Pakistan on Friday became the first country in the world to introduce a new typhoid vaccine in an effort to combat a drug-resistant strain of the potentially fatal disease in the Sindh province, officials said.

Pakistani health officials have reported an ongoing outbreak of an extensively drug-resistant typhoid fever that began in the country in November 2016. The strain of Salmonella Typhi bacteria, which has become a so-called “superbug”, has so far infected around 11,000 people in the country, with Sindh province the worst-hit.

According to experts, death rates among those infected by the “superbug” could rise dramatically to as much as 20%.

The typhoid conjugate vaccine (TCV) was introduced at a function in Karachi where Zafar Mirza, special assistant to the prime minister on health, and Azra Fazal Pechuho, provincial minister of health, were present.

Pakistan has become the first country in the world to introduce TCV into its routine immunisation programme through a campaign mode in Sindh, Mirza said.

The vaccine, approved by the World Health Organisation (WHO) in 2018, will initially be used during a two-week immunisation campaign staring from November 18 to November 30 in the urban areas of Sindh.

Later, the government would expand it to the rest of the country on the basis of a phased national introduction strategy, Mirza said.

Health officials said the government introduced the vaccine in Sindh province in a response to an outbreak of typhoid since November 2016 which affected a large number of children.

Mirza said in 2017, 63% of typhoid cases and 70% of typhoid deaths in Pakistan were among children aged below 15 years.

“Children are disproportionately affected by typhoid and its associated complications, and we strongly believe that TCV would protect our children against the potentially fatal disease of typhoid,” he said.

“Starting with Sindh Province, where the need is most urgent, the government has planned a phased national introduction strategy for the vaccine with strong, coordinated support from global and local partners,” he said.

The two-week campaign, launched with the support of Geneva-based Gavi vaccine alliance, aims at targeting 10.1 million children aged between nine months and 15 years in urban areas of Sindh. About 4.7 million children in the metropolis of Karachi would also be administered the vaccine, Mirza said.

GAVI vaccine alliance is backed by several global organisation, including the Bill & Melinda Gates Foundation, the WHO, the World Bank and the UNICEF, which arranges bulk buys to lower vaccine costs for poor countries.

Pechuho said later on the vaccine will be administered on nine-month-old babies across the province as part of routine immunisation programme.

“Beginning the vaccination in urban areas is critical in preventing the disease among the communities most at risk,” she said.

TCV is a one-dose vaccine, injected intramuscularly, that is lower in cost and has higher efficacy. It is expected to provide long lasting immunity in adults, children and infants older than 9 months of age.

Typhoid is a highly contagious disease that spreads quickly when people live in crowded neighbourhoods with weak water and sanitation infrastructure.

Applauding the Pakistan government for prioritizing immunisation of children at risk of typhoid, UNICEF Representative in Pakistan Aida Girma said, “Their phased national introduction plan for TCV will ensure that the vaccine will reach the children most at risk first.