XDR-typhoid travellers returning from Pakistan

There is an ongoing outbreak of extensively drug-resistant typhoid (XDR-typhoid), resistant to ampicillin, trimethoprim/sulphamethoxazole, chloramphenicol, fluoroquinolones and ceftriaxone, in Sindh province, Pakistan since late 2016, with over 10,000 cases reported to date.

In 2019, Ireland has identified an increase in notified cases of typhoid, with 22 cases notified year to date, compared to 10-16 cases per year in 2016-2018. The increase in cases is particularly in travellers returning from Pakistan (usually 2-3 cases per year, 12 cases in 2019 to date). The National Salmonella Shigella Listeria Reference Laboratory (NSSLRL) advise that three isolates from typhoid cases returning from Pakistan in 2019 have an XDR profile based on detection of resistance genes.

Travellers to typhoid-endemic countries, including Pakistan, should be advised of the need for typhoid vaccination prior to travelling. In addition, travellers should be aware of precautions to take to reduce their risk of acquiring typhoid infection including:

• wash hands before eating
• avoid ice and drink only bottled water
• avoid risky foods – undercooked food, raw, unpeeled, unwashed fruit and vegetables or fruit and vegetables washed in unsafe water
• More information is available at: https://www.hpsc.ie/a-z/gastroenteric/typhoid/factsheet/