KARACHI - Enteric Typhoid fever has engulfed large parts of Karachi as numbers of patients have been reported to be admitted in hospitals all over the city, The Nation learnt on Saturday. Orangi Town, Banaras, New Karachi, Clifton, Gizri, Delhi Colony, and other areas of the city are reported to have greater ratio of patients affected from such Typhoid, while the biggest reason is contaminated water. Dr BM Rathore, General Physician at Gizri Hospital told The Nation that out of 25 patients in his daily OPD, every fourth is suspected of contracting typhoid type irrespective of age factor, and the reasons for this are contaminated water, unhygienic conditions, and ignorance of hand-washing. Our city has parallel lines of drainage and drinking water, therefore, their mix up causes such diseases, and the affected most areas are Gizri, Clifton, Delhi Colony, he told. 'It is a routine matter now that I diagnose patients of such typhoid and of every age, thus I strongly recommend the concerned authorities to take notice of such issue unless it becomes an epidemic problem, he added. On a question he told that such kind of typhoid creates a low immunity in the Patient and make them vulnerable for infectious diseases in future such as viral infection. Dr Faiz ur Rehman Farooqi, from Abbasi Shaheed Hospital, who had diagnosed 98 patient positive for such Typhoid in the first 20 days of March, told the Nation that if the authorities do not control this situation, the whole city will be affected in a very short period of time. Unhygienic conditions, lack of awareness about health precautions, use of un-boiled drinking water in cooking, not-so-well-cooked food, are the main reasons to cause this disease, he told. 'I am receiving patients of every age and sex, and mostly are from Banaras, Orangi Town, New Karachi, which are the populous areas of the city, thus it must be taken in account immediately, He added. Asked about the future health vulnerability of the patient, he said the patient is more likely to suffer from the bone diseases and gallbladder as well. The WHO reports told that Typhoid Fever is a serious systemic infection caused by the enteric pathogen 'Salmonella Enterica Sevovar Typhi, which continues to be a public health problem in many developing countries of Asia, Africa and Latin America. It affects school age (5-15 years) children disproportionately. WHO estimates annual global incidence of typhoid fever at 21 million cases of which 1%-4% end fatally. Around 216,000 to 600,000 children between the ages so 2-15 die annually and 90% of such cases occur in Asia. Vaccination has greatly reduced the morbidity and mortality and according to recent data it has become a very cost effective measure in the Asian urban slum areas. In Asian urban slums incidence of typhoid in age group 5-15 is estimated to be 180-494 per 100,000. Typhoid fever caused by MDR strains of S. Typhi - that is, resistance to all 3 of the first line antibiotics (chloramphenicol, ampicillin and co-trimoxazole) - is associated with more sever illness and higher rates of complications and death, especially in children aged 2 years. According to Disease of the Most Impoverished (DOMI) program, covering 6 Asian cities the average cost per case of hospitalised typhoid fever ranged from US$ 334. Initially patients experience fatigue, headache, abdominal pain and fever. Constipation usually occur in older children and adults, where as younger children may suffer from diarrhoea. Severe forms of typhoid fever may entail cerebral dysfunction, delirium and shock, and occasionally also intestinal perforation and haemorrhages. The often non specific symptoms of typhoid fever result in frequent diagnostic confusion with malaria, dengue fever, influenza or other febrile illnesses. Confirmed diagnosis requires isolating S. Typhi in laboratory through blood culture. However, in developing countries most of these tests are not conducted for the majority of patients, especially those treated in non-hospital settings. In view of typhoid fever, and observations on the effectiveness of vaccination in interrupting outbreaks, typhoid fever vaccination is recommended by WHO for outbreak control. Evidence from China suggests that the programmatic use of Vi vaccine in selected areas may largely control the disease with in a 4-5 year period. Vaccination of school and pre-school children has always been estimated to be very cost effective (cost per DALYs (disability adjusted life years) averted to US$ 177-674 (DOMI program), considering the costs of illness borne by the public sector only.