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

• Published in: MMWR. Morbidity and mortality weekly report 2020-05, Vol.69 (20), p.618-622
• Main Authors: François Watkins, Louise K, Winstead, Alison, Appiah, Grace D, Friedman, Cindy R, Medalla, Felicita, Hughes, Michael J, Birhane, Meseret G, Schneider, Zachary D, Marcenac, Perrine, Hanna, Samir S, Godbole, Gauri, Walblay, Kelly A, Wiggington, Ashley E, Leeper, Molly, Meservey, Elizabeth H, Tagg, Kaitlin A, Chen, Jessica C, Abubakar, Abdinasir, Lami, Faris, Asaad, Asaad M, Sabaratnam, Vickneswaran, Ikram, Aamer, Angelo, Kristina M, Walker, Allison, Mintz, Eric
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Ampicillin; Ceftriaxone; Ceftriaxone - pharmacology; Ceftriaxone - therapeutic use; Child; Child, Preschool; Ciprofloxacin; Disease Outbreaks; Drug resistance; Drug Resistance, Microbial; Female; Full Report; Health aspects; Humans; Infant; Iraq - epidemiology; Male; Meropenem; Middle Aged; Pakistan - epidemiology; Public health; Salmonella; Salmonella typhi - drug effects; Travel-Related Illness; Travelers; Typhoid fever; Typhoid Fever - drug therapy; Typhoid Fever - epidemiology; Typhoid Fever - microbiology; United States - epidemiology; Young Adult
• ISSN: 0149-2195; 1545-861X
• DOI: 10.15585/mmwr.mm6920a2

Ceftriaxone-resistant Salmonella enterica serotype Typhi (Typhi), the bacterium that causes typhoid fever, is a growing public health threat. Extensively drug-resistant (XDR) Typhi is resistant to ceftriaxone and other antibiotics used for treatment, including ampicillin, chloramphenicol, ciprofloxacin, and trimethoprim-sulfamethoxazole (1). In March 2018, CDC began enhanced surveillance for ceftriaxone-resistant Typhi in response to an ongoing outbreak of XDR typhoid fever in Pakistan. CDC had previously reported the first five cases of XDR Typhi in the United States among patients who had spent time in Pakistan (2). These illnesses represented the first cases of ceftriaxone-resistant Typhi documented in the United States (3). This report provides an update on U.S. cases of XDR typhoid fever linked to Pakistan and describes a new, unrelated cluster of ceftriaxone-resistant Typhi infections linked to Iraq. Travelers to areas with endemic Typhi should receive typhoid vaccination before traveling and adhere to safe food and water precautions (4). Treatment of patients with typhoid fever should be guided by antimicrobial susceptibility testing whenever possible (5), and clinicians should consider travel history when selecting empiric therapy.