Diarrhoeal disease surveillance in Papua New Guinea : findings and challenges
- Abdad, Mohammad, Soli, Kevin, Pham, Bang, Bande, Grace, Maure, Tobias, Jonduo, Marinjo, Kisa, Debbie, Rai, Glennis, Phuanukoonnon, Suparat, Siba, Peter, Horwood, Paul, Greenhill, Andrew
- Authors: Abdad, Mohammad , Soli, Kevin , Pham, Bang , Bande, Grace , Maure, Tobias , Jonduo, Marinjo , Kisa, Debbie , Rai, Glennis , Phuanukoonnon, Suparat , Siba, Peter , Horwood, Paul , Greenhill, Andrew
- Date: 2020
- Type: Text , Journal article
- Relation: Western Pacific Surveillance and Response Vol. 11, no. 1 (Jan-Mar 2020), p. 6
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- Description: 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.
- Authors: Abdad, Mohammad , Soli, Kevin , Pham, Bang , Bande, Grace , Maure, Tobias , Jonduo, Marinjo , Kisa, Debbie , Rai, Glennis , Phuanukoonnon, Suparat , Siba, Peter , Horwood, Paul , Greenhill, Andrew
- Date: 2020
- Type: Text , Journal article
- Relation: Western Pacific Surveillance and Response Vol. 11, no. 1 (Jan-Mar 2020), p. 6
- Full Text:
- Reviewed:
- Description: 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.
A high burden of asymptomatic gastrointestinal infections in traditional communities in Papua New Guinea
- Horwood, Paul, Soli, Kevin, Maure, Tobias, Naito, Yuichi, Morita, Ayako, Natsuhara, Kazumi, Tadokoro, Kiyoshi, Baba, Jun, Odani, Shingo, Tomitsuka, Eriko, Igai, Katsura, Larkins, Jo-Ann, Siba, Peter, Pomat, William, McBryde, Emma, Umezaki, Masahiro, Greenhill, Andrew
- Authors: Horwood, Paul , Soli, Kevin , Maure, Tobias , Naito, Yuichi , Morita, Ayako , Natsuhara, Kazumi , Tadokoro, Kiyoshi , Baba, Jun , Odani, Shingo , Tomitsuka, Eriko , Igai, Katsura , Larkins, Jo-Ann , Siba, Peter , Pomat, William , McBryde, Emma , Umezaki, Masahiro , Greenhill, Andrew
- Date: 2017
- Type: Text , Journal article
- Relation: American Journal of Tropical Medicine and Hygiene Vol. 97, no. 6 (2017), p. 1872-1875
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- 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.
- Authors: Horwood, Paul , Soli, Kevin , Maure, Tobias , Naito, Yuichi , Morita, Ayako , Natsuhara, Kazumi , Tadokoro, Kiyoshi , Baba, Jun , Odani, Shingo , Tomitsuka, Eriko , Igai, Katsura , Larkins, Jo-Ann , Siba, Peter , Pomat, William , McBryde, Emma , Umezaki, Masahiro , Greenhill, Andrew
- Date: 2017
- Type: Text , Journal article
- Relation: American Journal of Tropical Medicine and Hygiene Vol. 97, no. 6 (2017), p. 1872-1875
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- 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.
- Tomitsuka, Eriko, Igai, Katsura, Tadokoro, Kiyoshi, Morita, Ayako, Baba, Jun, Suda, Wataru, Greenhill, Andrew, Horwood, Paul, Soli, Kevin, Siba, Peter, Odani, Shingo, Natsuhara, Kazumi, Morita, Hidetoshi, Umezaki, Masahiro
- Authors: Tomitsuka, Eriko , Igai, Katsura , Tadokoro, Kiyoshi , Morita, Ayako , Baba, Jun , Suda, Wataru , Greenhill, Andrew , Horwood, Paul , Soli, Kevin , Siba, Peter , Odani, Shingo , Natsuhara, Kazumi , Morita, Hidetoshi , Umezaki, Masahiro
- Date: 2017
- Type: Text , Journal article
- Relation: Metabolomics Vol. 13, no. 9 (2017), p.
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- Description: Introduction: Adequate amount of proteins from foods are normally needed to maintain muscle mass of the human body. Although protein intakes of Papua New Guinea (PNG) highlanders are less than biologically adequate, protein deficiency related disorders have rarely been reported. It has been postulated that gut microbiota play a role in such low-protein-adaptation. Objective: To explore underlying biological mechanisms of low-protein adaptation among PNG highlanders by investigating metabolomic profiles of faecal water and urine. Methods: We performed metabolome analysis using faecal water extracted from faecal samples of PNG highlanders, PNG non-highlanders and Japanese subjects. We paid special attention to amino acids and other metabolites produced by gut microbiota, as well as to metabolites involved in nitrogen recycling in the human gut. Results: Our results indicated that amino acid levels were higher in faecal water from PNG highlanders than PNG non-highlanders, but amino acid levels did not differ between PNG highlanders and Japanese subjects. Among PNG highlander samples, amino acid levels tended to be higher in those who consumed less protein. Conclusion: We speculated that a greater proportion of urea was excreted to the intestine among the PNG highlanders than other groups, and that the urea was used for nitrogen salvage. Intestinal bacteria are essential for producing ammonia from urea and also for producing amino acids from ammonia, which is a key process in low-protein adaptation. Profiling the gut microbiota of PNG highlanders is an important avenue for further research into the mechanisms of low-protein adaptation.
