‘Frightening’ typhoid fever outbreak spreads in Pakistan

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Science  20 Jul 2018:
Vol. 361, Issue 6399, pp. 214
DOI: 10.1126/science.361.6399.214

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A strain of the bacterium that causes typhoid fever has become resistant to most every drug and is spreading through Pakistan, causing at least 2000 confirmed cases. The so-called extensively drug resistant (XDR) strain of Salmonella typhi remains susceptible to one oral antibiotic, azithromycin, but the only other options are expensive intravenous drugs that most people in Pakistan and other resource-strapped countries cannot afford. The fear is that if S. typhi develops resistance to azithromycin, many people will die from the disease, which leads to bowl perforation and other life-threatening complications in about 15% of untreated people. A new vaccine that for the first time works in young children and has long-lasting immunity is now being rolled out in Pakistan. But antibiotic resistance and spread are a result of poor sanitation and contaminated water supplies, which reflect the serious infrastructure problems in Hyderabad and Karachi, the two main cities affected by XDR S. typhi. Public health officials worry that the XDR S. typhi will also jump borders and soon start spreading outside of Pakistan.