Key Points

  • An outbreak of extensively drug-resistant (XDR) typhoid fever in Pakistan is ongoing. Extensively drug-resistant infections do not respond to most antibiotics.
  • Cases of XDR typhoid fever have been reported among people in North America, Europe, East Asian, and the South Pacific who traveled to Pakistan.
  • All travelers to Pakistan are at risk of getting XDR typhoid fever.
  • If you are going to South Asia, including Pakistan, protect yourself by getting a typhoid fever vaccination before your trip and taking extra care to follow safe food and water guidelines.

In 2016, a large outbreak of extensively drug-resistant (XDR) Salmonella Typhi infections began in Sindh province, Pakistan, and spread throughout the country. The strains (kinds) of Typhi linked to the outbreak do not respond to most antibiotics used to treat typhoid fever. Some people linked to the outbreak have died. Several countries (including the United States) have reported XDR typhoid fever among people who traveled to and returned from Pakistan.

In the United States, public health officials have increased efforts to quickly interview and test samples from patients who may have typhoid fever.

CDC recommends that all travelers (even short-term travelers) to Pakistan and South Asia be vaccinated against typhoid fever before travel. Visit a doctor or travel clinic to discuss options. Two typhoid fever vaccines have been approved for use in the United States.

  • An injectable vaccine (approved for people aged 2 and older): given as a shot at least 2 weeks before travel
  • An oral vaccine (approved for people aged 6 and older): a total of four capsules taken by mouth (one every other day), finishing at least one week before travel

Because the maker of the oral vaccine temporarily stopped its production in December 2020, it may not be available to travelers. If the oral vaccine is not available, travelers aged 2 and older should get the injectable vaccine.

If you travel abroad and get sick while traveling, seek medical care. If you get sick after returning to the United States, seek medical care and tell your health care provider where and when you traveled. Do not prepare food for other people. Learn more about typhoid fever at CDC’s typhoid fever page for travelers.

CDC Factsheet and Information