Nitrogen fixation and nifH diversity in human gut microbiota
- Igai, Katsura, Itakura, Manabu, Nishijima, Suguru, Tsurumaru, Hirohito, Suda, Wataru, Tsutaya, Takumi, Tomitsuka, Eriko, Tadokoro, Kiyoshi, Baba, Jun, Odani, Shingo, Natsuhara, Kazumi, Morita, Ayako, Yoneda, Minoru, Greenhill, Andrew, Horwood, Paul, Inoue, Jun-ichi, Ohkuma, Moriya, Hongoh, Yuichi, Yamamoto, Taro, Siba, Peter, Hattori, Masahira, Minamisawa, Kiwamu, Umezaki, Masahiro
- Authors: Igai, Katsura , Itakura, Manabu , Nishijima, Suguru , Tsurumaru, Hirohito , Suda, Wataru , Tsutaya, Takumi , Tomitsuka, Eriko , Tadokoro, Kiyoshi , Baba, Jun , Odani, Shingo , Natsuhara, Kazumi , Morita, Ayako , Yoneda, Minoru , Greenhill, Andrew , Horwood, Paul , Inoue, Jun-ichi , Ohkuma, Moriya , Hongoh, Yuichi , Yamamoto, Taro , Siba, Peter , Hattori, Masahira , Minamisawa, Kiwamu , Umezaki, Masahiro
- Date: 2016
- Type: Text , Journal article
- Relation: Scientific Reports Vol. 6, no. (2016), p. 1-11
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- Description: It has been hypothesized that nitrogen fixation occurs in the human gut. However, whether the gut microbiota truly has this potential remains unclear. We investigated the nitrogen-fixing activity and diversity of the nitrogenase reductase (NifH) genes in the faecal microbiota of humans, focusing on Papua New Guinean and Japanese individuals with low to high habitual nitrogen intake. A 15 N 2 incorporation assay showed significant enrichment of 15 N in all faecal samples, irrespective of the host nitrogen intake, which was also supported by an acetylene reduction assay. The fixed nitrogen corresponded to 0.01% of the standard nitrogen requirement for humans, although our data implied that the contribution in the gut in vivo might be higher than this value. The nifH genes recovered in cloning and metagenomic analyses were classified in two clusters: one comprising sequences almost identical to Klebsiella sequences and the other related to sequences of Clostridiales members. These results are consistent with an analysis of databases of faecal metagenomes from other human populations. Collectively, the human gut microbiota has a potential for nitrogen fixation, which may be attributable to Klebsiella and Clostridiales strains, although no evidence was found that the nitrogen-fixing activity substantially contributes to the host nitrogen balance. © The Author(s) 2016.
- Authors: Igai, Katsura , Itakura, Manabu , Nishijima, Suguru , Tsurumaru, Hirohito , Suda, Wataru , Tsutaya, Takumi , Tomitsuka, Eriko , Tadokoro, Kiyoshi , Baba, Jun , Odani, Shingo , Natsuhara, Kazumi , Morita, Ayako , Yoneda, Minoru , Greenhill, Andrew , Horwood, Paul , Inoue, Jun-ichi , Ohkuma, Moriya , Hongoh, Yuichi , Yamamoto, Taro , Siba, Peter , Hattori, Masahira , Minamisawa, Kiwamu , Umezaki, Masahiro
- Date: 2016
- Type: Text , Journal article
- Relation: Scientific Reports Vol. 6, no. (2016), p. 1-11
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- Description: It has been hypothesized that nitrogen fixation occurs in the human gut. However, whether the gut microbiota truly has this potential remains unclear. We investigated the nitrogen-fixing activity and diversity of the nitrogenase reductase (NifH) genes in the faecal microbiota of humans, focusing on Papua New Guinean and Japanese individuals with low to high habitual nitrogen intake. A 15 N 2 incorporation assay showed significant enrichment of 15 N in all faecal samples, irrespective of the host nitrogen intake, which was also supported by an acetylene reduction assay. The fixed nitrogen corresponded to 0.01% of the standard nitrogen requirement for humans, although our data implied that the contribution in the gut in vivo might be higher than this value. The nifH genes recovered in cloning and metagenomic analyses were classified in two clusters: one comprising sequences almost identical to Klebsiella sequences and the other related to sequences of Clostridiales members. These results are consistent with an analysis of databases of faecal metagenomes from other human populations. Collectively, the human gut microbiota has a potential for nitrogen fixation, which may be attributable to Klebsiella and Clostridiales strains, although no evidence was found that the nitrogen-fixing activity substantially contributes to the host nitrogen balance. © The Author(s) 2016.
