Typhoid in Pakistan: Challenges, Efforts, and Recommendations

Abstract

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.

A pattern of antibiotic drug resistance of Salmonella Typhi and Salmonella Paratyphi among children with enteric fever in a tertiary care hospital in Lahore, Pakistan

“…These findings suggest that infection is attributable to short-cycle transmission, which involves direct contamination via the feco-oral pathway. Mobile street vendors and corner stores could play an important role in this context ( 11 , 19 ). They frequently place their carts near drainage systems and overlook essential hygiene procedures, such as handwashing during food preparation and raw goods handling.…”

“…The differences could be attributed to antibiotic stewardship programs, a well-developed health care infrastructure, and an exceptional surveillance and monitoring system in these countries. In contrast, Pakistan, a country facing economic challenges, can only allocate less than USD $200 million for its entire health care system ( 19 ).…”

“…In 2019, Pakistan became the first country to include typhoid vaccination (at the age of nine months) in the extended immunization program. A two-week mass vaccination campaign was launched in Sindh province in 2019, followed by similar campaigns in other provinces in 2021 and 2022 ( 19 , 39 , 40 ). Despite these efforts, vaccination rates in rural areas are poor due to cultural and religious stigmas associated with vaccines.…”

“…Despite these efforts, vaccination rates in rural areas are poor due to cultural and religious stigmas associated with vaccines. Some of these beliefs are that vaccinations include ingredients prohibited by Islamic law and that vaccines are part of an international conspiracy against Pakistan ( 19 , 39 ). Similar beliefs were related to other vaccines as well, including the belief that polio and COVID-19 vaccines cause infertility.…”

Water-related diseases following flooding in South Asian countries – a healthcare crisis

“…Cases in Pakistan sharply surged in 2016, following the introduction of a highly drug-resistant (XDR) typhi outbreak in Hyderabad. 16 Typhoid appears to have a seasonal pattern, peaking from July to October after rain, notably in the majority of South Asian and South East Asian countries, perhaps due to floods brought on by heavy rains that contaminate drinking water sources with sewage. 17 Per this, a study conducted in Karachi showed a prevalence of serologically positive patients at 20.13% in the summer and 17% in the winter.…”