%0 Journal Article
%@ 2369-2960
%I JMIR Publications
%V 7
%N 5
%P e27276
%T Risk Factors of Extensively Drug Resistant Typhoid Fever Among Children in Karachi: Case-Control Study
%A Vighio,Anum
%A Syed,Muhammad Asif
%A Hussain,Ishfaque
%A Zia,Syed Masroor
%A Fatima,Munaza
%A Masood,Naveed
%A Chaudry,Ambreen
%A Hussain,Zakir
%A Iqbal Baig,Mirza Zeeshan
%A Baig,Mirza Amir
%A Ikram,Aamer
%A S Khader,Yousef
%+ Field Epidemiology and Laboratory Training Program Pakistan, National Institute of Health, Park Road, Chak Shahzad, Islamabad, 44000, Pakistan, 92 519255307, anumvighio@gmail.com
%K case-control study
%K drug resistance
%K extensively drug resistant typhoid fever
%K risk factors
%K typhoid fever
%D 2021
%7 11.5.2021
%9 Original Paper
%J JMIR Public Health Surveill
%G English
%X Background: Extensively drug resistant typhoid fever (XDR-TF) has been responsible for an ongoing outbreak in Pakistan, which began in November 2016. Objective: This study aimed to determine the risk factors associated with XDR-TF. Methods: This age- and sex-matched case-control study was conducted during May-October 2018 in Karachi. All patients with XDR-TF were identified from the laboratory-based surveillance system data. Cases included patients aged <15 years living in Karachi with culture-positive Salmonella enterica serovar Typhi with resistance to chloramphenicol, ampicillin, trimethoprim/sulfamethoxazole, fluoroquinolones, and third-generation cephalosporins. Age- and sex-matched controls included children free from the symptoms of TF, aged under 15 years, and residing in Karachi. All controls were recruited from among those who attended outpatient clinics. Results: A total of 75 cases and 75 controls were included in this study. On univariate analysis, the odds of having XDR-TF were 13-fold higher among participants who used piped municipal water than among those who did not (odds ratio [OR] 12.6, 95% CI 4.1-38.6). The use of bore water was significantly associated with XDR-TF (OR 5.1, 95% CI 1.4-19.0). Cases were more likely to report eating French fries with sauce (OR 13.5, 95% CI 3.9-47.0) and poppadum (OR 3.4, 95% CI 1.7-6.7) from street vendors than controls. Boiling water at home was negatively associated with XDR-TF (OR 0.3, 95% CI 0.2-0.7). On multivariate analysis, 2 factors were independently associated with XDR-TF. Using piped municipal water (OR 10.3, 95% CI 3.4-30.4) and eating French fries with sauce from street vendors (OR 8.8, 95% CI 2.1-36.2) were significantly associated with an increased odds of XDR-TF. Conclusions: Community water supply and street food eating habits were implicated in the spread of the superbug S typhi outbreak, which continues to grow in Karachi. Therefore, it is recommended to improve the community water supply to meet recommended standards and to develop a policy to improve the safety of street food. In addition, health authorities are required to conduct mass vaccination for TF among high-risk groups. 
%M 33973861
%R 10.2196/27276
%U https://publichealth.jmir.org/2021/5/e27276
%U https://doi.org/10.2196/27276
%U http://www.ncbi.nlm.nih.gov/pubmed/33973861