A virulent strain.

Byline: Huma Khawar

TO the horror of healthcare experts, Hyderabad, Karachi and other parts of Sindh have experienced an unprecedented eruption of extensive drug-resistant (XDR) typhoid cases over the past two years. An XDR strain is just one step away from being resistant to any drug used to stem typhoid.

Ever since the first case was detected on Nov 30, 2016, the situation has escalated. In the last three years, a total of 10,195 typhoid fever cases have been reported, with a majority suffering from XDR.

Recent reports have confirmed that people diagnosed with XDR typhoid in several non-endemic countries - the US, the UK, Canada, Spain, Australia, Denmark, Taiwan and Ireland - have had a travel history in Pakistan.

This news sent shockwaves across the world health community, prompting an urgency to address the issue at its root. And so, later this month, all eyes will be on Pakistan. It will be the first country globally to introduce typhoid prevention vaccine - Typhoid Conjugate Vaccine (TCV) - in its childhood immunisation programme, at the age of nine months.

Starting from Sindh, the vaccine will then be introduced in Punjab and Islamabad in 2020, and the rest of the country in 2021. Spread over 12 days, up to 10.1 million children between nine months and 15 years of age in all urban areas of the 29 districts of Sindh will be vaccinated.

In the last three years, 10,195 typhoid cases have been reported in Sindh.

But the upcoming campaign to ensure coverage as high as 95 per cent in every town and district will face many challenges.

Almost half the targeted children (44pc) are school-going. The campaign teams will be spending the first four days vaccinating children only in school. Covering public schools may be relatively easy, but reaching private schools and madressahs may pose the same 'trust deficit in public healthcare' problem that previous measles and polio campaigns encountered.

The other hard-to-reach group would be the non-school-going children aged five years and above, which is almost 20pc of the total target. Most vulnerable and difficult to trace, this group includes children working as domestic help, at auto workshops, vendors and street children.

Karachi and Hyderabad are home to a large number of urban slums. A profiling of urban and peri-urban slums identified a total of 1,317 slums in Karachi and Hyderabad alone. Nearly 75pc of these slums are located in 18 towns of Karachi, while the remaining 25pc are within four...