Why is drug-resistant typhoid becoming more common?

Sindh is going to immunise children against typhoid and its extremely drug-resistant form, XDR typhoid, which has alarmed authorities with how quickly it has spread. The campaign begins November 18. 

Doctors at various hospitals across Karachi say they have been seeing more cases of drug-resistant typhoid compared to the non-resistant type, especially among children.

“All the cases of typhoid I’ve seen over the last year have been XDR or resistant ones. We’re also seeing children younger than one year who have been affected,” said Dr Naheed Maher, a paediatrician working at Ziauddin Hospital, Clifton. Dr Maher is also a fellow of England’s Royal College of Paediatrics and Child Health.

The largest public hospital for children in Sindh, the National Institute of Child Health in Karachi, has recorded 887 cases of typhoid this year.

Data shared by the NICH coordinator, Dr Jamal Raza, showed that 830 of these cases were drug-resistant typhoid. In October, the hospital received 82 new cases, of which 80 were XDR typhoid.

“We have had several patients with XDR typhoid,” said Dr Seemin Jamali, executive director of Jinnah Postgraduate Medical Centre.

Most presented with fever and test cultures showed multi-drug resistance, she said, adding that many doctors also caused havoc by prescribing antibiotics without any specific diagnosis.

The reason resistance has become widespread is because we use antibiotics meant to treat severe infections to treat common infections as well, explained Dr Maher.

There are only two antibiotics that work against drug-resistant typhoid and are approved by the National Institute of Health in Pakistan: azithromycin and carbapenems. Both these drugs are costly and their use needs to be restricted to prevent further antibiotic resistance.

If resistance to them develops, there’s no other medicine we have to treat XDR typhoid, Dr Maher warned. Multidrug-resistant typhoid fever is a deadly disease with severe complications, including internal bleeding and bowel perforations, she said.

The drugs meant to treat it are being used for colds and coughs since their side effect profile is safe, Dr Maher lamented.

The new typhoid vaccine

In an effort to control the typhoid outbreak, the Sindh government will vaccinate 10.1 million children between the ages of nine months and 15 years from November 18 to November 30.

The new vaccine that the government is introducing is approved by the WHO for typhoid outbreaks and will become a routine part of the expanded programme of immunisation.

“It’s a safe vaccine. It is recommended that even if your child has recently received the vaccine for typhoid they should be getting this vaccine,” Dr Maher advised.

The new vaccine is a typhoid conjugate vaccine (TCV) and strengthens the child’s immune system against both typhoid and XDR typhoid, she added.

Around 10,000 people in urban areas of Sindh were affected by multidrug-resistant typhoid, the Sindh EPI project director, Dr Muhammad Akram Sultan, had revealed at a meeting at the Emergency Operations Centre in Karachi on November 1.