Untreatable strains of typhoid threaten a global health emergency, experts warn

International neglect of the threat from typhoid and potentially untreatable new strains threaten a global health emergency, experts have warned.

The disease which causes as many as 21 million cases a year is too often overlooked as a disease of the past, when in fact it is increasingly difficult to treat.

Researchers from Oxford Martin School are calling for global health institutions to dedicate new resources to tackling typhoid.

Rising antimicrobial resistance and the ongoing outbreak of extensively drug-resistant (XDR) typhoid in Pakistan should be a wake-up call about the risks the disease poses.

"Popular notions of typhoid as a disease of the past are a myth,” said Dr Claas Kirchhelle, of the Wellcome Unit for History of Medicine at the University of Oxford.

"For poorer countries, the spectre of typhoid has never gone away.”

Countries have relied too heavily on antibiotics to fight the menace, rather than trying to tackle the root causes in poor sanitation, or running vaccination campaigns.

"The current resurgence of XDR typhoid bears the biosocial footprint of more than half a century of antibiotic-intensive international neglect," he said.

Typhoid, caused by Salmonella typhi bacteria, is highly contagious and spreads by contaminated food and water. Areas with poor sanitation are worst affected.

Symptoms include fever, stomach pain, headache and constipation or diarrhoea. If left untreated, it can kill. Each year there are an estimated 21 millions cases worldwide, with as many as 200,000 deaths.

The researchers, writing in the journal Clinical Infectious Diseases, said typhoid was still a major global health issue but was largely unrecognised because of poor surveillance and complex dynamics of the disease, including new drug-resistant strains.

A strain of drug resistant typhoid fever was discovered in Pakistan in 2016. The bug is resistant to at least five commonly used drugs. Further drug resistant strains were found in Bangladesh last year.

Dr Samantha Vanderslott, of the Oxford Vaccine Group, said: "The emergence of untreatable strains needs to be taken far more seriously.

"Top-down interventions such as vaccination programmes need to be combined with flexible credit to empower local communities, so that they can implement essential infrastructure such as waste disposal, sanitation and clean water systems."

Professor Andrew Pollard, who leads the Oxford Vaccine Group, added that: "The escalating problem of antimicrobial resistance means we need urgently to deploy new interventions to tackle typhoid.

"The availability and funding of new effective typhoid vaccines give us a critical tool for strengthening global control of typhoid, with the potential to protect vulnerable populations from this disease."

The researchers said a lack of international financing had stalled the spread of sanitation and health infrastructure that had helped stamp out the disease in wealthier countries.

“Instead, the focus in wealthier, typhoid-free countries has been on protecting travellers and preventing typhoid from crossing borders,” the researchers said.

Protect yourself and your family by learning more about Global Health Security