WHO staff inspecting a health center in Pakistan, where an outbreak of extensively drug-resistant typhoid fever started in 2016 (Photo: Mamunur Malik/WHO).

Typhoid fever is a life-threatening infection of the intestinal tract and bloodstream, caused by the highly virulent bacteria Salmonella Typhi. It only lives in humans and is usually spread between humans through food or water which is contaminated with faeces. The incubation period ranges from 7-14 days on average, but can range from 3 days to two months. Symptoms include prolonged high fever, fatigue, headache, nausea, abdominal pain, constipation or diarrhea, and in some cases a rash. Severe cases may lead to serious complications or even death.

Typhoid fever is an important public health problem in many low and middle income countries, causing between 11 and 21 million cases and between 128,000 to 161,000 deaths each year. The majority of cases occur in South Asia, South-East Asia, and sub-Saharan Africa. The actual burden of typhoid fever in the Eastern Mediterranean Region of WHO remains unknown. In recent time, Pakistan experienced an extensive drug resistant typhoid fever outbreak

To prevent and control Typhoid fever, key interventions include hygiene promotion, improvement of water safety, use of safe water for all purpose, better sanitation infrastructure and ensuring adequate and timely access to patient care. The disease can be treated with antibiotics, although increasing antimicrobial resistance (AMR) is making treatment more complicated. Typhoid vaccination can contribute to reduction of antibiotics use, which will delay AMR. The typhoid vaccination play an important role to control endemic typhoid fever and outbreaks as well. Among the available typhoid vaccines, typhoid conjugate vaccine (TCV) is preferred at all ages for its improved immunological properties, suitability for use in younger children and expected longer duration of protection. However, availability of good quality surveillance data on typhoid fever is a pre-requisite for introduction of typhoid conjugate vaccine either as preventive or control strategy for typhoid fever.   

WHO shipment of antibiotics to respond to the 2017 plague outbreak in Madagascar (Photo: WHO)

Plague is a zoonotic disease caused by enterobacteria Yersinia pestis. It is primarily carried by rodents and spreads to humans and other animals via fleas. Direct person-to-person transmission does not occur except in the case of pneumonic plague, when respiratory droplets may transfer the infection from the patient to others in close contact.

Infected persons usually start with “flu-like” symptoms after an incubation period of 3 to 7 days. Patients typically experience the sudden onset of fever, chills, head and body aches and weakness, vomiting and nausea. Clinical plague infection manifests itself in three forms depending on the route of infection: bubonic, septicaemic and pneumonic.

Plague continues to be a threat because of vast areas of persistent wild rodent infection, who are occasionally in contact with domestic rats. Wild rodent plague exist in scattered areas in the Americas, Asia and Africa including countries bordering the Mediterranean Sea. From 2010 to 2015 there were 3248 cases of plague reported worldwide, including 584 deaths. In the Eastern Mediterranean Region, plague has been reported sporadically in Iran (Islamic Republic of), Iraq, Libya and Pakistan over the past decades.

Antibiotic treatment is effective against plague bacteria, so early diagnosis and early treatment can save lives. Preventive measures include informing people when zoonotic plague is present in their environment and advising them to take precautions against flea bites, and not to handle animal carcasses. WHO aims to prevent plague outbreaks by supporting at-risk countries to build and maintain appropriate surveillance, improve laboratory detection capacity, risk communication and standardize case management.