COCA Call: Extensively Drug-resistant Salmonella Typhi Infections Emerge Among Travelers to or from Pakistan-United States, 2016-2018

Typhoid fever is caused by Salmonella enterica serotype Typhi (Typhi). Typhi is an important public health problem in developing countries. The estimated global burden of Typhi is 12 to 27 million cases annually. During 2016-2018, an extensively drug-resistant (XDR) Salmonella Typhi strain-only susceptible to azithromycin and carbapenems-emerged in Pakistan. More than 5,300 cases have been reported in the ongoing outbreak. During 2016-2018, typhoid fever was diagnosed in 29 patients in the United States with recent Pakistan travel; 5 had XDR Typhi.

The Centers for Disease Control and Prevention (CDC) recommends pre-travel vaccination and adherence to safe food and water practices to prevent typhoid fever. Empiric azithromycin should be used to treat patients with suspected, uncomplicated typhoid fever who have traveled to or from Pakistan. Carbapenems should be used for patients with suspected severe or complicated typhoid fever who have traveled to or from Pakistan. During this COCA Call, clinicians will learn about CDC recommendations for diagnosing, managing, and preventing XDR typhoid.

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