NIH directs To Stop Prescribing Two Basic Typhoid tests in Pakistan

The NIH has recommended that health facilities and practitioners use the blood culture test as the gold standard for typhoid diagnosis.

NIH directs To Stop Prescribing Two Basic Typhoid tests in Pakistan

The National Institute of Health (NIH), the country’s top public health institute, has directed health facilities and practitioners across the country to stop prescribing two basic typhoid tests in Pakistan due to the possibility of false positive results and only use “blood culture tests” for typhoid diagnosis.

Because most labs do not have the capability to perform blood culture tests, “Widal” and “Typhidot” tests are prescribed.

The NIH has recommended that health facilities and practitioners use the blood culture test as the gold standard for typhoid diagnosis. This test is more accurate and reliable than the other two tests.

According to an expert, both tests are contributing to the spread of extensively drug-resistant (XDR) typhoid fever in Pakistan, which is resistant to most antibiotics. He claimed that the country was already exporting poliovirus and had been blamed in recent years for exporting typhoid antimicrobial resistance (AMR) bacteria.

The NIH stated in a letter that it has come to the institution’s attention that some clinical laboratories and hospitals, particularly in flood-affected areas, are still using “Widal” and “Typhidot” tests for typhoid fever confirmation.

“Keeping in view the outbreak of typhoid fever in the country, it is re-emphasised that Widal and Typhidot tests cannot be used for confirmation of typhoid fever and should be discontinued with immediate effect. The only confirmatory test available is a blood culture test,” it said.

Authorities have been requested to conduct a thorough check on laboratories performing those tests through a letter sent to the health departments of the four provinces, the Surgeon General of the Pakistan Army, and the federal health ministry.

A senior NIH officer who is an infectious disease specialist told Dawn that almost a decade ago, the Widal test was discontinued worldwide, and the Typhidot test was also stopped or discouraged in most countries.

“Both tests can produce false-positive results, indicating that a patient is not suffering from typhoid but is infected with typhoid bacteria.” “Resultantly, doctors prescribe antibiotics to those patients, which become a reason for antimicrobial resistance (AMR),” he said.

He claimed that the Typhidot test was only Rs 150, but he was charged around Rs 1,000.

Although the best test for diagnosing typhoid is a blood culture test, which costs around Rs 2,000, the majority of labs do not have the facility to perform that test. “So labs pay doctors a commission to prescribe the Typhidot test, which is widely used across the country,” he explained.

An advisory issued in 2018 by the United States’ leading national public health institute regarding an outbreak of XDR typhoid fever in Pakistan alarmed national and international health officials, as Pakistan was already exporting the polio virus and was now being blamed for exporting AMR Typhoid bacteria.

The Centers for Disease Control and Prevention issued an advisory stating that there was an ongoing outbreak of XDR typhoid fever in Pakistan that did not respond to most antibiotics. Several cases were reported in the United Kingdom and the United States in 2018 among travellers returning from Pakistan.

Bacteria have an internal intelligence, as a result of which, when antibiotics are overused, they adapt to the medication and develop resistance to it. Bacteria could previously be killed with low-potency medicines, but due to AMR, high-potency medicines are now required for the same bacteria.

According to the NIH official, if the irrational use of antibiotics continues, Pakistan will have a large number of patients infected with the XDR typhoid virus.

For over 40 years, the NIH has been involved in multidisciplinary public health-related activities such as diagnostic services, research, and biological production.

In addition to being a national reference centre for influenza diagnosis, the institute is a World Health Organization (WHO) collaborating centre for viral diagnostics and a regional reference laboratory for polio. It also serves as the national laboratory for drug quality control and food quality control.