{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T14:02:19Z","timestamp":1790258539696,"version":"4.1.0"},"reference-count":37,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3_Suppl","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,9,6]]},"abstract":"<jats:p>Typhoid remains a major cause of morbidity and mortality in endemic countries. This review analyzed typhoid burden changes in Pakistan and its association with contextual factors. A retrospective cohort study on blood culture\u2013positive typhoid and antibiotic resistance was conducted from three tertiary hospitals and contextual factor data obtained from primary household surveys. <jats:italic>Salmonella<\/jats:italic> Typhi\/Paratyphi positivity rates were estimated and trend analysis was carried out using positive cases out of total number of blood cultures performed. Contextual factors\u2019 associations were determined through bivariate correlation analysis, using STATA (SataCorp, College Station, TX). We report a total of 17,387 <jats:italic>S.<\/jats:italic> Typhi<jats:italic>\u2013positive<\/jats:italic> and 8,286 <jats:italic>S.<\/jats:italic> Paratyphi A and B\u2013positive specimens from 798,137 blood cultures performed. The results suggest an overall decline in typhoid incidence as <jats:italic>S.<\/jats:italic> Typhi positivity rates declined from 6.42% in 1992 to 1.32% in 2015 and <jats:italic>S.<\/jats:italic> Paratyphi (A and B) from 1.29% to 0.39%. Subgroup analysis suggests higher <jats:italic>S.<\/jats:italic> Typhi prevalence in adults older than 18 years, whereas <jats:italic>S.<\/jats:italic> Paratyphi is greater in children aged 5\u201318 years. The relative contribution of <jats:italic>S.<\/jats:italic> Paratyphi to overall confirmed cases increased from 16.8% in 1992 to 23% in 2015. The analysis suggests high burden of fluoroquinolone resistance and multidrug-resistant <jats:italic>S.<\/jats:italic> Typhi strains. Statistically significant associations of water, sanitation indicators, and literacy rates were observed with typhoid positivity. Despite some progress, typhoid remains endemic and a strong political will is required for targeted typhoid control strategies. A multipronged approach of improving water, sanitation and hygiene in combination with large-scale immunization in endemic settings of Pakistan could help reduce burden and prevent epidemics.<\/jats:p>","DOI":"10.4269\/ajtmh.18-0145","type":"journal-article","created":{"date-parts":[[2018,7,26]],"date-time":"2018-07-26T07:00:24Z","timestamp":1532588424000},"page":"48-54","source":"Crossref","is-referenced-by-count":46,"title":["Trends, Associations, and Antimicrobial Resistance of Salmonella Typhi and Paratyphi in Pakistan"],"prefix":"10.4269","volume":"99","author":[{"given":"Jai K.","family":"Das","sequence":"first","affiliation":[{"name":"Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rumina","family":"Hasan","sequence":"additional","affiliation":[{"name":"Department of Pathology, The Aga Khan University, Karachi, Pakistan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afia","family":"Zafar","sequence":"additional","affiliation":[{"name":"Department of Pathology, The Aga Khan University, Karachi, Pakistan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imran","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aamer","family":"Ikram","sequence":"additional","affiliation":[{"name":"Armed Forces Institute of Pathology, National University of Medical Sciences, Rawalpindi, Pakistan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Summiya","family":"Nizamuddin","sequence":"additional","affiliation":[{"name":"Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saleel","family":"Fatima","sequence":"additional","affiliation":[{"name":"Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nauman","family":"Akbar","sequence":"additional","affiliation":[{"name":"Armed Forces Institute of Pathology, National University of Medical Sciences, Rawalpindi, Pakistan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faisal","family":"Sultan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zulfiqar A.","family":"Bhutta","sequence":"additional","affiliation":[{"name":"Centre of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan;"},{"name":"Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada;"},{"name":"Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Int J Infect Dis","first-page":"215","article-title":"Typhoid fever in children: some epidemiological considerations from Karachi, Pakistan","volume":"10","author":"Siddiqui","year":"2006"},{"key":"b2","series-title":"Arch Intern Med (Chic)","first-page":"629","article-title":"Typhoid: clinical analysis of three hundred and sixty cases","volume":"78","author":"Stuart","year":"1946"},{"key":"b3","series-title":"Int J Sci Stud","first-page":"83","article-title":"Knowledge, attitude and practice of general practitioners regarding typhoid fever","volume":"3","author":"Paul","year":"2016"},{"key":"b4","series-title":"Bull World Health Organ","first-page":"346","article-title":"The global burden of typhoid fever","volume":"82","author":"Crump","year":"2004"},{"key":"b5","author":"World Health Organization","year":"2016"},{"key":"b6","series-title":"J Glob Health","first-page":"010401","article-title":"Typhoid fever and paratyphoid fever: systematic review to estimate global morbidity and mortality for 2010","volume":"2","author":"Buckle","year":"2012"},{"key":"b7","series-title":"Bull World Health Organ","first-page":"260","article-title":"A study of typhoid fever in five Asian countries: disease burden and implications for controls","volume":"86","author":"Ochiai","year":"2008"},{"key":"b8","series-title":"Trop Geogr Med","first-page":"336","article-title":"Typhoid perforation. 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