Investigation of polymorphisms in Plasmodium falciparum hrp2, hrp3, aldolase and pldh genes and their impact on the performance of malaria rapid diagnostic tests in Papua New Guinea

@#The World Health Organization (WHO) recommends that parasitological confirmation of clinical malaria diagnosis be performed before antimalarial treatment is administered. Malaria rapid diagnostic tests (RDTs) represent a valuable tool for prompt and efficient diagnosis of malaria in settings where microscopic diagnosis is unavailable or unreliable. Concerns remain, however, that Plasmodium falciparum polymorphisms in the genes coding the antigens detected by RDT could impact on RDT performance. Using field isolates of Plasmodium falciparum, we aimed to characterize genetic variability in histidine-rich proteins 2 and 3 (PfHRP-2 and PfHRP-3), aldolase (ALD) and Plasmodium lactate dehydrogenase (pLDH) genes and to evaluate their impact on the performance of RDT. Pfhrp-2, Pfhrp-3, aldolase and pldh were amplified using polymerase chain reaction (PCR) and sequenced. Genetic variation was observed in pfhrp-2 and pfhrp-3 genes while aldolase and pldh showed high levels of conservation. These findings suggest that RDTs based on pLDH and ALD are reliable in the study settings where there is intense diversity or polymorphisms of histidine-rich protein (HRP). Nevertheless, there is no evidence from this study to suggest that RDTs based on the detection of PfHRP-2 and PfHRP-3 have lower sensitivity in Papua New Guinea (PNG). The results observed in this study will be used to inform the PNG National Department of Health on the continued usage of pLDH/ HRP-2 RDT for malaria diagnosis in PNG.

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.