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Extensively-drug resistant Typhoid in Pakistan (Update 3)

31 Dec 2018

The World Health Organisation have updated their report on the ongoing outbreak of extensively-drug resistant (XDR) typhoid in Sindh province in Pakistan. The outbreak began in November 2016 and since then until December 2018 there have been 5 274 cases of XDR typhoid out of 8 188 cases of typhoid reported within Sindh province. 69% of cases were reported in Karachi, 27% in Hyderabad district and 4% in other districts of Sindh province.

The risk of XDR typhoid at national level is considered high in Pakistan due to insufficient water, poor sanitation and hygiene practices and low vaccination coverage. Globally, the risk is considered low, although there is potential for travellers from Pakistan to spread disease.

There have been 6 travel-associated cases of XDR typhoid in travellers: 1 in the UK, 1 in Northern Ireland and 4 in the USA.

Advice to travellers

Typhoid is spread by the faecal oral route, precautionary measures should therefore 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 is recommended for all travellers to Pakistan. 

For further information see Typhoid.