Extensively drug-resistant typhoid in Pakistan
Level 1 - Practise health precautions (more details)
Original publication date: January 30, 2019
Updated: January 14, 2025
Current situation
Cases of extensively drug-resistant (XDR) typhoid fever have been reported in Pakistan. Some cases have also been found in people travelling back to Canada from Pakistan. XDR typhoid fever is hard to treat because the bacteria that causes it doesn’t respond to most antibiotics.
The risk of getting XDR typhoid fever in Pakistan can increase during the monsoon season, which happens from June to September. Flooding during this time can make it harder to find clean drinking water and proper sanitation, increasing the chances of getting typhoid fever.
About typhoid fever
Typhoid fever is an illness that is caused by a type of Salmonella bacteria called Salmonella typhi. Extensively drug-resistant typhoid is resistant to many different antibiotics.
Symptoms of typhoid fever include:
- fever
- cough
- diarrhea
- tiredness
- headache
- loss of appetite
- constipation (difficulty passing feces)
- rash of flat, rose-coloured spots on the abdomen or chest
After being exposed to the bacteria that causes typhoid fever, symptoms usually appear within 8 to 14 days, but it can take more or less time. Some people develop no symptoms at all.
In severe cases, the symptoms may worsen and lead to death. These symptoms can include:
- an enlarged liver
- an enlarged spleen
- bleeding in the intestines
Typhoid fever is spread by drinking water or eating food that has been contaminated with the bacteria that causes typhoid fever. It can also be spread if you come into contact with the feces of an infected person.
All travellers going to Pakistan are at risk of getting extensively drug-resistant typhoid fever.
Your risk of typhoid fever is highest while travelling to areas with:
- poor sanitation
- poor food-handling practices
- limited access to clean water
Travellers visiting family and friends are more likely to eat local food and be exposed to untreated water, which puts them at greater risk for food and water-borne diseases.
Learn more:
Typhoid fever
Visiting friends and relatives abroad
Recommendations
Before your trip
Talk to a healthcare provider or visit a travel health clinic preferably about 6 weeks before your trip to get personalized health advice. Even if your travel date is coming up soon, it’s still a good idea to make an appointment.
Discuss with the healthcare provider:
- which pre-travel vaccines or medications may be right for you, including the typhoid vaccine
- whether your routine vaccinations are up-to-date. Many require a booster as an adult
- the medications you’re currently taking or planning to bring with you
Review Pakistan’s Travel Advice and Advisories page often for the most up-to-date travel information and advice. Read any travel health notices applied to Pakistan.
Travel health notices
Pakistan travel advice and advisories
The Government of Canada’s offices abroad can assist Canadian citizens in case of an emergency. You should carry the contact information for the nearest Canadian office and the Emergency Watch and Response Centre in Ottawa open 24/7.
High Commission of Canada in Pakistan
Emergency Watch and Response Centre
Before travelling, sign up for the Registration of Canadians Abroad service so that the Government of Canada can contact and assist you in case of an emergency abroad or help your family or friends reach you in case of an emergency at home.
Registration of Canadians Abroad
Pack a travel health kit and consider purchasing travel health insurance.
Travel health kit
Travel health insurance
During your trip
Practise safe food and water precautions
- Drink water only if it has been boiled or disinfected or if it is in a commercially sealed bottle.
- Only eat foods that are well cooked and served hot. Avoid food served at room temperature.
- Only eat fruits and vegetables if you have washed them in safe water or peeled them yourself.
Clean your hands regularly
- Clean your hands regularly with soap and water for at least 20 seconds or use a hand sanitizer containing at least 60% alcohol.
- This is especially important before eating and after using the washroom/toilet.
- Keep a bottle of hand sanitizer with you when you travel.
- If your hands are visibly dirty, you should wash them with soap and water instead of using hand sanitizer.
Learn more:
Eat and drink safely abroad
Clean your hands to help reduce the spread of infectious diseases
Tips for healthy travel
Travel outside Canada
If you become sick or injured while travelling outside Canada or after your return
After your trip
Monitor your symptoms
If you begin to feel sick during your travel back to Canada, you should:
- put on a well-fitting respirator or mask, if possible
- limit contact with other people, if possible
- inform the flight attendant, cruise staff and/or a border services officer as soon as possible. You may be referred to a quarantine officer for a health assessment and further direction.
If you begin to feel sick after you return to Canada, you should:
- limit contact with other people
- call a healthcare provider and notify them about your symptoms before an in-person appointment, so they can take proper precautions, if necessary
- tell the healthcare provider where you have travelled
If you become ill, drink plenty of water or other fluids to prevent dehydration (loss of fluids) from diarrhea.
Learn more:
If you become sick or injured while travelling outside Canada or after your return
Information for Health Care Professionals
The Committee to Advise on Tropical Medicine and Travel (CATMAT) has developed a statement on International Travellers and Typhoid to provide guidance for health care professionals who are preparing travellers to visit areas with a risk of typhoid.
CATMAT Statement on international travellers and typhoid
- Date modified: