Ceftriaxone-resistant Salmonella Typhi Outbreak in Hyderabad City of Sindh, Pakistan: High Time for the Introduction of Typhoid Conjugate Vaccine

Background. The Aga Khan University clinical microbiology laboratory identified an outbreak of ceftriaxone-resistant Salmonella Typhi in Hyderabad, Pakistan, through antimicrobial resistance surveillance. An outbreak investigation was carried out to identify the risk factors and institute control measures. Here we report the preliminary findings of this outbreak investigation, using data collected from 30 November 2016 to 28 March 2017. Methods. The design for the investigation was a case-control study that included identification of culture-proven ceftriaxoneresistant S. Typhi cases, suspected cases from the households or neighborhood of the confirmed cases, and enrollment of controls matched by age to identify the risk factors. Data were collected through face-to-face interviews using a structured questionnaire. Blood cultures were obtained from all suspected cases. Drinking water samples from each household of cases and controls were obtained for microbiological testing. Geographic Information System coordinates were obtained for all cases and controls. Results. Only 2 subdistricts of Hyderabad (Latifabad and Qasimabad) were affected. A total of 101 confirmed cases of ceftriaxone- resistant S. Typhi had been reported in 4 months with the first case reported on 30 November 2016. Median age was 48 (interquartile range, 29-84) months. The majority (60% [61/101]) of the cases were 6-60 months old. More than half (56% [57/101]) of the cases were male. About 60% of the cases were admitted to hospital and treated as inpatient. More than half (57/101) of the patients developed complications related to typhoid. Conclusions. Community awareness was raised regarding chlorination of drinking water and sanitation measures in Hyderabad. These efforts were coordinated with the municipal water and sewage authority established to improve chlorination at processing plants and operationalize fecal sludge treatment plants. Outbreak investigation and control efforts have continued. Immunization of children with typhoid conjugate vaccine within Hyderabad city is planned

Removal of organic micropollutants using advanced membrane-based water and wastewater treatment: A review

© 2019 Elsevier B.V. The rising consumption of pharmaceuticals, personal care products, and endocrine disruptive compounds for healthcare purposes and improving living standards has resulted in the widespread occurrence of organic micropollutants (MPs) in water and wastewater. Conventional water/wastewater treatment plants are faced with inherent limitations in tackling these compounds, leading to difficulties in the provision of secure and safe water supplies. In this context, membrane technology has been found to be a promising method for resolving this emerging concern. To ensure the suitability of membrane-based treatment processes in full-scale applications, we first need to develop a better understanding of the behavior of MPs and the mechanisms behind their removal using advanced membrane technologies. This review provides a thorough overview of the advanced membrane-based treatment methods available for the effective removal of MPs, including reverse osmosis, nanofiltration, ultrafiltration, forward osmosis, and membrane distillation