Health Protection Scotland (HPS) have issued a reminder to travellers that an outbreak of extensively-drug resistant (XDR) typhoid continues in Pakistan. As reported by the Centers for Disease Control and Prevention (CDC), the XDR typhoid outbreak originated in Hyderabad in 2016, subsequently spreading to Karachi and multiple districts of Sindh Province. As a result, cases among travellers returning to the United Kingdom and the United States from Pakistan were reported in 2018.
Vaccination is recommended for travellers to high-risk areas where food and water may be contaminated. Vaccination in low-risk areas may be recommended only to those staying in conditions with poor sanitation and unable to maintain their own hygiene precautions e.g. hand hygiene and water purification.
Information and advice for travellers on typhoid is available from the TRAVAX (for health professionals) and fitfortravel (for the general public) websites.