Extensively drug-resistant typhoid in Pakistan

Original publication date: January 30, 2019

Updated: October 27, 2025

Key points

Typhoid fever is a disease that is caused by a type of bacteria.
Extensively-drug resistant typhoid fever is hard to treat because the bacteria that causes it doesn’t respond to most antibiotics.
Typhoid fever spreads through contaminated food or water, or by contact with an infected person’s feces.
Travellers can lower their risk of getting typhoid fever by taking food and water precautions, and by washing their hands often.
There is a vaccine available to prevent typhoid fever.

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.
Risk of typhoid fever is highest while travelling to areas with:
- poor sanitation
- poor food-handling practices
- limited access to clean water
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.

Talk to a health care provider or visit a travel health clinic, preferably about 6 weeks before your departure date, to get personalized health advice. Even if your travel date is coming up soon, it’s still a worthwhile to make an appointment. Discuss:
- 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.

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.

Sign up for the Registration of Canadians Abroad service to stay connected with the Government of Canada in case of an emergency abroad or an emergency at home.

Take 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 properly
- Wash your hands regularly with soap and water for at least 20 seconds or use a hand sanitizer containing at least 60% alcohol for 20 seconds or until dry.
- This is especially important before eating and after using the washroom/toilet.

Learn more:

Contact your health care provider if you develop symptoms of typhoid. Tell them where you’ve been travelling.
If you are sick from typhoid fever, you should drink plenty of fluids to prevent dehydration (loss of fluids).

Learn more:

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.
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.
It usually takes 8 to 14 days before you show symptoms, although it may take more or less time.
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
In severe cases, the symptoms may worsen and lead to death.