Sindh Health Department, on Tuesday, admitted its failure to formulate an action plan to prevent the spread of the extensively drug-resistant (XDR) strain of typhoid fever in the province. The provincial minister for health, Dr Azra Fazal Pechuho, sighed that the health department still awaited vaccines for XDR typhoid from the federal government as the province battles the outbreak caused by a superbug resistant to most known antibiotics. She added that the strain had claimed four lives since its outbreak from Hyderabad in November 2016, which later spread to Karachi and other cities and towns of the province. Dr Pechuho said that the Sindh Health Department had asked the local governments to improve the chlorination in water supplies, noting that the disease had spread due to the lack of sanitation and the presence of open garbage dumps in Karachi and other places. More than 5,000 children have been affected by this typhoid strain, she continued. XDR typhoid is caused by antimicrobial resistant (AMR) strains of Salmonella enterica serovar Typhi (or S. Typhi) and has been declared by the World Health Organisation (WHO) as a notable public health concern. A report by the Provincial Disease Surveillance and Response Unit (PDSRU) reported 5,274 cases of XDR typhoid out of 8,188 typhoid fever cases in Sindh from November 1, 2016, through December 9, 2018. Sixty-nine per cent of these cases was reported in Karachi, while 27 per cent in Hyderabad district, and four per cent in other districts across the province. The WHO recommended typhoid vaccination in response to confirmed outbreaks of typhoid fever. These vaccinations should be implemented in combination with other efforts to control the disease. At present, azithromycin remains the only affordable first-line oral therapeutic option to manage patients with XDR typhoid in low-resource settings. Published in Daily Times, February 20th 2019.