Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Feb 15;68(Suppl 1):S16-S21.
doi: 10.1093/cid/ciy877.

Ceftriaxone-resistant Salmonella Typhi Outbreak in Hyderabad City of Sindh, Pakistan: High Time for the Introduction of Typhoid Conjugate Vaccine

Mohammad Tahir Yousafzai  1 , Farah Naz Qamar  1 , Sadia Shakoor  1   2 , Khalid Saleem  1 , Heeramani Lohana  3 , Sultan Karim  1 , Aneeta Hotwani  1 , Shahida Qureshi  1 , Naveed Masood  4 , Mudasir Rauf  4 , Jamshed Ahmed Khanzada  5 , Momin Kazi  1 , Rumina Hasan  2
Affiliations

Ceftriaxone-resistant Salmonella Typhi Outbreak in Hyderabad City of Sindh, Pakistan: High Time for the Introduction of Typhoid Conjugate Vaccine

Mohammad Tahir Yousafzai et al. Clin Infect Dis. .

Abstract

Background: The Aga Khan University clinical microbiology laboratory identified an outbreak of ceftriaxone-resistant Salmonella Typhi in Hyderabad, Pakistan, through antimicrobial resistance surveillance. An outbreak investigation was carried out to identify the risk factors and institute control measures. Here we report the preliminary findings of this outbreak investigation, using data collected from 30 November 2016 to 28 March 2017.

Methods: The design for the investigation was a case-control study that included identification of culture-proven ceftriaxone-resistant S. Typhi cases, suspected cases from the households or neighborhood of the confirmed cases, and enrollment of controls matched by age to identify the risk factors. Data were collected through face-to-face interviews using a structured questionnaire. Blood cultures were obtained from all suspected cases. Drinking water samples from each household of cases and controls were obtained for microbiological testing. Geographic Information System coordinates were obtained for all cases and controls.

Results: Only 2 subdistricts of Hyderabad (Latifabad and Qasimabad) were affected. A total of 101 confirmed cases of ceftriaxone-resistant S. Typhi had been reported in 4 months with the first case reported on 30 November 2016. Median age was 48 (interquartile range, 29-84) months. The majority (60% [61/101]) of the cases were 6-60 months old. More than half (56% [57/101]) of the cases were male. About 60% of the cases were admitted to hospital and treated as inpatient. More than half (57/101) of the patients developed complications related to typhoid.

Conclusions: Community awareness was raised regarding chlorination of drinking water and sanitation measures in Hyderabad. These efforts were coordinated with the municipal water and sewage authority established to improve chlorination at processing plants and operationalize fecal sludge treatment plants. Outbreak investigation and control efforts have continued. Immunization of children with typhoid conjugate vaccine within Hyderabad city is planned.

Keywords: TCV; XDR; ceftriaxone resistance; outbreak; typhoid.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Geospatial map of ceftriaxone-resistant cases (N = 101).
Figure 2.
Figure 2.
Weekly distribution of ceftriaxone-resistant Salmonella Typhi cases (N = 101) during 30 November 2016 to 28 March 2017 in Hyderabad, Pakistan. Dates are presented as day/month.
See this image and copyright information in PMC

References

    1. Owais A, Sultana S, Zaman U, Rizvi A, Zaidi AK. Incidence of typhoid bacteremia in infants and young children in southern coastal Pakistan. Pediatr Infect Dis J 2010; 29:1035–9. - PMC - PubMed
    1. Azmatullah A, Qamar FN, Thaver D, Zaidi AK, Bhutta ZA. Systematic review of the global epidemiology, clinical and laboratory profile of enteric fever. J Glob Health 2015; 5:020407. - PMC - PubMed
    1. Saha SK, Talukder SY, Islam M, Saha S. A highly ceftriaxone-resistant Salmonella Typhi in Bangladesh. Pediatr Infect Dis J 1999; 18:387. - PubMed
    1. Qamar FN, Azmatullah A, Kazi AM, Khan E, Zaidi AK. A three-year review of antimicrobial resistance of Salmonella enterica serovars Typhi and Paratyphi A in Pakistan. J Infect Dev Ctries 2014; 8:981–6. - PubMed
    1. Qamar FN, Yousafzai MT, Sultana S, et al. . A retrospective study of laboratory-based enteric fever surveillance, Pakistan, 2012–2014 [manuscript published online ahead of print 27 July 2018]. J Infect Dis 2018. doi: 10.1093/infdis/jiy205. - DOI - PMC - PubMed

Publication types