- Naito, Yuichi, Morita, Ayako, Natsuhara, Kazumi, Tadokoro, Kiyoshi, Baba, Jun, Odani, Shingo, Tomitsuka, Eriko, Igai, Katsura, Tsutaya, Takumi, Yoneda, Minoru, Greenhill, Andrew, Horwood, Paul, Soli, Kevin, Phuanukoonnon, Suparat, Siba, Peter, Umezaki, Masahiro
- Authors: Naito, Yuichi , Morita, Ayako , Natsuhara, Kazumi , Tadokoro, Kiyoshi , Baba, Jun , Odani, Shingo , Tomitsuka, Eriko , Igai, Katsura , Tsutaya, Takumi , Yoneda, Minoru , Greenhill, Andrew , Horwood, Paul , Soli, Kevin , Phuanukoonnon, Suparat , Siba, Peter , Umezaki, Masahiro
- Date: 2015
- Type: Text , Journal article
- Relation: American Journal of Physical Anthropology Vol. 158, no. 3 (2015), p. 359-370
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- Description: Objectives: We present new nitrogen isotopic discrimination factor between diets and scalp hairs (Δ15NHair-Diet: δ15NHair - δ15NDiet) for indigenous residents in three communities in the Papua New Guinea Highlands who consumed various amounts and qualities of protein. The Δ15N is important for precise evaluation of the dietary habits of human populations; in both contemporary and traditional lifestyles. Several hypotheses have been proposed regarding factors that affect Δ15N values, based largely on observations from animal feeding experiments. However, variations and factors controlling Δ15N in humans are not well understood, mainly due to the difficulty of controlling the diets of participants. Materials and Methods: These residents were studied because they have maintained relatively traditional dietary habits, which allow quantitative recording of diets. Δ15N was estimated by comparing hair δ15N values to mean dietary δ15N values calculated from the recorded intake of each food item and their δ15N values. Results: The results showed that: i) there was a significant difference in Δ15N among study locations (3.9±0.9‰ for most urbanized, 5.2±1.0‰ for medium and 5.0±0.9‰ for least urbanized communities; range=1.2-7.3‰ for all participants); and ii) estimated Δ15N values were negatively correlated with several indicators of animal protein intake (% nitrogen in diet: range=0.9-7.6%). Discussion: We hypothesize that a combination of several factors, which presumably included urea recycling and amino acid and protein recycling and/or de novo synthesis during metabolic processes, altered the Δ15N values of the participants. Am J Phys Anthropol 158:359-370, 2015. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
Characterization of the gut microbiota of Papua New Guineans using reverse transcription quantitative PCR
- Greenhill, Andrew, Tsuji, Hirokazu, Ogata, Kiyohito, Natsuhara, Kazumi, Morita, Ayako, Soli, Kevin, Larkins, Jo-Ann, Tadokoro, Kiyoshi, Odani, Shingo, Baba, Jun, Naito, Yuichi, Tomitsuka, Eriko, Nomoto, Kriko, Siba, Peter, Horwood, Paul, Umezaki, Masahiro
- Authors: Greenhill, Andrew , Tsuji, Hirokazu , Ogata, Kiyohito , Natsuhara, Kazumi , Morita, Ayako , Soli, Kevin , Larkins, Jo-Ann , Tadokoro, Kiyoshi , Odani, Shingo , Baba, Jun , Naito, Yuichi , Tomitsuka, Eriko , Nomoto, Kriko , Siba, Peter , Horwood, Paul , Umezaki, Masahiro
- Date: 2015
- Type: Text , Journal article
- Relation: PLoS ONE Vol. 10, no. 2 (2015), p. 1-15
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- Description: There has been considerable interest in composition of gut microbiota in recent years, leading to a better understanding of the role the gut microbiota plays in health and disease. Most studies have been limited in their geographical and socioeconomic diversity to high-income settings, and have been conducted using small sample sizes. To date, few analyses have been conducted in low-income settings, where a better understanding of the gut microbiome could lead to the greatest return in terms of health benefits. Here, we have used quantitative real-time polymerase chain reaction targeting dominant and sub-dominant groups of microorganisms associated with human gut microbiome in 115 people living a subsistence lifestyle in rural areas of Papua New Guinea. Quantification of Clostridium coccoides group, C. leptum subgroup, C. perfringens, Bacteroides fragilis group, Bifidobacterium, Atopobium cluster, Prevotella, Enterobacteriaceae, Enterococcus, Staphylococcus, and Lactobacillus spp. was conducted. Principle coordinates analysis (PCoA) revealed two dimensions with Prevotella, clostridia, Atopobium, Enterobacteriaceae, Enterococcus and Staphylococcus grouping in one dimension, while B. fragilis, Bifidobacterium and Lactobacillus grouping in the second dimension. Highland people had higher numbers of most groups of bacteria detected, and this is likely a key factor for the differences revealed by PCoA between highland and lowland study participants. Age and sex were not major determinants in microbial population composition. The study demonstrates a gut microbial composition with some similarities to those observed in other low-income settings where traditional diets are consumed, which have previously been suggested to favor energy extraction from a carbohydrate rich diet. © 2015 PLOS ONE.
- Authors: Greenhill, Andrew , Tsuji, Hirokazu , Ogata, Kiyohito , Natsuhara, Kazumi , Morita, Ayako , Soli, Kevin , Larkins, Jo-Ann , Tadokoro, Kiyoshi , Odani, Shingo , Baba, Jun , Naito, Yuichi , Tomitsuka, Eriko , Nomoto, Kriko , Siba, Peter , Horwood, Paul , Umezaki, Masahiro
- Date: 2015
- Type: Text , Journal article
- Relation: PLoS ONE Vol. 10, no. 2 (2015), p. 1-15
- Full Text:
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- Description: There has been considerable interest in composition of gut microbiota in recent years, leading to a better understanding of the role the gut microbiota plays in health and disease. Most studies have been limited in their geographical and socioeconomic diversity to high-income settings, and have been conducted using small sample sizes. To date, few analyses have been conducted in low-income settings, where a better understanding of the gut microbiome could lead to the greatest return in terms of health benefits. Here, we have used quantitative real-time polymerase chain reaction targeting dominant and sub-dominant groups of microorganisms associated with human gut microbiome in 115 people living a subsistence lifestyle in rural areas of Papua New Guinea. Quantification of Clostridium coccoides group, C. leptum subgroup, C. perfringens, Bacteroides fragilis group, Bifidobacterium, Atopobium cluster, Prevotella, Enterobacteriaceae, Enterococcus, Staphylococcus, and Lactobacillus spp. was conducted. Principle coordinates analysis (PCoA) revealed two dimensions with Prevotella, clostridia, Atopobium, Enterobacteriaceae, Enterococcus and Staphylococcus grouping in one dimension, while B. fragilis, Bifidobacterium and Lactobacillus grouping in the second dimension. Highland people had higher numbers of most groups of bacteria detected, and this is likely a key factor for the differences revealed by PCoA between highland and lowland study participants. Age and sex were not major determinants in microbial population composition. The study demonstrates a gut microbial composition with some similarities to those observed in other low-income settings where traditional diets are consumed, which have previously been suggested to favor energy extraction from a carbohydrate rich diet. © 2015 PLOS ONE.
