Enhancing the Effectiveness of Surveillance Systems in Pacific Island Countries as Early Warning Systems for Detecting and Responding to COVID-19 Outbreaks: Key Strategies and Recommendations

@#The coronavirus disease 2019 (COVID-19) pandemic has uncovered the need for health systems to be strengthened in order to be able to respond quickly to any potential future outbreaks. In response, the Pacific Syndromic Surveillance System (PSSS) is currently being used by many countries within the Pacific Islands for tracking and addressing infectious disease outbreaks, including COVID-19. To maximise its usefulness as an early warning system, investments must be made in strengthening data quality, data sharing, health facility capacity, technology, and ongoing evaluation of surveillance systems. Doing so will ensure that the PSSS and other surveillance systems can remain effective tools for monitoring and respond to infectious disease outbreaks in the Pacific Islands

Inequities and inequalities in health and some Public Health Proposals that may improve inequities and inequalities in accessing Primary Healthcare Services in Papua New Guinea

@#Inequity and inequality in accessing primary healthcare services can be created by systemic and structural barriers in a health system. A recent review of Papua New Guinea’s (PNG) health system revealed that there are inequities and inequalities in primary healthcare service access. This disparity is magnified in the rural and remote regions of the country. One of the main reasons for this has been the chronic shortage in government funding. This paper presents an overview of inequities and inequalities in health and suggests some public health approaches that may improve primary healthcare service access in PNG

A short report on the COVID-19 response and preparedness activities in Pohnpei, Federated States of Micronesia

@#On January 31st 2020 the President of the Federate States of Micronesia declared a public health emergency due to the global outbreak of Corona Virus Disease 2019 (COVID-19). This short report presents an overview of the COVID-19 response and preparedness activities in the state of Pohnpei following this declaration.

Comparison of Xpert® MTB/RIF with microscopy and cytology in the diagnosis of tuberculous lymphadenopathy in patients presenting for fine needle aspiration biopsy at the Port Moresby General Hospital

@#SUMMARY Patients with a clinical diagnosis of tuberculous lymphadenitis (TBLN) undergoing fine needle aspiration (FNA) biopsy at Port Moresby General Hospital (PMGH) were recruited in a pilot study to compare Xpert® MTB/RIF (Xpert) with microscopy and cytology. From a total of 1080 patients attending the FNA clinic during the study period 107 were recruited, of whom 105 were analysed. Xpert detected Mycobacterium tuberculosis in 65/105 subjects (62%), acid-fast bacilli (AFB) were found in 35/105 (33%) and cytology was positive in 59/105 (56%). 3 of 7 samples unsuitable for microscopy and 9 of the 28 cases (32%) initially classified as non-TBLN were Xpert positive. Xpert was comparable to cytology but more sensitive than microscopy. Xpert also detected multidrug-resistant tuberculosis (MDR-TB) TBLN cases. The results demonstrated that FNA samples are suitable for Xpert analysis at PMGH to diagnose TBLN, which has the added advantage of detecting MDR-TB.

Diagnostic Accuracy of Xpert® Mtb / Rif Compared to Microscopy-Based Methods for Diagnosing Tuberculous Lymphadenitis from Fine Needle Aspirates at the Port Moresby General Hospital, Papua New Guinea

@#Data on the accuracy of Xpert® MTB/RIF (Xpert) assay in detecting TB in lymph node aspirates in Papua New Guinea (PNG) is scanty. This study evaluated Xpert performance in diagnosing tuberculous lymphadenitis (TBLN) using lymph node needle aspirates at the Port Moresby General Hospital (PMGH). The objective of the study was to compare Xpert accuracy to acid fast bacilli (AFB) microscopy, cytomorphology, a composite reference test (CRS) and culture. A total of 107 eligible subjects were recruited out of 1080 clinic attendees. Results showed Xpert detected significantly more cases of TBLN than AFB microscopy (66 vs 35; p=0.001). Compared to AFB microscopy Xpert had a sensitivity of 45.4% (95% CI 33.1-58.1), specificity of 87.8% (95% CI 73.8-95.9), positive predictive value (PPV) of 85.7% (95% CI 71.6-93.4) and negative predictive value (NPV) of 50.0%% (95% CI 43.8-56.1). There was no difference between Xpert and cytomorphology (66 vs 60; p=0.5). Compared to cytomorphology Xpert had a sensitivity of 71.6% (95% CI 58.5-82.5), specificity of 51.1% (95% CI 35.7-66.3), PPV of 66.1% (95% CI 58.2-73.2) and NPV of 57.5% (95% CI 45.2-68.9). There was no difference between Xpert and CRS (66 vs 71; p=0.6). Compared to CRS Xpert had a sensitivity of 76.0% (95% CI 64.4- 85.3), specificity of 66.6% (95% CI 49.0-81.4), PPV of 81.8% (95% CI 73.5-87.9) and NPV of 58.4% (95% CI 46.7-69.4). Culture was completed on 24 subjects with positive isolates in 14 giving a culture yield of 58.3%. Of the 24 subjects, Xpert was positive in 21 subjects. There was no difference between Xpert and culture (21 vs 14; p=0.8). Compared to culture Xpert had a sensitivity of 100.0% (95% CI 76.8-100.0), specificity of 30.0% (95% CI 6.6-65.2), PPV of 66.6% (95% CI 57.1-75) and NPV of 100.0%. The results suggest Xpert is more sensitive than AFB microscopy but comparable to cytomorphology and CRS for TBLN diagnosis in the PNG context. Xpert can be used for diagnosing TBLN at PMGH

Assessment of antibiotics prescribed to patients with peripheral lymphadenopathy referred for fine needle aspiration biopsy at Port Moresby General Hospital, Papua New Guinea

@#The pattern of antibiotics prescribed to patients with peripheral lymphadenopathy was assessed and compared with existing standard treatment guidelines (STGs) in Papua New Guinea (PNG). Information was obtained from patients referred to the Port Moresby General Hospital for fine needle aspiration biopsy by interviewing patients and reviewing patients’ clinic attendance record books and referral letters. Of the 107 patients recruited for the study, 51 (48%) were prescribed antibiotics and, of these, prescription data were obtained from 40 (78%). Amoxycillin, which is recommended as a first-line antibiotic for peripheral lymphadenopathy in PNG STGs, was prescribed in only 18/40 patients (45%). There was also high variability in other antibiotic selection, antibiotic combinations and treatment duration. The results highlight a need for ongoing training on rational antibiotic prescribing.