Transitioning from Analog to Digitalization of Essential Vaccination for Travellers through National Immunization Management System (NIMS) at the Points of Entry in Pakistan

this strain, this is due to culturing constraints as C. difficile is anaerobic therefore making it difficult to culture.A total of 100 clinical stool samples presumptively positive for C. difficile by Gen-eXpert real-time PCR assay and ELISA were collected from public and private settings.Clostridioides difficile was isolated using a selective medium and multiplex polymerase chain reaction (M-PCR) assays were used to identify and screen for toxigenic C. difficile isolates.Results: The study identified 62 toxigenic C. difficile isolates and 53% (33/62) were from public settings, while 47% (29/62) were from private settings.The most frequent toxin profile was tcdA + , tcdB + , cdtA + , cdtB + in 26 (42%) followed by tcdA + , tcdB + , cdtA , cdtB in 22 (35%) isolates.The genes encoding CDT (binary toxin) were also found in 37(60%) isolates.Discussion: This study provides a reference point for further epidemiological and genomic surveillance of CDI in South Africa and Africa in general.This study reports for the first time the hypervirulent strain toxin profile (tcdA + , tcdB + , cdtA + , cdtB + ) in South Africa.Conclusion: Our data advances our knowledge and pathogenicity characteristics of C. difficile in South Africa.Carefully implementing infection control techniques is necessary to stop the spread of C. difficile strains in hospital settings.