MILLIONS could be at risk as untreatable typhoid strains threaten a new global health emergency, experts have warned.
The disease – which causes 21 million cases every year – is often overlooked as an ancient condition from the past, they said.
But new extensively drug-resistant variants of typhoid fever are spreading across international borders.
Cases have been reported in the UK, US, Germany, Pakistan, India, Bangladesh, the Philippines, Iraq, Guatemala, as well as more recently in Australia and Canada.
Researchers from Oxford Martin School are now calling for urgent collective action from global health institutions to dedicate new resources to tackling the highly contagious bacterial infection.
They say it has become a neglected disease of poorer countries following its elimination in many high-income countries.
Scientists argue the rising antimicrobial resistance and the ongoing outbreak of extensively drug-resistant (XDR) typhoid in Pakistan should be a wake-up call to the international community.
The experts say that while new vaccines offer hope, one intervention alone will not be enough to eliminate the disease which affects 11 million people a year.
A new typhoid conjugate vaccine (TCV) is already in use in Pakistan on a pilot basis, and is undergoing testing in Malawi.
A full roll-out is expected in the coming months.
Popular notions of typhoid as a disease of the past are a myth
Dr Claas Kirchhelle
Dr Claas Kirchhelle, of the Wellcome Unit for History of Medicine at the University of Oxford, said: “Popular notions of typhoid as a disease of the past are a myth.
“For poorer countries, the spectre of typhoid has never gone away.
“Over the last decades, international neglect, lacking sanitary infrastructures and vaccine programmes, and compensatory reliance on antibiotics have resulted in a situation where typhoid is increasingly difficult to treat.
“The current resurgence of XDR typhoid bears the biosocial footprint of more than half a century of antibiotic-intensive international neglect.”
What is typhoid fever?
Typhoid fever is a bacterial infection that can spread throughout the body, affecting many organs.
Without prompt treatment, it can cause serious complications and can be fatal.
It’s caused by a bacterium called Salmonella typhi, which is related to the bacteria that cause salmonella food poisoning.
Typhoid fever is highly contagious. An infected person can pass the bacteria out of their body in their poo or, less commonly, in their pee.
If someone else eats food or drinks water that’s been contaminated with a small amount of infected poo or urine, they can become infected with the bacteria and develop typhoid fever.
Typhoid fever is most common in parts of the world that have poor sanitation and limited access to clean water.
Worldwide, children are thought to be most at risk of developing typhoid fever because their immune system is still developing.
The main symptoms of typhoid fever are:
- a high temperature that can reach 39 to 40C
- general aches and pains
As the infection progresses, you may lose your appetite, feel sick, and have a tummy ache and diarrhoea. Some people may develop a rash.
If typhoid fever isn’t treated, the symptoms will continue to get worse over the following weeks and the risk of developing potentially fatal complications will increase.
Typhoid fever is uncommon in the UK, with an estimated 500 cases occurring each year.
In most of these cases, the person developed the infection while visiting relatives in Bangladesh, India or Pakistan.
But you’re also at risk of developing the infection if you visit Asia, Africa or South America.
Analysing the past and present of typhoid control, in the journal Clinical Infectious Diseases, the researchers identify a range of actions key to the strategic elimination of typhoid globally.
They say typhoid is still a major global health issue but is largely unrecognised, due to factors including poor surveillance and the complex dynamics of the disease, including new drug-resistant strains.
The scientists also find the availability of cheap credit and sustainable financing schemes for affordable water and sanitary systems at the municipal level have an important role to play in typhoid control – as seen in the elimination of typhoid in the UK and US.
Another finding is that progress on typhoid control will depend on support for independent research and policy decisions within endemic countries to improve water quality.
The emergence of untreatable strains needs to be taken far more seriously
Dr Samantha Vanderslott
Researchers, including historians, immunologists and social scientists, also say the recent advent of a new generation of typhoid conjugate vaccines can play an important role until clean water and sanitation are in place for those at greatest risk.
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, said: “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.”