- Morita, Ayako, Natsuhara, Kazumi, Tomitsuka, Eriko, Odani, Shingo, Baba, Jun, Tadokoro, Kiyoshi, Igai, Katsura, Greenhill, Andrew, Horwood, Paul, Soli, Kevin, Phuanukoonnon, Suparat, Siba, Peter, Umezaki, Masahiro
- Authors: Morita, Ayako , Natsuhara, Kazumi , Tomitsuka, Eriko , Odani, Shingo , Baba, Jun , Tadokoro, Kiyoshi , Igai, Katsura , Greenhill, Andrew , Horwood, Paul , Soli, Kevin , Phuanukoonnon, Suparat , Siba, Peter , Umezaki, Masahiro
- Date: 2015
- Type: Text , Journal article
- Relation: American Journal of Human Biology Vol. 27, no. 3 (2015), p. 349-357
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- Description: Objectives: The aim of this article was to develop a semi-quantitative food frequency questionnaire (FFQ) and evaluate its validity to estimate habitual protein intake, and investigate current dietary protein intakes of Papua New Guinea (PNG) Highlanders. Methods: A 32-item FFQ was developed and tested among 135 healthy male and female volunteers. The FFQ-estimated daily total and animal protein intakes were compared with biomarkers and 3-day Weighed Food Records (WFR) by correlation analyses, Bland-Altman plot analyses and joint classification analyses. Results: The FFQ-estimated total protein intake significantly correlated with urinary nitrogen in the first morning void after adjusting urinary creatinine concentration (r=0.28, P<0.01) and the FFQ-estimated animal protein intake significantly correlated with the hair δ15N (Spearman's r=0.34, P<0.001). The limits of agreement were ±2.39 Z-score residuals for total protein intake and ±2.19 Z-score for animal protein intake, and intra-individual differences increased as protein intake increased. The classification into the same and adjacent quartiles was 66.0% for total protein intake and 73.6% for animal protein intake. Median daily total and animal protein intake estimates from the FFQ and the 3-day WFR showed a good agreement with differences of 0.2 and 4.9 g, respectively. None of the studied communities in the PNG Highlands met the biologically required protein intake; although the community closer to an urban center showed higher protein intake than the more remote communities. Conclusions: The newly developed 32-item FFQ for PNG Highlanders is applicable for evaluation of protein intake at the individual level. Am. J. Hum. Biol. 27:349-357, 2015. © 2014 Wiley Periodicals, Inc.
- Unger, Holger, Aho, Celestine, Ome-Kaius, Maria, Wangnapi, Regina, Umbers, Alexandra, Jack, Wanda, Lafana, Alice, Michael, Audrey, Hanieh, Sarah, Siba, Peter, Mueller, Ivo, Greenhill, Andrew, Rogerson, Stephen
- Authors: Unger, Holger , Aho, Celestine , Ome-Kaius, Maria , Wangnapi, Regina , Umbers, Alexandra , Jack, Wanda , Lafana, Alice , Michael, Audrey , Hanieh, Sarah , Siba, Peter , Mueller, Ivo , Greenhill, Andrew , Rogerson, Stephen
- Date: 2015
- Type: Text , Journal article
- Relation: Journal of Clinical Microbiology Vol. 53, no. 4 (2015), p. 1317-1323
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- Description: Sulfadoxine-pyrimethamine (SP) plus azithromycin (AZ) (SPAZ) has the potential for intermittent preventive treatment of malaria in pregnancy (IPTp), but its use could increase circulation of antibiotic-resistant bacteria associated with severe pediatric infections. We evaluated the effect of monthly SPAZ-IPTp compared to a single course of SP plus chloroquine (SPCQ) on maternal nasopharyngeal carriage and antibiotic susceptibility of Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus at delivery among 854 women participating in a randomized controlled trial in Papua New Guinea. Serotyping was performed, and antibiotic susceptibility was evaluated by disk diffusion and Etest. Potential risk factors for carriage were examined. Nasopharyngeal carriage at delivery of S. pneumoniae (SPAZ, 7.2% [30/418], versus SPCQ, 19.3% [84/436]; P < 0.001) and H. influenzae (2.9% [12/418] versus 6.0% [26/436], P = 0.028), but not S. aureus, was significantly reduced among women who had received SPAZ-IPTp. The number of macrolide-resistant pneumococcal isolates was small but increased in the SPAZ group (13.3% [4/30], versus SPCQ, 2.2% [2/91]; P = 0.033). The proportions of isolates with serotypes covered by the 13-valent pneumococcal conjugate vaccine were similar (SPAZ, 10.3% [3/29], versus SPCQ, 17.6% [16/91]; P = 0.352). Although macrolide-resistant isolates were rare, they were more commonly detected in women who had received SPAZ-IPTp, despite the significant reduction of maternal carriage of S. pneumoniae and H. influenzae observed in this group. Future studies on SPAZ-IPTp should evaluate carriage and persistence of macrolide-resistant S. pneumoniae and other pathogenic bacteria in both mothers and infants and assess the clinical significance of their circulation.
