Description:
Stool samples were collected from 148 healthy adults living a traditional subsistence lifestyle in Papua New Guinea and screened for enteric pathogens using real-time RT-PCR/PCR assays. Enteric pathogens were detected in a high proportion (41%) of individuals. Clear differences were observed in the detection of pathogens between highland and lowland communities. In particular, there was a marked difference in detection rates of norovirus GII (20% and 0%, respectively) and Shigella sp. (15% and 0%, respectively). Analysis of the relationship between enteric pathogen carriage and microbial community composition of participants, using box plots to compare specific normal flora population numbers, did not suggest that gut microbial composition was directly associated with pathogen carriage. This study suggests that enteric pathogens are common in healthy individuals in Papua New Guinean highland communities, presumably acting as a reservoir of infection and thus contributing to a high burden of gastrointestinal illnesses.
Description:
OBJECTIVE: The objective of this study was to investigate a large outbreak of shigellosis in Papua New Guinea that began in a camp for internally displaced persons before spreading throughout the general community. METHODS: Outbreak mitigation strategies were implemented in the affected area to curtail the spread of the disease. Data were collected from the surveillance system and analysed by time, place and person. Rectal swab samples were tested by standard culture methods and real-time polymerase chain reaction to determine the etiology of the outbreak. RESULTS: Laboratory analysis at two independent institutions established that the outbreak was caused by Shigella sp., with one strain further characterized as Shigella flexneri serotype 2. Approximately 1200 suspected cases of shigellosis were reported in a two-month period from two townships in Morobe Province, Papua New Guinea. The outbreak resulted in at least five deaths, all in young children. DISCUSSION: This outbreak of shigellosis highlights the threat of enteric diseases to vulnerable populations such as internally displaced persons in Papua New Guinea, as has been observed in other global settings.
Description:
OBJECTIVE: The objective of this study was to investigate a large outbreak of shigellosis in Papua New Guinea that began in a camp for internally displaced persons before spreading throughout the general community. METHODS: Outbreak mitigation strategies were implemented in the affected area to curtail the spread of the disease. Data were collected from the surveillance system and analysed by time, place and person. Rectal swab samples were tested by standard culture methods and real-time polymerase chain reaction to determine the etiology of the outbreak. RESULTS: Laboratory analysis at two independent institutions established that the outbreak was caused by Shigella sp., with one strain further characterized as Shigella flexneri serotype 2. Approximately 1200 suspected cases of shigellosis were reported in a two-month period from two townships in Morobe Province, Papua New Guinea. The outbreak resulted in at least five deaths, all in young children. DISCUSSION: This outbreak of shigellosis highlights the threat of enteric diseases to vulnerable populations such as internally displaced persons in Papua New Guinea, as has been observed in other global settings.
Description:
Papua New Guinea (PNG) is known to have a large resource base of sago with over 1 million ha, as well as a high number of germplasm types of the Metroxylon species. The country’s food security status is very low and is primarily dependent on subsistence fresh garden produce as practiced by 85% of the population who are rural dwellers. Postharvest losses can be as high as 40% with little to no postharvest technology nor processing of foods done. Sago provides well for food security and sustains life in rural communities during disasters such as droughts, floods, and cyclones. The dilemma of sago being an underutilized crop in PNG is exacerbated by the introduction of new food crops, cash crops, and limited accessibility to cash to purchase other foods. Over the last 50 years, sago consumption has diminished as one of the major traditional food staples, from 16% to less than 10%. Neglect of sago is further due to food safety concerns about traditionally processed sago, in particular, the risk from sago hemolytic disease (SHD). For over 30 years, SHD has been a food safety issue since it was first reported in 1973. Investigations on SHD highlight the serious need to improve on the hygiene and sanitation of the traditional postharvest processing and storage methods of sago starch in PNG. A set of hazard analysis and critical control point (HACCP) protocols has been developed for traditional processing of sago as a food safety measure to improve food safety for food security. While commercial cultivation is nonexistent, there is increased planting of the larger hapaxanthic, non-soboliferous sago species, Metroxylon salomonense Becc., in some nontraditional sago-consuming areas as a low-cost raw material source for roof thatching and other building materials. It is however a wasted opportunity for food security in these areas as the starch from the palm is not utilized. Current work in these areas promotes sago as a potential food source that can be harvested or processed into flour. This is to improve the food security status in areas of high population density, like island communities where land is scarce.
