Typhoid Outbreak And The Role Of Nurses In Karachi, Pakistan: A Systematic Review

Abstract

Background: Typhoid fever remains a major public health concern in Pakistan, particularly in Sindh province, where extensively drug-resistant (XDR) Salmonella enterica serovar Typhi emerged and spread rapidly in urban settings such as Karachi and Hyderabad. The outbreak was intensified by unsafe drinking water, poor sanitation, overcrowding, inappropriate antibiotic use, and delayed healthcare access. Nurses are central to typhoid outbreak response through clinical care, infection prevention and control, vaccination campaigns, surveillance, health education, and community mobilization.

Objective: This systematic review aimed to synthesize evidence on typhoid outbreak trends in Pakistan, with a focus on Karachi, and to critically examine the role of nurses in outbreak prevention, control, and response.

Methods: A systematic narrative review was conducted following PRISMA 2020 principles. Peer-reviewed articles, outbreak reports, surveillance documents, WHO/CDC updates, and relevant grey literature published between 2000 and 2025 were reviewed. Databases and sources included PubMed, Scopus, Web of Science, CINAHL, WHO, CDC/MMWR, UNICEF, Gavi, Coalition Against Typhoid, and national or provincial health reports. Evidence was synthesized around epidemiological trends, XDR typhoid burden, typhoid conjugate vaccine implementation, and nursing roles in clinical and community settings.

Results: The XDR typhoid outbreak in Sindh represents one of the most serious antimicrobial-resistant enteric fever events globally. WHO reported 8,188 typhoid cases in Sindh from November 2016 to December 2018, of which 5,274 were XDR, and Karachi accounted for approximately 69% of XDR cases. Pakistan became the first country to introduce typhoid conjugate vaccine into routine immunization, beginning in Sindh in 2019. Nurses contributed significantly through early case recognition, hydration and fever management, antibiotic administration, infection prevention, vaccine delivery, cold-chain support, health education, school/community mobilization, and reporting of suspected cases.

Conclusion: Nurses are indispensable in typhoid outbreak control in Karachi and other endemic settings. Strengthening nursing capacity in outbreak preparedness, public health surveillance, infection prevention, immunization, antimicrobial stewardship, and WASH-related education can reduce typhoid transmission and improve patient outcomes. Sustainable typhoid control requires integration of nursing leadership with vaccination, safe water, sanitation, laboratory surveillance, and rational antibiotic use.