The typhoid superbug in Pakistan

While the Pakistani media has not given it much attention, the outbreak of a highly drug-resistant typhoid superbug in Sindh has certainly stirred international concern.

The Wellcome Sanger Institute and Aga Khan University in Karachi found a new strain of typhoid in Hyderabad in late 2016, which has now shown itself to be resistant to multiple antibiotics. Aggressive typhoid strains began appearing in Asia and Africa during the 1990s, which only third-generation antibiotics, such as ceftriaxone, could treat. Now this new typhoid found in Sindh, has infected several hundred patients with a strain that third-generation antibiotics are failing against. So far, recently developed fourth-generation antibiotics still seem to be working. Yet, these latest antibiotics are expensive, and if another typhoid strain develops resistance against these antibiotics too, the results would be devastating.

The increased levels of drug resistance in typhoid have highlighted the urgency to implement preventative vaccination campaigns. A new typhoid vaccine has been recently approved by the World Health Organisation which is longer-lasting, require lesser doses, and can be administered to children as young as six months of age.

The Sindh health department has launched a four-month emergency vaccination campaign in Hyderabad’s worst-hit areas, such as Latifabad and Qasimabad. It is imperative that this vaccination campaign is comprehensive enough to prevent spread of this new strain to other parts of the country.

Besides focusing on vaccination against the emergent strain, there is also need for launching an awareness health campaign in the affected area. Since typhoid fever is a bacterial infection caused by bacteria, spread by contaminated food and water, and it is highly contagious, there is need to stress preventative measures such as washing hands frequently, practising proper physical hygiene, and only eating well cooked foods and drinking boiled water.

One hopes that it is not too late, and that the threat of the typhoid superbug will be contained. However, Pakistan still faces serious risks of being hit by large epidemics due to a range of linked factors. We have over-crowded cities, underserved rural areas, inadequate water and sanitation facilities, and low vaccination coverage.

Climate-related disasters can make matters worse. Droughts and floods, for example, increase the risk of typhoid and other water-borne disease outbreaks. During droughts, people are compelled to consume any water they can find, even as water sources become more likely to be contaminated with typhoid or other bacteria. Flooding can overwhelm our already inadequate sewage and sanitation systems, allowing human waste to further contaminate water supplies.

Given this dire situation, we need multipronged preventive measures to deal with these public-health threats. Currently, most of our relevant line departments across all the provinces work in silos, whereas they need to develop a much more collaborative and comprehensive approach to deal with the threat of epidemics.

There is pressing need to deal with our unsafe drinking water and dismal sewage and drainage systems. While modest progress has been made in recent years, a significant proportion of the country lacks access to safe drinking water and toilet facilities.

Water-borne diseases such as diarrohea remain a leading cause of preventable diseases like the aforementioned, which is still a major cause of death. Stagnant water has become a breeding ground for dengue. Since 2005, Pakistan has seen a spike in the incidence of dengue. We desperately need to enact and implement better food hygiene laws.

Unless these interrelated issues are given the urgency and attention they deserve, emergent public health hazards could cause a crisis which our already struggling, underdeveloped, and underfunded public-health institutions will not be able to cope with.

Published in The Express Tribune, March 2^nd, 2018.

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