t be vaccinated against the bacterial infection mainly due to restrictions on movement and lockdowns introduced to contain spread of Covid-19. These steps hampered the expanded programme for immunisation,” he said.

The typhoid conjugate vaccine had been included in the EPI following an outbreak of XDR typhoid a few years back, he pointed out. “Also, the government had launched a massive typhoid vaccination drive in 2019 during which a reasonable number of child population in Sindh were vaccinated that brought a sharp decline in typhoid cases.”

Dr Shafi was of the opinion that vaccination was one part of the strategy to prevent diseases. Other equally important components were the provision of safe drinking water and hygienic living conditions. “If we could just provide clean water to our population, we can prevent 50 per cent of infectious diseases, including hepatitis, cholera and dysentery. Besides, there is a need for creating awareness and education on hygiene and disease prevention.”

Asked about his clinical assessment of typhoid cases, Dr Jamal Raza, former director of the National Institute of Child Health, now heading the government-run Sindh Institute of Child Health, said XDR typhoid consisted of around 80 per cent cases currently being diagnosed at the NICH, the largest tertiary care public sector hospital for children in the province.

He agreed to Dr Shafi’s analysis that the situation was not alarming. “For the past two to three months, 30 to 50 typhoid cases are being reported in a month at the NICH. The majority of which required hospitalisation for 10 to 15 days. Treatment for XDR typhoid is costly and prolonged.

“The chances of mortality are around 2pc. Typhoid can kill if there is a prolonged delay in diagnosis and treatment.”

Published in Dawn, August 30th, 2021