Streptococcus pneumoniae and Haemophilus influenzae in paediatric meningitis patients at Goroka General Hospital, Papua New Guinea : Serotype distribution and antimicrobial susceptibility in the pre-vaccine era
- Greenhill, Andrew, Phuanukoonnon, Suparat, Michael, Audrey, Yoannes, Mition, Orami, Tilda, Smith, Helen, Murphy, Denise, Blyth, Christopher, Reeder, John, Siba, Peter, Pomat, William, Lehmann, Deborah
- Authors: Greenhill, Andrew , Phuanukoonnon, Suparat , Michael, Audrey , Yoannes, Mition , Orami, Tilda , Smith, Helen , Murphy, Denise , Blyth, Christopher , Reeder, John , Siba, Peter , Pomat, William , Lehmann, Deborah
- Date: 2015
- Type: Text , Journal article
- Relation: BMC Infectious Diseases Vol. 15, no. 485 (2015), p. 1-8
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- Description: Background: Bacterial meningitis remains an important infection globally, with the greatest burden in children in low-income settings, including Papua New Guinea (PNG). We present serotype, antimicrobial susceptibility and outcome data from paediatric meningitis patients prior to introduction of Haemophilus influenzae type b (Hib) and pneumococcal conjugate vaccines (PCVs) in PNG, providing a baseline for evaluation of immunisation programs. Methods: Cerebrospinal fluid (CSF) was collected from children admitted to Goroka General Hospital with suspected meningitis between 1996 and 2005. Culture and sensitivity was conducted, and pneumococci and H. influenzae were serotyped. Laboratory findings were linked to clinical outcomes. Results: We enrolled 1884 children. A recognised pathogen was identified in 375 children (19.9%). Streptococcus pneumoniae (n = 180) and Hib (n = 153) accounted for 88.8% of pathogens isolated. 24 different pneumococcal serogroups were identified; non-PCV types 2, 24 and 46 accounted for 31.6% of pneumococcal meningitis. 10- and 13-valent PCVs would cover 44.1% and 45.4% of pneumococcal meningitis respectively. Pneumococcal isolates were commonly resistant to penicillin (21.5%) and 23% of Hib isolates were simultaneously resistant to ampicillin, co-trimoxazole and chloramphenicol. The case fatality rate in patients with a recognised bacterial pathogen was 13.4% compared to 8.5% in culture-negative patients. Conclusions: If implemented in routine expanded programme of immunisation (EPI) with high coverage, current PCVs could prevent almost half of pneumococcal meningitis cases. Given the diversity of circulating serotypes in PNG serotype replacement is of concern. Ongoing surveillance is imperative to monitor the impact of vaccines. In the longer term vaccines providing broader protection against pneumococcal meningitis will be needed. © 2015 Greenhill et al.
- Authors: Greenhill, Andrew , Phuanukoonnon, Suparat , Michael, Audrey , Yoannes, Mition , Orami, Tilda , Smith, Helen , Murphy, Denise , Blyth, Christopher , Reeder, John , Siba, Peter , Pomat, William , Lehmann, Deborah
- Date: 2015
- Type: Text , Journal article
- Relation: BMC Infectious Diseases Vol. 15, no. 485 (2015), p. 1-8
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- Description: Background: Bacterial meningitis remains an important infection globally, with the greatest burden in children in low-income settings, including Papua New Guinea (PNG). We present serotype, antimicrobial susceptibility and outcome data from paediatric meningitis patients prior to introduction of Haemophilus influenzae type b (Hib) and pneumococcal conjugate vaccines (PCVs) in PNG, providing a baseline for evaluation of immunisation programs. Methods: Cerebrospinal fluid (CSF) was collected from children admitted to Goroka General Hospital with suspected meningitis between 1996 and 2005. Culture and sensitivity was conducted, and pneumococci and H. influenzae were serotyped. Laboratory findings were linked to clinical outcomes. Results: We enrolled 1884 children. A recognised pathogen was identified in 375 children (19.9%). Streptococcus pneumoniae (n = 180) and Hib (n = 153) accounted for 88.8% of pathogens isolated. 24 different pneumococcal serogroups were identified; non-PCV types 2, 24 and 46 accounted for 31.6% of pneumococcal meningitis. 10- and 13-valent PCVs would cover 44.1% and 45.4% of pneumococcal meningitis respectively. Pneumococcal isolates were commonly resistant to penicillin (21.5%) and 23% of Hib isolates were simultaneously resistant to ampicillin, co-trimoxazole and chloramphenicol. The case fatality rate in patients with a recognised bacterial pathogen was 13.4% compared to 8.5% in culture-negative patients. Conclusions: If implemented in routine expanded programme of immunisation (EPI) with high coverage, current PCVs could prevent almost half of pneumococcal meningitis cases. Given the diversity of circulating serotypes in PNG serotype replacement is of concern. Ongoing surveillance is imperative to monitor the impact of vaccines. In the longer term vaccines providing broader protection against pneumococcal meningitis will be needed. © 2015 Greenhill et al.
The Gut Microbiota of Rural Papua New Guineans : Composition, Diversity Patterns, and Ecological Processes
- Martínez, Inés, Stegen, James, Maldonado-Gómez, Maria, Eren, Murat, Siba, Peter, Greenhill, Andrew, Walter, Jens
- Authors: Martínez, Inés , Stegen, James , Maldonado-Gómez, Maria , Eren, Murat , Siba, Peter , Greenhill, Andrew , Walter, Jens
- Date: 2015
- Type: Text , Journal article
- Relation: Cell Reports Vol. 11, no. 4 (2015), p. 527-538
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- Description: Although recent research revealed an impact of westernization on diversity and composition of the human gut microbiota, the exact consequences on metacommunity characteristics are insufficiently understood, and the underlying ecological mechanisms have not been elucidated. Here, we have compared the fecal microbiota of adults from two non-industrialized regions in Papua New Guinea (PNG) with that of United States (US) residents. Papua New Guineans harbor communities with greater bacterial diversity, lower inter-individual variation, vastly different abundance profiles, and bacterial lineages undetectable in US residents. A quantification of the ecological processes that govern community assembly identified bacterial dispersal as the dominant process that shapes the microbiome in PNG but not in the US. These findings suggest that the microbiome alterations detected in industrialized societies might arise from modern lifestyle factors limiting bacterial dispersal, which has implications for human health and the development of strategies aimed to redress the impact of westernization. © 2015 The Authors.
