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So far in 2018, three cases of extensively drug-resistant XDR typhoid fever were reported in travelers to Pakistan — one who returned to the United Kingdom, and two who returned to the United States.

This has prompted the Centers for Disease Control and Prevention (CDC) to issue a Level 2 travel alert for travelers to the country.


Health officials in Pakistan have reported an ongoing outbreak of XDR typhoid fever that began in Hyderabad in November 2016. The strain of Salmonella Typhi does not respond to most antibiotics used to treat typhoid fever. The outbreak has spread to the city of Karachi and to multiple districts, and several deaths have been reported.

Public health authorities in Pakistan are identifying possible typhoid fever cases, starting typhoid vaccination campaigns in the most affected districts, and spreading educational messages about proper handwashing and safe food and water practices.

CDC says all travelers to Pakistan are at risk of getting XDR typhoid fever. Those who are visiting friends or relatives are at higher risk than are tourists and business travelers.

All travelers (even short-term travelers) to South Asia, including Pakistan, should get vaccinated against typhoid fever. Two typhoid fever vaccines are available in the United States — an oral vaccine and an injectable vaccine. The oral vaccine can be given to people at least 6 years old and should be given at least one week before travel. The injectable vaccine can be given to people at least 2 years old and should be given at least two weeks before travel.

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In addition, because the bacteria that cause typhoid fever are spread through contaminated food and water, you can reduce your risk of infection in several ways: Follow safe food and water guidelines, wash your hands often, especially before eating and avoid eating food prepared by anyone who is sick or has recently been sick.

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.

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