GPs are key in directing travellers on how to avoid contracting a new strain of extensively drug resistant typhoid
Infants under two years old, who are too young to receive a typhoid vaccine, could be at risk of contracting an extensively drug-resistant (XDR) clade of the disease, experts say.
A research letter, recently published in the Medical Journal of Australia said XDR typhoid had been occurring around the world in recent years, with seven cases being identified in returned travellers, most of whom were children.
The authors cited a case involving a 20-month-old girl at Westmead Children’s Hospital in Sydney who presented with enteric fever symptoms that didn’t respond to first-line treatment.
The child had returned from a three-month stay in Karachi, Pakistan where she had experienced ongoing diarrhoea for six weeks, despite taking oral antibiotics.
“Blood and stool cultures grew extended spectrum beta-lactamase producing Salmonella enterica serovar Typhi. The isolate showed microbiological features typical for the XDR clade, with resistance to chloramphenicol, ampicillin, trimethoprim–sulfamethoxazole, fluoroquinolones and third-generation cephalosporins,” the authors said.
The infection was successfully treated with intravenous meropenem and oral azithromycin and the child was discharged after eight days to complete a further week of azithromycin.
But when looking at the child’s history it seems while she had received her routine vaccines, she had not been recommended any pre-travel vaccines.
Dr Deborah Mills, a travel doctor from Brisbane, said while infants below the vaccination age were at risk of typhoid, even vaccinated patients could be at risk because of the low efficacy of the vaccines, which range from 50-80%.
“Because it’s not a highly effective vaccine, patients ask if it’s worth having,” she said. “But it’s still worth having when the alternative is catching a disease that has no particular treatment.”
One of the most important measures to preventing typhoid infection was preventative measures with food hygiene.
Unlike other bacterial infections, the severity of typhoid symptoms was dependent on how much exposure the individual had to the contaminated food, water or even dust.
“Encouraging food and water precautions is particularly important for travellers because they might be able to decrease the amount of exposure they have to typhoid, and will, therefore, experience a less severe illness,” Dr Mills said.
Anecdotally Dr Mills said most typhoid infections tended to be among patients who were staying with friends or family when travelling.
Often, these same patients would be travelling to these countries frequently, without thinking about a travel pre-travel consult with their GP.
“With these patients, it’s important to use another routine appointment, such as coming in to get blood pressure checked, as an opportunity to mention if they are travelling to not forget to get their travel vaccines, such as typhoid,” Dr Mills said.
The authors said that GPs should offer the typhoid vaccine from two years of age for any travel to endemic regions, including South and South-East Asia.
“The important role of GPs in providing travel-related vaccine advice and care to returning travellers must not be underestimated,” they concluded.
