1.The epidemiology of tuberculosis in the Pacific, 2000 to 2013
Viney Kerri ; Hoy Damian ; Roth Adam ; Kelly Paul ; Harley David ; Sleigh Adrian
Western Pacific Surveillance and Response 2015;6(3):59-67
Objective:Tuberculosis (TB) poses a significant public health challenge in the 22 Pacific island countries and territories. Using TB surveillance data and World Health Organization (WHO) estimates from 2000 to 2013, we summarize the epidemiology of TB in the Pacific.
This was a descriptive study of incident TB cases reported annually by Pacific island national TB programmes to WHO. We counted cases and calculated proportions and case notification rates per 100 000 population. We calculated the proportion of TB patients who completed TB treatment and summed estimates of national incidence, prevalence and mortality, provided by WHO, to produce regional incidence, prevalence and mortality rates per 100 000 population.Results:Estimated TB incidence in the Pacific has remained high but stable from 2000 to 2013; estimated prevalence and mortality have fallen by 20% and 47%, respectively. The TB case notification rate increased by 58%, from 146 to 231 per 100 000 population in the same time period. In 2013, 24 145 TB cases were notified, most (94% or 22 657) were from Papua New Guinea. Kiribati had the highest TB case notification rate at 398 cases per 100 000 population. TB case notification rates were also high in Papua New Guinea, the Marshall Islands and Tuvalu (309, 283 and 182, respectively).Discussion:TB in the Pacific is improving in some areas; however, high rates affect many countries and the estimated regional incidence rate is stable. To further reduce the burden of TB, a combination of dedicated public health and system-wide approaches are required along with poverty reduction and social protection initiatives.
2.Investigating an outbreak of acute fever in Chuuk, Federated States of Micronesia
Hoy Damian ; Yichiro Yoster ; Otoko Kasian ; Heldart Helden ; Meyshine Andita ; Assito Prisca ; Pretrick Moses ; Souares Yvan ; Hancock Thane ; Durand Mark ; Roth Adam
Western Pacific Surveillance and Response 2014;5(4):5-12
Objective:In September 2012, there was an unexpected increase of acute febrile illness (AFI) in Chuuk State of the Federated States of Micronesia. At the same time, dengue outbreaks were occurring in two of the Federated States of Micronesia’s other three states. The cause of AFI was suspected to be dengue; however, by the end of October, only one of 39 samples was positive for dengue. The objective of the investigation was to establish the cause of the outbreak.Methods:A line list was created and data analysed by time, place, person and clinical features. Reported symptoms were compared with the published symptoms of several diagnoses and laboratory testing undertaken.Results:Of the 168 suspected cases, 62% were less than 20 years of age and 60% were male. The clinical features of the cases were not typical for dengue but suggestive of respiratory illness. Nasopharyngeal swabs were subsequently collected and found to be positive for influenza. Public health measures were undertaken and the AFI returned to expected levels.Discussion:Clinical diagnosis of acute febrile illness (AFI) can often be difficult and misleading. This can mean that opportunities for preventive measures early on in an outbreak are missed. In any outbreak, descriptive epidemiological analyses are valuable in helping to ascertain the cause of the outbreak.
3.Prevalence of HIV and sexually transmitted infections among young women engaged in sex work aboard foreign fishing vessels in Kiribati
Tebuka TOATU ; Paul WHITE ; Damian HOY ; Dennie INIAKWALA ; Onofre Edwin MERRILLES ; Sameer Vali GOPALANI
Western Pacific Surveillance and Response 2018;9(1):8-15
Objective: To assess the prevalence of HIV and sexually transmitted infections (STIs) among women who board foreign fishing vessels for sex work in Kiribati.
Methods: A cross-sectional study was designed to collect data on behavioural risk factors for STIs and knowledge of and attitudes towards HIV and STIs during 2007. Urine and blood samples were collected to test for HIV and select STIs. Descriptive statistics were performed for sociodemographic and behavioural characteristics, and χ2 tests were used to assess associations between potential key determinants and the presence of genital Chlamydia infection.
Results: Women who boarded foreign fishing vessels for transactional sex were younger, had less education, were less likely to live with a partner and were less likely to be otherwise employed. Although no HIV infections were detected, more than half (57.5%) of the women were diagnosed with an STI. One quarter of the women tested positive for chlamydia, and 40% tested positive for mycoplasma. The presence of chlamydia was strongly associated with age at first sexual intercourse (P = 0.02) and number of sexual partners during the prior seven days (P = 0.02).
Conclusion: The high rate of STIs in this population of sex workers is concerning given the potential of severe pregnancy-related and chronic health problems and the increased risk of transmission within the general population of Kiribati. We identified a specific sex worker population as a priority group for targeted public health efforts to prevent and control the spread of STIs in Kiribati.
4.Enhanced syndromic surveillance for mass gatherings in the Pacific: a case study of the 11th Festival of Pacific Arts in Solomon Islands, 2012
Damian Hoy ; Salanieta T Saketa ; Roy Roger Maraka ; Alison Sio ; Ian Wanyeki ; Pascal Frison ; Divi Ogaoga ; Dennie Iniakawala ; Cynthia Joshua ; Sala Duituturaga ; Christelle Lepers ; Adam Roth ; Paul White ; Yvan Souares
Western Pacific Surveillance and Response 2016;7(3):15-20
Mass gatherings pose public health challenges to host countries, as they can cause or exacerbate disease outbreaks within the host location or elsewhere. In July 2012, the 11th Festival of Pacific Arts (FOPA), a mass gathering event involving 22 Pacific island states and territories, was hosted by Solomon Islands. An enhanced syndromic surveillance (ESS) system was implemented for the event. Throughout the capital city, Honiara, 15 sentinel sites were established and successfully took part in the ESS system, which commenced one week before the FOPA (25 June) and concluded eight days after the event (22 July). The ESS involved expanding on the existing syndromic surveillance parameters: from one to 15 sentinel sites, from four to eight syndromes, from aggregated to case-based reporting and from weekly to daily reporting. A web-based system was developed to enable data entry, data storage and data analysis. Towards the end of the ESS period, a focus group discussion and series of key informant interviews were conducted. The ESS was considered a success and played an important role in the early detection of possible outbreaks. For the period of the ESS, 1668 patients with syndrome presentations were received across the 15 sentinel sites. There were no major events of public health significance. Several lessons were learnt that are relevant to ESS in mass gathering scenarios, including the importance of having adequate lead in time for engagement and preparation to ensure appropriate policy and institutional frameworks are put in place.
