America's Centres for Disease Control and Prevention (CDC) has said anyone heading to Pakistan or anywhere else in South Asia should take extra care with food and water and get a typhoid vaccination.
The CDC said the level two alert had been triggered by an ongoing outbreak of extensively drug-resistant (XDR) typhoid fever in Pakistan that does not respond to most antibiotics. As it has spread through the country, at least four people have died and around 800 have become ill, but travellers have also been affected. One infected traveller returned to the UK and two more returned to the US.
The CDC said: “All travellers to Pakistan are at risk of getting XDR typhoid fever. Those who are visiting friends or relatives are at higher risk than are tourists and business travellers.”
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 more than 200,000 deaths.
Health officials in Pakistan are starting vaccination campaigns in the worst affected areas, while US officials have “increased efforts to quickly interview and test samples from patients with suspected typhoid fever”, the CDC said Antibiotic resistance is a growing problem in lower and middle-income countries such as Pakistan and India, where drugs are poorly regulated and it is easy to buy antibiotics over the counter.
There have also been reports of superbugs in countries such as Yemen and Syria, where the health infrastructure has been damaged after years of unrest. A spokesman for the UK's Foreign and Commonwealth Office added: “The FCO keeps Travel Advice for Pakistan – and all countries – under constant review, and this update reflects the latest understanding of the risks faced by British nationals.
“We encourage British visitors to check FCO Travel Advice fully before travelling.”