Diarrhoeal disease surveillance in Papua New Guinea: findings and challenges

Abstract@#Diarrhoeal diseases are among the leading causes of morbidity and mortality in the Western Pacific Region. However, data on the major causes of infectious diarrhoea are limited in many countries within the Region, including Papua New Guinea. In 2013–2014, we conducted surveillance for acute diarrhoeal illness in four provinces in Papua New Guinea. One rural health clinic from each province participated in the surveillance activity. Samples were sent to central laboratories and batch analysed for bacterial and viral gastrointestinal pathogens that are commonly associated with diarrhoea. Across the four sites, the most commonly detected pathogens were Shigella spp., Campylobacter spp. and rotavirus. In this paper, we report the results of the surveillance activity and the challenges that we faced. The lessons learnt may be applicable to other parts of the Region with a similar socioeconomic status.

External quality assessment for arbovirus diagnostics in the World Health Organization Western Pacific Region, 2013–2016: improving laboratory quality over the years

Arboviruses continue to pose serious public health threats in the World Health Organization (WHO) Western Pacific Region. As such, laboratories need to be equipped for their accurate detection. In 2011, to ensure test proficiency, the WHO Regional Office for the Western Pacific piloted an external quality assessment (EQA) programme for arbovirus diagnostics. By 2016, it had grown into a global programme with participation of 96 laboratories worldwide, including 25 laboratories from 19 countries, territories and areas in the Region. The test performance of the 25 laboratories in the Region in 2016 was high with 23 (92%) reporting correct results in all specimens for dengue and chikungunya viruses. For Zika virus, 18 (72%) of the 25 laboratories reported correct results in all specimens, while seven (28%) demonstrated at least one error. When comparing iterations of this EQA programme in the Region between 2013 and 2016, the number of participating laboratories increased from 18 to 25. The first round only included dengue virus, while the latest round additionally included chikungunya, Zika and yellow fever viruses. Proficiency for molecular detection of dengue virus remained high (83–94%) over the four-year period. The observed proficiency for arbovirus diagnostics between 2013 and 2016 is an indicator of laboratory quality improvement in the Region.

Towards elimination of yaws in Papua New Guinea

@#Yaws is a chronic infectious disease caused by Treponema pallidum subsp. pertenue, which causes disease of the skin, bones and joints and is spread by skin-to-skin contact. Most cases are seen in young children living in rural remote communities in coastal areas. A major campaign to eradicate yaws between 1953 and 1958, by mass treatment of affected communities with long-acting, injectable penicillin, reduced the number of cases by 95% in Papua New Guinea (PNG), but yaws has reappeared in recent years. In the period 2008- 2015 PNG reported >25,000 cases per year, and the country is currently home to about 40% of all the cases of yaws in the world. In 2012, one oral dose of azithromycin was shown to be as effective as intramuscular penicillin in the treatment of the disease, and the World Health Organization launched a new initiative to eradicate yaws by 2020. The new treatment policy recommends mass azithromycin treatment of the entire population in endemic areas. Continued vigilance for the development of macrolide resistance in T. pallidum ssp. pertenue will be important as the drug is introduced into public health practice.