- Authors: Martínez, Inés , Stegen, James , Maldonado-Gómez, Maria , Eren, Murat , Siba, Peter , Greenhill, Andrew , Walter, Jens
- Date: 2015
- Type: Text , Journal article
- Relation: Cell Reports Vol. 11, no. 4 (2015), p. 527-538
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- Description: Although recent research revealed an impact of westernization on diversity and composition of the human gut microbiota, the exact consequences on metacommunity characteristics are insufficiently understood, and the underlying ecological mechanisms have not been elucidated. Here, we have compared the fecal microbiota of adults from two non-industrialized regions in Papua New Guinea (PNG) with that of United States (US) residents. Papua New Guineans harbor communities with greater bacterial diversity, lower inter-individual variation, vastly different abundance profiles, and bacterial lineages undetectable in US residents. A quantification of the ecological processes that govern community assembly identified bacterial dispersal as the dominant process that shapes the microbiome in PNG but not in the US. These findings suggest that the microbiome alterations detected in industrialized societies might arise from modern lifestyle factors limiting bacterial dispersal, which has implications for human health and the development of strategies aimed to redress the impact of westernization. © 2015 The Authors.
Antibiotic resistant Shigella is a major cause of diarrhoea in the Highlands of Papua New Guinea
- Greenhill, Andrew, Guwada, Carlton, Siba, Valentine, Michael, Audrey, Yoannes, Mution, Wawarie, Yolandah, Ford, Rebecca, Siba, Peter, Horwood, Paul
- Authors: Greenhill, Andrew , Guwada, Carlton , Siba, Valentine , Michael, Audrey , Yoannes, Mution , Wawarie, Yolandah , Ford, Rebecca , Siba, Peter , Horwood, Paul
- Date: 2014
- Type: Text , Journal article
- Relation: Journal of Infection in Developing Countries Vol. 8, no. 11 (2014), p. 1391-1397
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- Description: 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. © 2014 Greenhill et al.
- Authors: Greenhill, Andrew , Guwada, Carlton , Siba, Valentine , Michael, Audrey , Yoannes, Mution , Wawarie, Yolandah , Ford, Rebecca , Siba, Peter , Horwood, Paul
- Date: 2014
- Type: Text , Journal article
- Relation: Journal of Infection in Developing Countries Vol. 8, no. 11 (2014), p. 1391-1397
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- Description: 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. © 2014 Greenhill et al.
Detection of enteric viral and bacterial pathogens associated with paediatric diarrhoea in Goroka, Papua New Guinea
- Soli, Kevin, Maure, Tobias, Kas, Monalisa, Bande, Grace, Bebes, Sauli, Luang-Suarkia, Dagwin, Siba, Peter, Morita, Ayako, Umezaki, Masahiro, Greenhill, Andrew, Horwood, Paul
- Authors: Soli, Kevin , Maure, Tobias , Kas, Monalisa , Bande, Grace , Bebes, Sauli , Luang-Suarkia, Dagwin , Siba, Peter , Morita, Ayako , Umezaki, Masahiro , Greenhill, Andrew , Horwood, Paul
- Date: 2014
- Type: Text , Journal article
- Relation: International Journal of Infectious Diseases Vol. 27, no. (2014), p. 54-58
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- Description: Objectives: The aim of this study was to investigate the viral and bacterial causes of acute watery diarrhoea in hospitalized children in Papua New Guinea. Methods: A retrospective analysis was conducted on stool samples collected from 199 children (age > 5 years) admitted to the paediatric ward of Goroka General Hospital from August 2009 through November 2010. A large range of viral and bacterial enteric pathogens were targeted using real-time PCR/RT-PCR assays. Results: Young children were much more likely to be admitted with acute gastroenteritis, with 62.8% of patients aged >1 year and 88.4% aged >2 years. An enteric pathogen was detected in 69.8% (n= 138) of patients. The most commonly detected pathogens were Shigella spp (26.6%), rotavirus (25.6%), adenovirus types 40/41 (11.6%), enterotoxigenic Escherichia coli (11.1%), enteropathogenic E. coli (8.5%), norovirus G2 (6.0%), and Campylobacter spp (4.0%). Norovirus G1, sapovirus, and Salmonella spp were also detected, but below our statistical limit of detection. Vibrio cholerae and astrovirus were not detected in any patients. Mixed infections were detected in 22.1% of patients, with Shigella and rotavirus most commonly detected in co-infections with other pathogens. Conclusions: This study demonstrates that Shigella and rotavirus are the major pathogens associated with acute paediatric gastroenteritis in this setting. © 2014 The Authors.
- Authors: Soli, Kevin , Maure, Tobias , Kas, Monalisa , Bande, Grace , Bebes, Sauli , Luang-Suarkia, Dagwin , Siba, Peter , Morita, Ayako , Umezaki, Masahiro , Greenhill, Andrew , Horwood, Paul
- Date: 2014
- Type: Text , Journal article
- Relation: International Journal of Infectious Diseases Vol. 27, no. (2014), p. 54-58
- Full Text:
- Reviewed:
- Description: Objectives: The aim of this study was to investigate the viral and bacterial causes of acute watery diarrhoea in hospitalized children in Papua New Guinea. Methods: A retrospective analysis was conducted on stool samples collected from 199 children (age > 5 years) admitted to the paediatric ward of Goroka General Hospital from August 2009 through November 2010. A large range of viral and bacterial enteric pathogens were targeted using real-time PCR/RT-PCR assays. Results: Young children were much more likely to be admitted with acute gastroenteritis, with 62.8% of patients aged >1 year and 88.4% aged >2 years. An enteric pathogen was detected in 69.8% (n= 138) of patients. The most commonly detected pathogens were Shigella spp (26.6%), rotavirus (25.6%), adenovirus types 40/41 (11.6%), enterotoxigenic Escherichia coli (11.1%), enteropathogenic E. coli (8.5%), norovirus G2 (6.0%), and Campylobacter spp (4.0%). Norovirus G1, sapovirus, and Salmonella spp were also detected, but below our statistical limit of detection. Vibrio cholerae and astrovirus were not detected in any patients. Mixed infections were detected in 22.1% of patients, with Shigella and rotavirus most commonly detected in co-infections with other pathogens. Conclusions: This study demonstrates that Shigella and rotavirus are the major pathogens associated with acute paediatric gastroenteritis in this setting. © 2014 The Authors.
