Drug-resistant typhoid cases rise, say scientists 

Saturday October 23 2021

Typhoid is spread through poor sanitation. PHOTO | FILE

By Elizabeth Merab

Scientists have warned of a “dramatic” increase in the number of multidrug-resistant typhoid, a bacterial disease spread through contaminated food, water, or close contact.

A three-year case-control study on more than 13,000 children, aged less than 16 in an informal settlement in Nairobi county, revealed that more are getting infected with the hard-to-treat typhoid, further creating a burden on the health system.

Genomic sequencing of the stool cultures (4,670 cases of typhoid fever and 8,549 age-matched controls) showed 97 per cent were found to be resistant to some types of broadly used antibiotics. A further 76 percent (3,549) were found to have multidrug-resistant characteristics.

“The high rate of multidrug-resistant H58 S. typhi, and the close phylogenetic relationships between cases and controls, provides evidence of the role of carriers as a reservoir for the community spread of typhoid in this setting,” the authors, led by Samuel Kariuki, the acting director general of Kenya Medical Research Institute, said.

Typhoid is a bacterial infection that can lead to a high fever, diarrhoea, vomiting and death. It is caused by the bacteria Salmonella typhi.

The infection occurs predominantly through poor sanitation and lack of clean drinking water, in both urban and rural settings.


Every year, the World Health Organisation estimates that 11 million to 20 million people get sick from typhoid, and between 128,000 and 161,000 people die from it globally.

Inadequate sanitation

However, urbanisation, with associated overcrowded populations and inadequate water and sanitation systems, as well as climate change, have the potential to further increase the global burden of typhoid. Increasing antibiotic resistance is making it easier for typhoid to spread.

According to the US Centers for Disease Control and Prevention, the H58 S. Typhi is resistant to commonly used antibiotics like chloramphenicol, ampicillin, and trimethoprim/sulfamethoxazole.

Hard-to-treat infections (antimicrobial resistance, AMR) have become a serious public health concern for doctors and scientists across the world.

Resistance occurs when bacteria, viruses, fungi, and parasites change over time and no longer respond to medicines, especially antibiotics, making infections harder to treat and increasing the risk of disease spread, severe illness, and death.

According to WHO, infections that are resistant to antibiotics could cause an estimated 10 million deaths each year by 2050.

According to a two-year study commissioned by the UK government in 2016, 700,000 people die of resistant infections every year.

Antibiotics are a special category of drugs that underpin modern medicine as we know it: If they lose their effectiveness, key medical procedures such as stomach surgery, Caesarean sections, joint replacements, and treatments that depress the immune system, such as chemotherapy for cancer could become too dangerous to perform.

There is little national data on the deaths caused by AMR in Kenya, but the Ministry of Health reported more than 600,000 drug resistance tuberculosis cases in 2016.

The increasing resistance to antibiotics is largely caused by misuse and overuse of the drugs.

Some bacteria that are capable of causing serious diseases are becoming resistant to the most commonly available antibiotics.

Often called superbugs, antibiotic-resistant bacteria can cause infections in the lungs, urinary tract, and skin infections.

These superbugs can spread and share their antibiotic-resistant qualities with healthy bacteria in a person’s body.

When an infection happens, it is difficult, if not impossible, to treat effectively.

Between 2008 and 2011, WHO received reports that Vibrio cholera — the bacteria that causes cholera — was resistant to cotrimoxazole sold under the generic name Septrin, a broad-spectrum antibiotic.