Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Jan 19, 2021
Date Accepted: Mar 10, 2021
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Risk Factors of Extensive Drug Resistant Typhoid Fever among Children in Karachi: A Case-Control Study Extensively Drug-Resistant Typhoid Fever (XDR-TF) was responsible for a continuing outbreak in Pakistan that began in November 2016.
ABSTRACT
Background:
Extensively Drug-Resistant Typhoid Fever (XDR-TF) was responsible for a continuing outbreak in Pakistan that began in November 2016.
Objective:
This study aimed to determine the risk factors associated with XDR-TF.
Methods:
Age and sex-matched case-control study (75 cases and 75 Controls) was conducted during May-October 2018 in Karachi. All patients with XDR-TF were identified from the lab-based surveillance system data. Cases were defined as patients aged < 15 years living in Karachi with culture positive Salmonella enterica serovar who are resistant to chloramphenicol, ampicillin, trimethoprim-sulfamethoxazole, fluoroquinolones and third generation cephalosporins. Age and sex-matched controls were defined as children free from symptoms of typhoid fever, under 15 years, and resident of Karachi. All controls were recruited from those attending outpatient clinics.
Results:
A total of 75 cases and 75 controls were included in this study. In the univariate analysis, the odds of having XDR-TF in participants who used piped municipal water were 13 times higher as compared to those who did not (OR=12.6, 95% CI: 4.1 – 38.6). Use of bore water was significantly associated with XDR-TF (OR=5.1, 95% CI: 1.4-19.0). Cases were more likely to report eating French fries with sauce (OR=13.5, 95% CI: 3.9 –47.0) and poppadum (OR=3.4, 95% CI: 1.7 – 6.7) from street vendors. Boiling water at home was negatively associated with with XDR-TF (OR=0.3, 95% CI: 0.2 – 0.7). In the multivariate analysis, two factors were independently associated with XDR-TF. Using piped municipal water (OR=10.3, 95% CI: 3.4 – 30.4) and eating French fries with sauce from street vendors (OR=8.8, 95% CI: 2.1 – 36.2) were significantly associated with increased odds of XDR-TF.
Conclusions:
Community water supply and street vendor eating habits were implicated in the spread of the superbug S typhi outbreak that continues to grow in Karachi. Therefore, it is recommended to improve community water supply to meet recommended standards and develop a policy to improve safety of street food. In addition, health department should conduct mass vaccination in high-risk group against typhoid fever.
Citation
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