Spatio-temporal epidemiology of the cholera outbreak in Papua New Guinea, 2009-2011
- Horwood, Paul, Karl, Stephan, Mueller, Ivo, Jonduo, Marinjho, Pavlin, Boris, Dagina, Rosheila, Ropa, Berry, Bieb, Sibauk, Rosewell, Alexander, Umezaki, Masahiro, Siba, Peter, Greenhill, Andrew
- Authors: Horwood, Paul , Karl, Stephan , Mueller, Ivo , Jonduo, Marinjho , Pavlin, Boris , Dagina, Rosheila , Ropa, Berry , Bieb, Sibauk , Rosewell, Alexander , Umezaki, Masahiro , Siba, Peter , Greenhill, Andrew
- Date: 2014
- Type: Text , Journal article
- Relation: BMC Infectious Diseases Vol. 14, no. 1 (2014), p.
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- Description: Background: Cholera continues to be a devastating disease in many developing countries where inadequate safe water supply and poor sanitation facilitate spread. From July 2009 until late 2011 Papua New Guinea experienced the first outbreak of cholera recorded in the country, resulting in > 15,500 cases and > 500 deaths. Methods: Using the national cholera database, we analysed the spatio-temporal distribution and clustering of the Papua New Guinea cholera outbreak. The Kulldorff space-time permutation scan statistic, contained in the software package SatScan v9.2 was used to describe the first 8 weeks of the outbreak in Morobe Province before cholera cases spread throughout other regions of the country. Data were aggregated at the provincial level to describe the spread of the disease to other affected provinces. Results: Spatio-temporal and cluster analyses revealed that the outbreak was characterized by three distinct phases punctuated by explosive propagation of cases when the outbreak spread to a new region. The lack of road networks across most of Papua New Guinea is likely to have had a major influence on the slow spread of the disease during this outbreak. Conclusions: Identification of high risk areas and the likely mode of spread can guide government health authorities to formulate public health strategies to mitigate the spread of the disease through education campaigns, vaccination, increased surveillance in targeted areas and interventions to improve water, sanitation and hygiene.
- Authors: Horwood, Paul , Karl, Stephan , Mueller, Ivo , Jonduo, Marinjho , Pavlin, Boris , Dagina, Rosheila , Ropa, Berry , Bieb, Sibauk , Rosewell, Alexander , Umezaki, Masahiro , Siba, Peter , Greenhill, Andrew
- Date: 2014
- Type: Text , Journal article
- Relation: BMC Infectious Diseases Vol. 14, no. 1 (2014), p.
- Full Text:
- Reviewed:
- Description: Background: Cholera continues to be a devastating disease in many developing countries where inadequate safe water supply and poor sanitation facilitate spread. From July 2009 until late 2011 Papua New Guinea experienced the first outbreak of cholera recorded in the country, resulting in > 15,500 cases and > 500 deaths. Methods: Using the national cholera database, we analysed the spatio-temporal distribution and clustering of the Papua New Guinea cholera outbreak. The Kulldorff space-time permutation scan statistic, contained in the software package SatScan v9.2 was used to describe the first 8 weeks of the outbreak in Morobe Province before cholera cases spread throughout other regions of the country. Data were aggregated at the provincial level to describe the spread of the disease to other affected provinces. Results: Spatio-temporal and cluster analyses revealed that the outbreak was characterized by three distinct phases punctuated by explosive propagation of cases when the outbreak spread to a new region. The lack of road networks across most of Papua New Guinea is likely to have had a major influence on the slow spread of the disease during this outbreak. Conclusions: Identification of high risk areas and the likely mode of spread can guide government health authorities to formulate public health strategies to mitigate the spread of the disease through education campaigns, vaccination, increased surveillance in targeted areas and interventions to improve water, sanitation and hygiene.
- Kas, Monalisa, Maure, Tobias, Soli, Kevin, Umezaki, Masahiro, Morita, Ayako, Bebes, Sauli, Jonduo, Marinjho, Larkins, Jo-Ann, Luang-Suarkia, Dagwin, Siba, Peter, Greenhill, Andrew, Horwood, Paul
- Authors: Kas, Monalisa , Maure, Tobias , Soli, Kevin , Umezaki, Masahiro , Morita, Ayako , Bebes, Sauli , Jonduo, Marinjho , Larkins, Jo-Ann , Luang-Suarkia, Dagwin , Siba, Peter , Greenhill, Andrew , Horwood, Paul
- Date: 2013
- Type: Text , Journal article
- Relation: Papua and New Guinea Medical Journal Vol. 56, no. 3-4 (2013), p. 141-144
- Full Text: false
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- 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.
- Phuanukoonnon, Suparat, Namosha, Elias, Kua, Lydia, Siba, Peter, Greenhill, Andrew
- Authors: Phuanukoonnon, Suparat , Namosha, Elias , Kua, Lydia , Siba, Peter , Greenhill, Andrew
- Date: 2013
- Type: Text , Journal article
- Relation: Papua and New Guinea medical journal Vol. 56, no. 3-4 (2013), p. 126-135
- Full Text: false
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- 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.
