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

Greenhill, Andrew R.; Rosewell, Alexander; Kas, Monalisa P.; Manning, Laurens; Latorre, Leomeldo; Siba, Peter; Horwood, Paul F.

doi:10.5365/wpsar.2011.2.4.016

Cited by 12 publications

(12 citation statements)

References 8 publications

(5 reference statements)

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“…In this study we did not type rotavirus, however the globally circulating strains G1P [8], G3P [8], and G2P [4] were recently demonstrated to be the most prevalent in this setting. 6 Routine rotavirus vaccination has not been initiated in Papua New Guinea, so pre-existing immunity due to vaccination is unlikely to have influenced the incidence of rotaviral disease.…”

Section: Discussionmentioning

confidence: 83%

“…3 However, poor diagnostic capacity has greatly limited knowledge pertaining to the aetiology and epidemiology of enteric illnesses in this setting. 4 Past studies have established rotavirus as an important cause of acute gastroenteritis in children in this setting, 5,6 and outbreaks of cholera 7 and shigellosis 8 have also affected many communities. However, little effort has been made in recent years to fully comprehend the aetiology of childhood enteric illness in Papua New Guinea by way of detection of multiple aetiologies, with the most recent comprehensive study conducted on samples that were collected approximately 25 years ago.…”

Section: Introductionmentioning

confidence: 99%

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Detection of enteric viral and bacterial pathogens associated with paediatric diarrhoea in Goroka, Papua New Guinea

Soli

Maure

Kas

et al. 2014

International Journal of Infectious Diseases

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Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Detection of enteric viral and bacterial pathogens associated with paediatric diarrhoea in Goroka, Papua New Guinea

Soli

Maure

Kas

et al. 2014

International Journal of Infectious Diseases

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“…Recent outbreaks of shigellosis [9] and cholera [10,11] in PNG have demonstrated the impact diarrhoeal diseases can have on the adult population. The recent cholera epidemic was the first outbreak of this disease in PNG and the response at the national level was hampered by a lack of diagnostic capacity [12]. As part of the response to the cholera outbreak, we conducted surveillance of diarrhoea in children and adults in the Eastern Highlands of PNG at a time when sporadic cases of cholera had been reported in highland provinces.…”

Section: Introductionmentioning

confidence: 99%

Antibiotic resistant Shigella is a major cause of diarrhoea in the Highlands of Papua New Guinea

Greenhill

Guwada

Siba

et al. 2014

J Infect Dev Ctries

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Introduction: Diarrhoea remains a major cause of illness in Papua New Guinea (PNG); however, little is known about its aetiology. As a result of the cholera outbreak that spread throughout PNG in 2009-2011, we conducted diarrhoeal surveillance in Eastern Highlands Province. Methodology: Following informed consent and a brief questionnaire, participants provided a stool sample or duplicate rectal swabs. Samples were tested for common bacterial pathogens Salmonella spp., Shigella spp., Vibrio spp., Campylobacter spp. and Yersinia enterocolitica using established culture methods. Enteric parasites were detected using microscopy. Results: A total of 216 participants were enrolled; where age was recorded, 42% were under 5 years of age, 6.7% were 5 to 17 years of age and 51.3% ≥18 years of age. One or more pathogens were detected in 68 (31.5%) participants, with Shigella (primarily S. flexneri) being the most commonly isolated (47 of 216 participants). Enteric parasites were detected in 23 of the 216 participants, occurring as a co-infection with another pathogen in 12 of 23 cases. No Vibrio cholerae was detected. Shigella isolates were commonly resistant to ampicillin, tetracycline, co-trimoxazole and chloramphenicol. Conclusions: Shigellae, specifically S. flexneri, are important pathogens in the highlands of PNG. While most studies in low-income settings focus on childhood aetiology, we have demonstrated the importance of Shigella in both children and adults. Enteric parasites remain present and presumably contribute to the burden of gastrointestinal illness. While improvements in sanitation and hygiene would help lower the burden of all aetiologies of infectious diarrhoea, additional control strategies targeting Shigella may also be warranted.

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“…Microbiologic confirmation of only a small proportion of suspected cholera cases is also reported in other national surveillance systems in resource-limited countries [26] – [28] . Since culture confirmation takes time, delays in identification of outbreaks have been reported as seen in the experience in Papua New Guinea [29] . Third, although conventional culture is the gold standard in the diagnosis of cholera, in a study in Bangladesh, ∼40% of suspected cholera cases occurring during acute diarrhea outbreaks and lacking a confirmed etiology were later determined to have V. cholerae using direct fluorescent antibody assay, multiplex-PCR and El Tor-specific lytic phage on plaque assay [30] .…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Cholera in the Philippines

et al. 2015

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BackgroundDespite being a cholera-endemic country, data on cholera in the Philippines remain sparse. Knowing the areas where cholera is known to occur and the factors that lead to its occurrence will assist in planning preventive measures and disaster mitigation.MethodsUsing sentinel surveillance data, PubMed and ProMED searches covering information from 2008–2013 and event-based surveillance reports from 2010–2013, we assessed the epidemiology of cholera in the Philippines. Using spatial log regression, we assessed the role of water, sanitation and population density on the incidence of cholera.Results and DiscussionWe identified 12 articles from ProMED and none from PubMed that reported on cholera in the Philippines from 2008 to 2013. Data from ProMed and surveillance revealed 42,071 suspected and confirmed cholera cases reported from 2008 to 2013, among which only 5,006 were confirmed. 38 (47%) of 81 provinces and metropolitan regions reported at least one confirmed case of cholera and 32 (40%) reported at least one suspected case. The overall case fatality ratio in sentinel sites was 0.62%, but was 2% in outbreaks. All age groups were affected. Using both confirmed and suspected cholera cases, the average annual incidence in 2010–2013 was 9.1 per 100,000 population. Poor access to improved sanitation was consistently associated with higher cholera incidence. Paradoxically, access to improved water sources was associated with higher cholera incidence using both suspected and confirmed cholera data sources. This finding may have been due to the breakdown in the infrastructure and non-chlorination of water supplies, emphasizing the need to maintain public water systems.ConclusionOur findings confirm that cholera affects a large proportion of the provinces in the country. Identifying areas most at risk for cholera will support the development and implementation of policies to minimize the morbidity and mortality due to this disease.

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

Cited by 12 publications

References 8 publications

Detection of enteric viral and bacterial pathogens associated with paediatric diarrhoea in Goroka, Papua New Guinea

Detection of enteric viral and bacterial pathogens associated with paediatric diarrhoea in Goroka, Papua New Guinea

Antibiotic resistant Shigella is a major cause of diarrhoea in the Highlands of Papua New Guinea

Epidemiology of Cholera in the Philippines

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