Rising XDR-Typhoid Fever Cases in Pakistan: Are We Heading Back to the Pre-antibiotic Era?

Butt, Muhammad Hammad; Saleem, Aisha; Javed, Syed Owais; Ullah, Irfan; Rehman, Mujeeb Ur; Islam, Nayyer; Tahir, Muhammad Nouman; Malik, Tangina; Hafeez, Sara; Misbah, Shahzadi

doi:10.3389/fpubh.2021.794868

Cited by 35 publications

(30 citation statements)

References 9 publications

(12 reference statements)

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“…10 The lack of proper sewage systems, clean food and water result in air-borne diseases. 6 , 10 Moreover, despite the establishment of health units set up by the government in local districts, adequate residential infrastructure and standard sanitation routines are not provided due to a lack of funding. 11 Hence, many doctors refuse to work in rural areas.…”

Section: Challenges and Implicationsmentioning

confidence: 99%

“…Potential carriers from underdeveloped areas migrate to cities in search of stable jobs or to seek refuge, ultimately increasing Typhoid cases among urban dwellers. 6 Street foods are a popular option among many, however, high levels of Typhoid cases are caused by 70% to 90% reports of animals, insects and liquid waste found in food preparation areas. 12 , 13 Carts are often placed next to roads or above drains, contaminating food items with feces and dust.…”

Section: Challenges and Implicationsmentioning

confidence: 99%

“…This is partly due to cultural and religious stigmas surrounding vaccines which limit widespread vaccination. 6 , 20 Apart from this, poor infrastructure, low-income rates and few healthcare facilities present in the rural areas add up to the low vaccination rates. 21 Moreover, many locals tend to self-medicate due to lack of awareness causing excess use of antibiotics increasing the chances of resistance.…”

Section: Challenges and Implicationsmentioning

confidence: 99%

“… 5 This new strain rendered the treatment with Chloramphenicol, Ampicillin, Co-trimoxazole, Fluoroquinolones, and Third-generation Cephalosporins ineffective, and ultimately requiring treatment with stronger antimicrobials including; Carbapenems, Tigecycline, and Azithromycin. 3 , 6 …”

Section: Introductionmentioning

confidence: 99%

“…This is emphasized with the number of new XDR cases reaching 52 in the week just before August 14. 6 On the contrary, some sources have reported a fall in Typhoid cases after the emergence of COVID-19, which can be explained by possibly decreased surveillance in different states secondary to the lack of resources amidst the pandemic. 8 Moreover, the mutual symptoms and differential diagnoses of COVID-19 and Typhoid also made it difficult for physicians to differentiate between them, 7 which can potentially mask the true number of Typhoid cases.…”

Section: Introductionmentioning

confidence: 99%

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Typhoid in Pakistan: Challenges, Efforts, and Recommendations

Tharwani¹,

Kumar²,

Salman³

et al. 2022

IDR

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Typhoid, and its extra drug resistant form which is highly prevalent Pakistan, is increasing the burden on healthcare through multiple factors. These range from lack of sanitation, the collapsing economy, and poor access to clean drinking water which have made it arduous for the government and various other organizations in containing it. With the COVID-19 pandemic, treatment of typhoid became a challenge as focus was driven towards limiting the COVID-19 spread, and hence preferential use of antibiotics such as azithromycin may limit future empirical antibiotic therapy for typhoid. Socioeconomic disparities and geographical as well as demographic barriers further limit access to appropriate typhoid management. Lastly, illiteracy and self-medication with antibiotics may predispose Pakistan to another outbreak of typhoid. These concerns, although largely unaddressed effectively, need immediate action. Previously, the government and international organizations have made efforts to control the spread through the introduction of TCV as a part of EPI and awareness, additional improvements are needed. These include: improving access to telemedicine in rural areas, extensive vaccination programs, and routine awareness programs especially in schools.

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Section: Challenges and Implicationsmentioning

confidence: 99%