- Soli, Kevin, Kas, Monalisa, Maure, Tobias, Umezaki, Masahiro, Morita, Ayako, Siba, Peter, Greenhill, Andrew, Horwood, Paul
- Authors: Soli, Kevin , Kas, Monalisa , Maure, Tobias , Umezaki, Masahiro , Morita, Ayako , Siba, Peter , Greenhill, Andrew , Horwood, Paul
- Date: 2013
- Type: Text , Journal article
- Relation: Diagnostic Microbiology and Infectious Disease Vol. 77, no. 4 (2013), p. 321-323
- Full Text: false
- Reviewed:
- 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.
- Kas, Monalisa, Horwood, Paul, Laman, Moses, Manning, Laurens, Atua, Vincent, Siba, Peter, Greenhill, Andrew
- Authors: Kas, Monalisa , Horwood, Paul , Laman, Moses , Manning, Laurens , Atua, Vincent , Siba, Peter , Greenhill, Andrew
- Date: 2013
- Type: Text , Journal article
- Relation: Papua and New Guinea medical journal Vol. 56, no. 3-4 (2013), p. 110-115
- Full Text: false
- Reviewed:
- Description: When cholera was first detected in Papua New Guinea (PNG) in mid-2009, national diagnostic capacity faced many challenges. This was in part due to the non-endemic status of the outbreak, resulting in few local staff experienced in Vibrio cholerae detection and poor access to the required consumables. The PNG Institute of Medical Research conducted culture on specimens from suspected cholera patients in Madang Province, with presumptive V. cholerae isolates sent to Goroka for confirmation. Of 98 samples analysed 15 were culture positive, with V. cholerae detected by polymerase chain reaction (PCR) in an additional 3 samples. Further analyses were conducted to identify other pathogenic bacteria from thiosulphate citrate bile salt sucrose (TCBS) agar. Molecular-based assays detected enteropathogenic (n = 1) and enterotoxigenic (n = 1) strains of Escherichia coli. No other major enteric pathogens were detected. The low detection rate of V. cholerae at the provincial level reflects challenges in the laboratory diagnosis of cholera and in-country challenges in responding to an outbreak of a non-endemic disease, such as lack of in-country diagnostic expertise and available consumables in the early stages. It also suggests that full aetiological investigations are warranted in future outbreaks of acute watery diarrhoea in PNG to fully elucidate the potentially complex aetiology, which could in turn guide diagnostic, treatment and prevention measures.
- Asa, Henao, Laman, Moses, Greenhill, Andrew, Siba, Peter, Davis, Timothy, Maihua, John, Manning, Laurens
- Authors: Asa, Henao , Laman, Moses , Greenhill, Andrew , Siba, Peter , Davis, Timothy , Maihua, John , Manning, Laurens
- Date: 2012
- Type: Text , Journal article
- Relation: Papua and New Guinea Medical Journal Vol. 55, no. 1-4 (2012), p. 5-11
- Full Text: false
- Reviewed:
- 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.
- Siba, Valentine, Horwood, Paul, Vanuga, Kilagi, Wapling, Johanna, Sehuko, Rebecca, Siba, Peter, Greenhill, Andrew
- Authors: Siba, Valentine , Horwood, Paul , Vanuga, Kilagi , Wapling, Johanna , Sehuko, Rebecca , Siba, Peter , Greenhill, Andrew
- Date: 2012
- Type: Text , Journal article
- Relation: Clinical and Vaccine Immunology Vol. 19, no. 11 (2012), p.
- Full Text: false
- Reviewed:
- Description: Typhoid fever remains a major global health problem. A major impediment to improving outcomes is the lack of appropriate diagnostic tools, which have not significantly improved in low-income settings for 100 years. We evaluated two commercially available rapid diagnostic tests (Tubex and TyphiDot), a prototype (TyphiRapid TR-02), and the commonly used single-serum Widal test in a previously reported high-burden area of Papua New Guinea. Samples were collected from 530 outpatients with axillary temperatures of ≥37.5°C, and analysis was conducted on all malaria-negative samples (n = 500). A composite reference standard of blood culture and PCR was used, by which 47 participants (9.4%) were considered typhoid fever positive. The sensitivity and specificity of the Tubex (51.1% and 88.3%, respectively) and TyphiDot (70.0% and 80.1%, respectively) tests were not high enough to warrant their ongoing use in this setting; however, the sensitivity and specificity for the TR-02 prototype were promising (89.4% and 85.0%, respectively). An axillary temperature of ≥38.5°C correlated with typhoid fever (P = 0.014). With an appropriate diagnostic test, conducting typhoid fever diagnosis only on patients with high-grade fever could dramatically decrease the costs associated with diagnosis while having no detrimental impact on the ability to accurately diagnose the illness.
- Greenhill, Andrew, Rosewell, Alexander, Kas, Monalisa, Manning, Laurens, Latorre, Leomeldo, Siba, Peter, Horwood, Paul
- Authors: Greenhill, Andrew , Rosewell, Alexander , Kas, Monalisa , Manning, Laurens , Latorre, Leomeldo , Siba, Peter , Horwood, Paul
- Date: 2012
- Type: Text , Journal article
- Relation: Western Pacific Surveillance and Response Vol. 3, no. 2 (2012 2012), p. 1-3
- Full Text: false
- Reviewed:
- Description: Cholera was first detected in Papua New Guinea in July 2009, caused by Vibrio cholerae O1 El Tor serotype Ogawa.1 By late 2011, 15 500 cases had been reported throughout lowland Papua New Guinea with a case fatality rate of 3.2%.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.