Description:
In view of the dearth of information relating to antibiotic resistance in community- and hospital-acquired bacterial infections in Papua New Guinea (PNG), we carried out a prospective, hospital-based observational study of surgical patients between October 2008 and October 2009. In a sample of 115 patients (median age 30 years; 55% males) suspected of having a bloodstream infection, blood cultures were positive in 11 (10%) and a significant pathogen was isolated in 9 (8%). Staphylococcus aureus was isolated in 4 patients (44%) and 3 were methicillin resistant; all these isolates were considered community acquired because cultures were performed within 48 hours of admission. Of the remaining 5 isolates, 4 were Gram-negative organisms with at least intermediate resistance to chloramphenicol that were grown from blood taken > 48 hours post-admission and thus considered nosocomially acquired. These data suggest two distinct patterns of bacterial infection in PNG surgical inpatients that have implications for national antibiotic prescription guidelines.
Description:
Background: Pneumonia and meningitis are common causes of severe childhood illness in Papua New Guinea (PNG). The etiology of both clinical conditions in PNG has not been recently assessed. Changes in lifestyle, provision and access to healthcare, antimicrobial utilization and resistance, and the national childhood vaccination schedule necessitate reassessment. Methods: A prospective case-control study was undertaken, enrolling children <5 years of age to determine the contemporary etiology of clinically defined moderate or severe pneumonia or suspected meningitis. Cases were identified following presentation for inpatient or outpatient care in Goroka town, the major population centre in the Eastern Highlands Province. Following enrolment, routine diagnostic specimens including blood, nasopharyngeal swabs, urine and (if required) cerebrospinal fluid, were obtained. Cases residing within one hour’s drive of Goroka were followed up, and recruitment of healthy contemporaneous controls was undertaken in the cases’ communities. Results: 998 cases and 978 controls were enrolled over 3 years. This included 784 cases (78.6%) with moderate pneumonia, 187 (18.7%) with severe pneumonia and 75 (7.5%) with suspected meningitis, of whom 48 (4.8%) had concurrent pneumonia. The median age of cases was 7.8 months (Interquartile range [IQR] 3.9–14.3), significantly lower than community controls, which was 20.8 months (IQR 8.2–36.4). Half the cases were admitted to hospital (500/998; 50.1%). Recruitment of cases and controls and successful collection of diagnostic specimens improved throughout the study, with blood volume increasing and rates of blood culture contamination decreasing. The overall case fatality rate was 18/998 (1.8%). Of cases eligible for follow-up, outcome data was available from 76.7%. Low but increasing coverage of Haemophilus influenzae type B conjugate vaccines on the national schedule was observed during the study period: three dose DTPw-HepB-Hib coverage in children >3 months increased from 14.9 to 43.0% and 29.0 to 47.7% in cases and controls (both p < 0.001). Despite inclusion in the national immunization program in 2014, 2015 PCV13 three-dose coverage in cases and controls >3 months was only 4.0 and 6.5%. Conclusions: Recruitment of large numbers of pediatric pneumonia and meningitis cases and community controls in a third-world setting presents unique challenges. Successful enrolment of 998 cases and 978 controls with comprehensive clinical data, biological specimens and follow up was achieved. Increased vaccine coverage remains an ongoing health priority.
Description:
Background: Pneumonia and meningitis are common causes of severe childhood illness in Papua New Guinea (PNG). The etiology of both clinical conditions in PNG has not been recently assessed. Changes in lifestyle, provision and access to healthcare, antimicrobial utilization and resistance, and the national childhood vaccination schedule necessitate reassessment. Methods: A prospective case-control study was undertaken, enrolling children <5 years of age to determine the contemporary etiology of clinically defined moderate or severe pneumonia or suspected meningitis. Cases were identified following presentation for inpatient or outpatient care in Goroka town, the major population centre in the Eastern Highlands Province. Following enrolment, routine diagnostic specimens including blood, nasopharyngeal swabs, urine and (if required) cerebrospinal fluid, were obtained. Cases residing within one hour’s drive of Goroka were followed up, and recruitment of healthy contemporaneous controls was undertaken in the cases’ communities. Results: 998 cases and 978 controls were enrolled over 3 years. This included 784 cases (78.6%) with moderate pneumonia, 187 (18.7%) with severe pneumonia and 75 (7.5%) with suspected meningitis, of whom 48 (4.8%) had concurrent pneumonia. The median age of cases was 7.8 months (Interquartile range [IQR] 3.9–14.3), significantly lower than community controls, which was 20.8 months (IQR 8.2–36.4). Half the cases were admitted to hospital (500/998; 50.1%). Recruitment of cases and controls and successful collection of diagnostic specimens improved throughout the study, with blood volume increasing and rates of blood culture contamination decreasing. The overall case fatality rate was 18/998 (1.8%). Of cases eligible for follow-up, outcome data was available from 76.7%. Low but increasing coverage of Haemophilus influenzae type B conjugate vaccines on the national schedule was observed during the study period: three dose DTPw-HepB-Hib coverage in children >3 months increased from 14.9 to 43.0% and 29.0 to 47.7% in cases and controls (both p < 0.001). Despite inclusion in the national immunization program in 2014, 2015 PCV13 three-dose coverage in cases and controls >3 months was only 4.0 and 6.5%. Conclusions: Recruitment of large numbers of pediatric pneumonia and meningitis cases and community controls in a third-world setting presents unique challenges. Successful enrolment of 998 cases and 978 controls with comprehensive clinical data, biological specimens and follow up was achieved. Increased vaccine coverage remains an ongoing health priority.
