Fifth International Symposium on Typhoid Fever and other Salmonelloses
Over 200
National and International Delegates Recommend Increased Public
Health Spending on Preventive Strategies
Despite
major advances in understanding the risk factors for typhoid
fever, the disorder is still widely prevalent throughout the
developing world. It is estimated that typhoid fever accounts
for almost 16 million cases and over 600,000 deaths annually
worldwide, according to World Health Organisation (WHO).
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| During
the symposium, Dr. Zulfiqar A. Bhutta highlighted the
growing importance of typhoid as a public health problem
in Pakistan. |
The focus of the fifth international symposium organised
by AKU in February 2002 was Typhoid Fever and other Salmonelloses.
The three-day workshop and symposium was held in collaboration
with WHO, the Welcome Trust, International Center for Genetics
and Biotechnology (ICGEB) (Trieste), International Vaccine
Institute (Seoul), and National Institute for Biotechnology
and Genetic Engineering (NIBGE) (Faisalabad). It was attended
by speakers and delegates from UK, US, Switzerland, Australia,
Indonesia, India, Malaysia, Korea and several other countries.
Over 200 national and international delegates attended the
symposium and workshop on molecular methods in the epidemiology
and diagnosis of typhoid, and strongly recommended an increase
in public health spending on preventive strategies such as
provision of clean water, sanitation and vaccination programmes.
The inaugural session of the symposium featured a keynote
address by the chief guest, Prof. Atta-ur-Rahman, Federal
Minister for Science and Technology who, while describing
typhoid as a poor man's disease, said that because most pharmaceutical
companies found it difficult to invest in the development
of anti-typhoid drugs due to diminished returns, the progress
in curbing typhoid had been slow. He proposed the use of biotechnology
in fighting typhoid, especially the development of vaccines
and biodiagnostic tools, and said that this technology was
one of the areas the government had identified for its focus.
In his keynote lecture on Global Status and Preventive Strategies
for Typhoid Fever, Dr. Bernard Ivanoff of WHO stated that
typhoid fever was a global disease, occurring endemically
throughout the developing world. Dr. Ivonhoff stated that,
"Although available data from developing countries are
probable estimates of the true burden, there are indications
that the true incidence of typhoid in South Asia may exceed
500 cases per 100,000 population." Referring to a recent
survey in Delhi and Karachi, he suggested that the disease
was much more common in preschool children.
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,
Associate Professor in the Department of Microbiology at AKU,
echoed this further in a presentation on increasing quinolone-resistance
among typhoid isolates in Karachi.
In
his presentation on clinical and therapeutic aspects of typhoid
fever in Pakistan, Dr. Zulfiqar A. Bhutta, Professor of Paediatrics
at AKU, highlighted the growing importance of typhoid as a
public health problem in Pakistan. He explained, "Available
information indicates that the disease is predominantly a
paediatric disorder with almost 70% of all culture proven
cases occurring in children." He added that the severity
of disease and rates of hospitalization also appeared to be
higher in this population. Referring to a study among urban
community setting in Karachi using passive surveillance, Prof.
Bhutta said that high rates of typhoid fever were seen in
children. Explaining further, he said that by using a simple
system of clinical screening and decision making in community
settings, the investigators were able to recognise 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's Imperial
College reviewed the available options for micro- biological
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 discussed 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, and Dr. Tariq
Mahmood, who shared his experience at JPMC in the use of ultrasound
in the diagnosis of typhoid fever.
Other
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 WHO and other major international funding organisations
of research needed to place much greater emphasis on this
disease.
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