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Typhoid infections

What is typhoid fever?

Typhoid fever is caused by Salmonella typhi bacteria and remains a serious health threat in the developing world, especially for children.

Typhoid fever spreads through contaminated food and water or through close contact with someone who’s infected.

Signs and symptoms usually include:

  • High fever, 39–40° C (103–104° F)
  • Headache,
  • Abdominal pain,
  • Constipation or diarrhoea.

Most people with typhoid fever feel better within a few days of starting antibiotic treatment, although a small number of them may die of complications.

Vaccines against typhoid fever are available, but they’re only partially effective. Vaccines usually are reserved for those who may be exposed to the disease or are travelling to areas where typhoid fever is common.

Since 2016, five children in the United States have been diagnosed with extensively drug-resistant typhoid fever after traveling to or from Pakistan, where a large ongoing typhoid outbreak has sickened more than 5,300 people, according to a report published today in MMWR . The outbreak in Pakistan involves a […]

The outbreak in Pakistan involves a Salmonella typhi strain that is resistant to most antibiotics commonly used to treat the illness, researchers said.

The MMWR report states that 29 patients diagnosed in the U.S. with typhoid fever had travelled to or from Pakistan from 2016 to 2018, including the five children with extensively drug-resistant (XDR) infections.

Typhoid infections

“It’s important for travellers and clinicians to know that all from to Pakistan are at risk of getting extensively drug-resistant typhoid fever, which can be very difficult to treat,” Kevin Chatham-Stephens, MD, MPH, FAAP, a medical officer in the CDC’s Division of Foodborne, Waterborne, and Environmental Diseases, told Infectious Disease News.

“Travellers to South Asia, including Pakistan, India, and Bangladesh, should take precautions to protect themselves from typhoid fever.”

According to Chatham-Stevens and colleagues, between November 2016 and September 2017, 339 infections caused by the XDR Typhi strain were reported in Pakistan, with one travel-related case also reported in the United Kingdom. Enhanced surveillance efforts in Pakistan identified a total of 5,372 cases as of Dec. 30.

Every year in the U.S., about 350 culture-confirmed typhoid fever cases are reported to the CDC, according to Chatham-Stephens and colleagues. Worldwide, the annual number of typhoid fever cases is around 12 to 27 million, they said. The researchers advised clinicians to be aware that most typhoid fever infections in the U.S. are nonsusceptible to fluoroquinolones — which they said should not be used as empiric therapy — and that the outbreak strain is susceptible to only azithromycin and carbapenems.

What to do when Travelling

Typhoid infections


  • Keep your hands clean and wash regularly. 
    • Frequent hand-washing in hot, soapy water is the best way to control infection. Wash before eating or preparing food and after using the toilet. Use alcohol-based hand sanitisers for times when water isn’t available.
  • Don’t drink untreated water. 
    • Contaminated drinking water is a particular problem in areas where typhoid fever is endemic. Drink only bottled water or carbonated beverages, when travelling. Ask for drinks without ice. Use bottled water to brush your teeth, and try not to swallow water in the shower.
  • Stay away from raw fruits and vegetables. 
    • Raw produce may have been washed in unsafe water, avoid fruits and vegetables that you can’t peel, especially lettuce. To be absolutely safe, you may want to avoid raw foods entirely.
  • Only eat hot foods. 
    • Stay away from foods that are stored or served at ambient temperature. Steaming hot foods are best. And although there’s no guarantee that meals served at the finest restaurants are safe, it’s best to avoid food from street vendors — it’s more likely to be contaminated.