Description:
For approximately 200 years, cholera has been feared globally as a disease that can cause rapid-onset epidemics. The causative organisms, Vibrio cholerae O1 and O139 serogroups, are endemic to Southern Asia, but appear to spread globally in waves resulting in seven recognised pandemics to date. The current seventh pandemic has seen the introduction of V. cholerae O1 El Tor into the Oceania region. Since 1962 there have been five large outbreaks at a frequency of approximately one per decade. There have also been regular small outbreaks and clusters of disease throughout the region during the seventh pandemic. The most recent outbreak of cholera in the region occurred in Papua New Guinea in 2009–2011, and this was the largest outbreak to occur in the region to date. In Oceania the majority of people live in high-income settings (Australia and New Zealand) so the risk of cholera transmission is low. Despite this, an estimated 6.5 million people living in the region are at risk of cholera. The most important risk factors are inadequate access to safe water and lack of appropriate sanitation and hygiene measures. However, many other factors may contribute to cholera transmission risk, and people living in Pacific Island countries may be at increased risk in the future due to climate change. Strengthening health delivery services in the region will ensure countries are better equipped to handle future cholera outbreaks; and further understanding the epidemiology of cholera and the causative agent in the region could help prevent future transmission.
Description:
Cholera is a severe diarrhoeal illness caused by infection with the bacterium Vibrio cholerae. From July 2009 to late 2011 Papua New Guinea (PNG) experienced thefirst outbreak of cholera ever reported in this country. During this time > 15,000 cases of cholera were reported, resulting in approximately 500 deaths. The origin of this outbreak is unknown, but considering the remote location of the initial outbreak an infected international traveller is unlikely to be the source. In this paper we review the characteristics of the PNG cholera outbreak and discuss the ongoing threat of cholera to the country and the region.
Description:
We used multilocus sequence typing and variable number tandem repeat analysis to determine the clonal origins of Vibrio cholerae O1 El Tor strains from an outbreak of cholera that began in 2009 in Papua New Guinea. The epidemic is ongoing, and transmission risk is elevated within the Pacific region.
Description:
We used multilocus sequence typing and variable number tandem repeat analysis to determine the clonal origins of Vibrio cholerae O1 El Tor strains from an outbreak of cholera that began in 2009 in Papua New Guinea. The epidemic is ongoing, and transmission risk is elevated within the Pacific region.
Description:
In January 2017, an estimated 3,700 (93%) of 4,000 Khaki Campbell ducks (Anas platyrhynchos domesticus) died in Kampong Thom Province, Cambodia. We detected low pathogenicity avian influenza A(H7N3) virus and anatid herpesvirus 1 (duck plague) in the affected flock; however, the exact cause of the mortality event remains unclear.
Description:
We evaluated the IP-Triple I immunochromatographic rapid test for the detection of rotavirus, norovirus and adenovirus using stool samples from children with diarrhoea. The detection of norovirus and adenovirus was poor compared to polymerase chain reaction assays. However, high sensitivity (92%) and specificity (99%) were obtained for the detection of rotavirus.
Description:
Water, sanitation and hygiene (WASH) interventions aim to improve health outcomes through provision of safe water supplies and improved sanitation facilities, while also promoting better hygiene practices in communities. Population Services International introduced a WASH intervention project in the Hiri District, Central Province in May 2012. Shortly after its introduction we conducted a survey to determine the uptake of the intervention and gauge its impact. We invited 400 households to participate in the study, which consisted of a questionnaire for the head of the household. A total of 395 questionnaires were completed: 314 from households that had participated in the WASH intervention and 81 that had not (controls). Results demonstrated that improved water sources were not routinely used, with a high dependence on well and surface water. While self-reported handwashing was common, use of soap was not common. Treatment of water inside the house was common in the intervention group (95%), compared to 49% in the non-WASH group. The study indicates that people in the Hiri District are supportive of a WASH intervention, with good uptake of some aspects of the intervention. The sustainability of the intervention remains unknown. Targetted interventions focusing on community priorities might be beneficial in the future.
Description:
We evaluated loop-mediated isothermal amplification end-point detection methods for Salmonella, Shigella, and Vibrio cholerae. Detection sensitivities were comparable to real-time PCR methods. The colorimetric dyes hydroxynaphthol blue and SYBR Green I showed increased sensitivity when compared to visual and automated turbidity readings. End-point colorimetric dyes promise great utility in developing settings.