Pakistan’s Field Epidemiology & Disease Surveillance Division (FEDSD) at the National Institute of Health (NIH) in Islamabad issued two health advisories this week over prevention and treatment of typhoid fever and Crimean-Congo Hemorrhagic Fever (CCHF) ahead of Eidul Azha.

More than 2,000 extensively drug-resistant (XDR Typhoid) have been reported from different areas of the country, especially from some areas of Sindh, including Hyderabad and Karachi.


Typhoid fever is a potentially life-threatening illness caused by the bacterium Salmonella typhi. Salmonella typhi lives only in humans. Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract. In addition, a small number of persons, called carriers, recover from typhoid fever but continue to carry the bacteria. Both ill persons and carriers shed S.typhi in their feces.

You can get typhoid fever if you eat food or drink beverages that have been handled by a person who is shedding S. typhi or if sewage contaminated with S. typhi bacteria gets into the water you use for drinking or washing food. Therefore, typhoid fever is more common in areas of the world where handwashing is less frequent and water is likely to be contaminated with sewage.

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Typhoid fever can be successfully treated with appropriate antibiotics, and persons given antibiotics usually begin to feel better within 2 to 3 days.

In addition, with the likely increased human-animal interaction with religious rituals with Eidul Azha celebration, concerns of Crimean-Congo Hemorrhagic Fever (CCHF) spread exists.

CCHF cases have been reported in most areas of the country, Baluchistan remains the most affected province. Since the beginning of this year, a total of 59 suspected cases of the virus have been submitted for testing at the NIH, of which eight were found to be positive for CCHF, according to the advisory.

According to the WHO, Crimean-Congo hemorrhagic fever is a widespread disease caused by a tick-borne virus (Nairovirus) of the Bunyaviridae family. The CCHF virus causes severe viral hemorrhagic fever outbreaks, with a case fatality rate of 10–40%.

CCHF is endemic in Africa, the Balkans, the Middle East and Asian countries south of the 50th parallel north – the geographical limit of the principal tick vector. The hosts of the CCHF virus include a wide range of wild and domestic animals such as cattle, sheep and goats.

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Animals become infected by the bite of infected ticks and the virus remains in their bloodstream for about one week after infection, allowing the tick-animal-tick cycle to continue when another tick bites. Although a number of tick genera are capable of becoming infected with CCHF virus, ticks of the genus Hyalomma are the principal vector.

The CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, such as agricultural workers, slaughterhouse workers and veterinarians. Human-to-human transmission is possible.