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.

Improved laboratory capacity is required to respond better to future cholera outbreaks in Papua New Guinea

Cholera was first detected in Papua New Guinea in July 2009, caused by Vibrio cholerae O1 El Tor serotype Ogawa. By late 2011, 15 500 cases had been reported throughout lowland Papua New Guinea with a case fatality rate of 3.2%. The epidemic has since slowed, with only sporadic cases reported in Western Province and the Autonomous Region of Bougainville (ARB). Accurate and timely diagnosis is a critical element of the public health response to cholera, yet in low-income countries where the burden of cholera is the greatest, diagnostic services are often limited. Here we report on the diagnostic challenges and the logistical factors that impacted on diagnosis during the first reported outbreak of cholera in Papua New Guinea.

Cholera in Papua New Guinea and the importance of safe water sources and sanitation

Until recently cholera had never been reported in Papua New Guinea despite the close proximity of cholera-endemic countries and the presence of environmental and social characteristics that are considered risk factors for cholera outbreaks. The current outbreak began in July 2009 and rapidly spread throughout the coastal regions of the country. Initial characterization studies using variable-number tandem repeat analysis indicate that the outbreak was a recent clonal incursion from South-East Asia. By mid-2011 the outbreak had resulted in the reporting of more than 15 500 cases of cholera and over 500 deaths: a case fatality ratio (CFR) of approximately 3.2%. Following an outbreak of cholera, interventions such as the introduction of oral rehydration therapy aim to reduce the CFR to below 1%. This elevated CFR is likely a reflection of the inaccessibility of much of the country, the lack of health care services available in remote regions and the general unpreparedness for an outbreak of this kind. This premise is supported by the differences in CFRs between the relatively well-serviced National Capital District (0.1%) and more remote regions such as the Western Province (8.8%).