XDR Typhoid Fever Cases Found in the USA
The US Centers for Disease Control and Prevention (CDC) announced nine extensively drug-resistant (XDR) typhoid fever cases in the USA unrelated to international travel.
Additionally, the CDC’s Health Advisory Network issued an Alert on February 12, 2021, stating an ongoing outbreak of XDR typhoid fever has sickened more than 5,000 people in the Islamic Republic of Pakistan since 2016.
As of January 14, 2021, the CDC received 71 reports of XDR Typhi infection in the USA, with specimens obtained from February 2018 through November 2020. Among 67 patients with known travel history, 87% had traveled to Pakistan in the 30 days before illness began.
However, the nine patients from six states (NY, CA, IL, MD, NJ, and TX) reported that they had not traveled to Pakistan or any other country. Susceptibility testing of these specimens showed the same resistance pattern described in Pakistan.
Most people in the USA diagnosed with typhoid fever acquired it during international travel. However, CDC has not identified linkages among these patients or a common infection source.
Before the outbreak in Pakistan, no case of ceftriaxone-resistant Typhi infection had been identified in the United States. An unrelated cluster of ceftriaxone-resistant Typhi infections linked to Iraq has been reported in the USA and the United Kingdom.
According to the CDC, up to 30% of people with typhoid fever will die without appropriate antibiotic treatment.
The CDC states ‘Clinicians should consider empiric treatment with a carbapenem, azithromycin, or both agents for suspected typhoid fever in patients who did not travel out of the USA and those who traveled to Pakistan or Iraq.
Ceftriaxone remains an appropriate empiric treatment option for patients who traveled to countries other than Pakistan and Iraq.
Taking antibiotics will not prevent typhoid fever; they only help treat it.
‘Vaccinate patients who are at high risk for typhoid fever, including those traveling to parts of the world where typhoid fever is common, those in close contact with a typhoid carrier, and those who might work with Typhi in a laboratory, says the CDC.
Two typhoid fever vaccines are available in the United States, which are not 100% effective since Typhoid vaccines lose effectiveness over time.
Vivotif oral vaccine: Can be given to people at least six years old. It consists of four pills taken every other day and should be finished at least one week before travel and requires a booster every five years.
Typhim IV injectable vaccine: Can be given to people at least two years old and should be given at least two weeks before travel. The injectable vaccine requires a booster every two years. If you were vaccinated in the past, ask your doctor if it is time for a booster vaccination.
As of September 2020, the CDC issued a Level 1, Practice Usual Precautions, for anyone visiting Pakistan. This advisory says, ‘All travelers to Pakistan are at risk of getting XDR typhoid fever. Those visiting friends or relatives are at a greater risk than tourists or business travelers.’
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