Two Hundred National and International Delegates Recommend Increase in Public Health Spendings on Preventive Strategies: Provision of Clean Water, Sanitation and Vaccination Programmes

The Fifth International Symposium on Typhoid Fever and other Salmonelloses held at Aga Khan University (AKU) over the last three days, concluded on February 7, 2002 with strong recommendations to increase public health spending on preventive strategies such as provision of clean water, sanitation and vaccination programmes.

Leading national and international speakers repeatedly highlighted the need for greater indigenous research into this disease and international collaboration in improving the understanding of the pathogenesis, spread, increasing drug resistance and effective vaccination strategies against typhoid. It was also suggested that the World Health Organization and major international funding organizations of research needed to place much greater emphasis on this disease.

In the opening plenary session, Dr. Chris Parry from Oxford presented an overview of treatment strategies for typhoid and highlighted that although fluoroquinolones are still very effective in the treatment of typhoid, there are worrying trends of increasing resistance in different parts of the world. Dr. Rumina Hasan from Aga Khan University echoed this further in a presentation of increasing quinolone-resistance among typhoid isolates in Karachi.

In his presentation on clinical and therapeutic aspects of typhoid fever in Pakistan, Prof. Zulfiqar A. Bhutta of AKU highlighted the growing importance of typhoid as a public health problem in Pakistan. Available information indicates that the disease is predominantly a paediatric disorder with almost 70% of all culture proven cases occurring in children. The severity of disease and rates of hospitalization also appeared to be higher in this population. In a study among urban community setting in Karachi using passive surveillance, high rates of typhoid fever were seen in children. Using a simple system of screening and decision making the investigators were able to successfully recognize almost 75% of cases of typhoid successfully and treat almost 80-85% with the right choice of antibiotics.

In a session on diagnostics, Dr. John Wain from London Imperial College, reviewed the available options for microbiological detection of typhoid, highlighting the need for better quality control and adequate culture methods. Dr. Pak Leong Lim from Chinese University, Hong Kong, described available serological diagnostic tests and described newer methods that appeared promising. Other speakers in the session included Dr. Abdul Haque from NIBGE (Faisalabad) who described experience with the new PCR test for the detection of typhoid. Dr. Tariq Mahmood presented the experience from JPMC in the use of ultrasound in the diagnosis of typhoid fever.

The Fifth International Symposium on Typhoid Fever and other Salmonelloses and the preceding workshop on Molecular methods in the epidemiology and diagnosis of Typhoid were attended by over 200 national and international delegates, and attracted considerable attention among local scientists and practitioners.