It's rare in developed countries, but the ancient threat of tetanus is still a serious problem in our world.

According to new research, the bacterium that causes the disease is evolving extensive drug resistance and is rapidly replacing strains that aren't resistant.

Antibiotics are the only way to treat the bacterium that causes typhoid. Over the past 30 years, the bacterium's resistance to antibiotics has grown.

In Nepal, Bangladesh, Pakistan, and India, researchers found a recent rise in extensively drug- resistant Typhi strains.

XDR Typhi is impervious to frontline antibiotics, like ampicillin, chloramphenicol, and trimethoprim/sulfamethoxazole, but it is also growing resistant to newer antibiotics, like fluoroquinolones and third- generation cephalo

These strains are spreading quickly around the world.

More than 200 instances of international spread have been identified since 1990.

The majority of the strains have been exported to Southeast Asia, as well as East and Southern Africa.

The rapid spread of highly resistant strains of S. Typhi is a cause for concern and highlights the need to expand prevention measures in countries at greatest risk.

Scientists have been warning about drug-resistant typhoid for a long time, but the new research is the largest genome analysis on the bacterium to date.

The first XDR strain was found in Pakistan. By the end of the year, it had become the most dominant strain in the country.

Most XDR typhoid strains have been fought with third- generation antibiotics.

The majority of cases in Bangladesh, India, Pakistan, Nepal, and Singapore were caused by quinolone resistance. The resistance was taking over.

There is only one oral antibiotic left today. This medicine may not work for a long time.

The efficacy of all oral antimicrobials for typhoid treatment is at risk due to the spread of resistance to azithromycin. We are in serious trouble if these areadopted by XDR S Typhi.

Up to 20 percent of typhoid cases can be fatal if not treated.

If the world doesn't expand access to typhoid conjugate vaccines, there will be another health crisis on its hands.

The authors write that the recent emergence of XDR and S Typhi creates greater urgency for rapidly expanding prevention measures.

Measures need to be taken in countries where the prevalence of antibiotic resistance is high, but given the propensity for international spread, should not be restricted to those settings.

South Asia accounts for 70 percent of all typhoid cases, but if COVID-19 is to be believed, it is easy to spread disease in our modern world.

Health experts argue that nations need to invest in new antibiotic research to prevent that from happening. Up to 36 percent of typhoid cases and deaths could be prevented with a vaccine for children in India.

Pakistan is in the lead on this front. It's the first nation in the world to offer a vaccine for the disease. More nations should follow in the footsteps of millions of children who received the vaccine last year.

Antibiotic resistance is the leading cause of death in the world and it can be prevented with vaccines.

There is no time to waste.

The study was published in a journal