Extensively Drug-Resistant Typhoid Fever in Pakistan
Level 4 - Avoid All Travel
Level 3 - Reconsider Nonessential Travel
Level 2 - Practice Enhanced Precautions
Level 1 - Practice Usual Precautions
Key Points
- An outbreak of extensively drug-resistant (XDR) typhoid fever began in Pakistan in 2016, and cases continue to occur. The strains (kind) of Typhi that cause XDR typhoid fever do not respond to most antibiotics used to treat the disease.
- Cases of XDR typhoid fever have been reported worldwide, mostly among travelers returning from Pakistan.
- All travelers to Pakistan are at risk of getting XDR typhoid fever.
- If you are going to Pakistan or other countries in South Asia where typhoid is common, protect yourself by getting a typhoid fever vaccination before your trip and taking extra care to follow safe food and water guidelines during your trip, and washing hands thoroughly with soap and water before eating or touching food. Do not prepare food for others if you become ill.
- If you get sick while traveling, seek medical care. Visit Getting Health Care During Travel to learn how to connect with a doctor or medical services during your trip. If you get sick after returning to the United States, seek medical care, and tell your healthcare provider where and when you traveled. Learn more about typhoid fever at CDC’s typhoid fever page for travelers.
What is typhoid fever?
Typhoid fever is a serious disease caused by Salmonella Typhi (Typhi) bacteria. The bacteria spread through contaminated food and water and person-to-person contact.
Symptoms of typhoid fever include high fever, weakness, stomach pain, headache, constipation or diarrhea, cough, and loss of appetite. Typhoid fever can be fatal without appropriate antibiotic treatment.
Resistance to antibiotics is increasing so your doctor may need to order special tests to determine which antibiotic is right for you.
Typhoid fever can be prevented by receiving a typhoid fever vaccine and following safe food and water guidelines.
Traveler Information
- CDC's Typhoid Fever Website
- Food and Water Safety
- Educational Resources in Bengali, English, Hindi, and Urdu
- Vaccine Information Statement
Clinician Information
- Typhoid & Paratyphoid Fever in CDC Yellow Book
- Typhoid Fever Information for Healthcare Professionals
- Updated Recommendations for the Use of Typhoid Vaccine — Advisory Committee on Immunization Practices, United States, 2015 (MMWR)
- Health Alert Network Health Advisory: Extensively Drug-Resistant Salmonella Typhi Infections Among U.S. Residents Without International Travel
- Update on Extensively Drug-Resistant Salmonella Serotype Typhi Infections Among Travelers to or from Pakistan and Report of Ceftriaxone-Resistant Salmonella Serotype Typhi Infections Among Travelers to Iraq — United States, 2018–2019
Translations of this travel health notice:
This notice was originally posted September 30, 2019.