ISLAMABAD-The National Institute of Health (NIH) has issued an advisory to all provincial health departments to take prevention and treatment measures to control typhoid fever during summer and monsoon season.

Typhoid fever is endemic in Pakistan and outbreaks of extremely Drug Resistant Salmonella Typhi (XDR S. Typhi) have been reported since 2016 from different parts of the country, especially during summer and monsoon season.

Keeping in view the seasonal trend of XDR Typhoid, it is important to take necessary measures to limit transmission through preventive measures, early detection, using recommended diagnostic tools and prompt treatment.

The NIH advisory aims to alert the health authorities for timely actions for preparedness for prevention and control of typhoid fever including XDR Typhoid. Moreover, the health departments must involve other line departments such as WASA, Public Health Engineering, District and Local Administration for preparedness and response.

According to the advisory any person with a history of fever of at-least 38°C for 3 or more days with abdominal symptoms like diarrhoea, constipation, abdominal tenderness and prostration is suspected and any person that is laboratory confirmed by isolation of S.Typhi from blood/stool or urine.

About the mode of transmission it is said that typhoid infection occurs through feco-oral route and infection spreads through contaminated food, milk, frozen fruits and water or through close contact with already infected persons.

The contamination of food and water usually occurs due to poor sanitation and mixing of sewerage water with drinking water.

Incubation period depends on the inoculum size and host factors; 3 days to more than 60 days with a usual range of 8 to 14 days. Preschool children are at greater risk of developing disease and usually have milder symptoms than the adults do.

Travellers to or workers in endemic areas and caregivers of the patient infected with S.Typhi are also at high risk.

It says that typhoid can be isolated from blood during the first week of illness or from stool and urine after the first week of illness.

About the treatment it says that suspected patients having history compatible with case definition should immediately seek medical advice from health care facilities. Sample should be collected for culture and sensitivity before starting the empirical therapy from all the suspected cases.

Unnecessary use of antimicrobial agents should be discouraged to treat the patients presenting with fever. To limit the antimicrobial resistance, antibiotics should be prescribed based on the results of culture and sensitivity tests.

The XDR Typhoid cases information and lab culture report must be notified to the concerned district health authorities, DG offices of the respective province and the NIH.

It says since the emergence of COVID-19, it has been observed that health care professionals are frequently prescribing azithromycin for the COVID-19 patients may develop resistance against azithromycin through selective pressure due to overuse of azithromycin leading to strains, and consequently their spread which will further limit out the treatment options in the XDR typhoid cases.

This practice should therefore immediately be addressed and azithromycin must carefully be prescribed for COVID-19 cases based on local and international recommendations.

About the preventive measures and vaccination the NIH said that it is suggested that with treatment options for typhoid becoming more limited, following preventive measures are urgently needed, including improved sanitation and vaccination campaigns.