5.Enhanced surveillance for the Third United Nations Conference on Small Island Developing States, Apia, Samoa, September 2014
Paul White ; Salanieta Saketa ; Alexis Durand ; Saine Vaai-Nielsen ; Tile Ah Leong-Lui ; Take Naseri ; Ailuai Matalima ; Filipina Amosa ; Alize Mercier ; Christelle Lepers ; Vjesh Lal ; Richard Wojcik ; Sheri Lewis ; Adam Roth ; Yvan Souares ; Onofre Edwin Merilles Jr ; Damian Hoy
Western Pacific Surveillance and Response 2017;8(1):15-21
The Ministry of Health in Samoa, in partnership with the Pacific Community, successfully implemented enhanced surveillance for the high-profile Third United Nations Conference on Small Island Developing States held concurrently with the popular local Teuila festival during a widespread chikungunya outbreak in September 2014.
Samoa’s weekly syndromic surveillance system was expanded to 12 syndromes and 10 sentinel sites from four syndromes and seven sentinel sites; sites included the national hospital, four private health clinics and three national health service clinics. Daily situation reports were produced and were disseminated through PacNet (the email alert and communication tool of the Pacific Public Health Surveillance Network) together with daily prioritized line lists of syndrome activity to facilitate rapid response and investigation by the Samoan EpiNet team. Standard operating procedures for surveillance and response were introduced, together with a sustainability plan, including a monitoring and evaluation framework, to facilitate the transition of the mass gathering surveillance improvements to routine surveillance.
The enhanced surveillance performed well, providing vital disease early warning and health security assurance. A total of 2386 encounters and 708 syndrome cases were reported. Influenza-like illness was the most frequently seen syndrome (17%). No new infectious disease outbreaks were recorded. The experience emphasized: (1) the need for a long lead time to pilot the surveillance enhancements and to maximize their sustainability; (2) the importance of good communication between key stakeholders; and (3) having sufficient staff dedicated to both surveillance and response.
6.Mass gathering enhanced syndromic surveillance for the 8th Micronesian Games in 2014, Pohnpei State, Federated States of Micronesia
Paul WHITE ; Salanieta SAKETA ; Eliaser JOHNSON ; Sameer Vali GOPALANI ; Eliashib EDWARD ; Charles LONEY ; Alize MERCIER ; Tebuka TOATU ; Richard WOJCIK ; Sheri LEWIS ; Damian HOY
Western Pacific Surveillance and Response 2018;9(1):1-7
Pohnpei State’s Division of Primary Health Care implemented enhanced surveillance for early warning and detection of disease to support the 8th Micronesian Games (the Games) in July 2014.
The surveillance comprised 11 point-of-care sentinel sites around Pohnpei, Federated States of Micronesia, collecting data daily for eight syndromes using standard case definitions. Each sentinel site reported total acute care encounters, total syndrome cases and the total for each syndrome. A public health response, including epidemiological investigation and laboratory testing, followed when syndrome counts reached predetermined threshold levels.
The surveillance was implemented using the web-based Suite for Automated Global Electronic bioSurveillance Open-ESSENCE (SAGES-OE) application that was customized for the Games. Data were summarized in daily situation reports (SitReps) issued to key stakeholders and posted on PacNet, a Pacific public health e-mail network.
Influenza-like illness (ILI) was the most common syndrome reported (55%, n = 225). Most syndrome cases (75%) were among people from Pohnpei. Only 30 cases out of a total of 408 syndrome cases (7%) presented with acute fever and rash, despite the large and ongoing measles outbreak at the time. No new infectious disease outbreak was recorded during the Games. Peaks in diarrhoeal and ILI cases were followed up and did not result in widespread transmission.
The technology was a key feature of the enhanced surveillance. The introduction of the web-based tool greatly improved the timeliness of data entry, analysis and SitRep dissemination, providing assurance to the Games organizers that communicable diseases would not adversely impact the Games.
7.Lessons learnt from a three-year pilot field epidemiology training programme
Damian Hoy ; A Mark Durand ; Thane Hancock ; Haley Cash ; Kate Hardie ; Beverley Paterson ; Yvette Paulino ; Paul White ; Tony Merritt ; Dawn Fitzgibbons ; Sameer Vali Gopalani ; James Flint ; Onofre Edwin Merilles Jr ; Mina Kashiwabara ; Viema Biaukula ; Christelle Lepers ; Yvan Souares ; Eric Nilles ; Anaseini Batikawai ; Sevil Huseynova ; Mahomed Patel ; Salanieta Saketa ; David Durrheim ; Alden Henderson ; Adam Roth
Western Pacific Surveillance and Response 2017;8(3):21-26
Problem: The Pacific region has widely dispersed populations, limited financial and human resources and a high burden of disease. There is an urgent need to improve the availability, reliability and timeliness of useable health data.
Context: The purpose of this paper is to share lessons learnt from a three-year pilot field epidemiology training programme that was designed to respond to these Pacific health challenges. The pilot programme built on and further developed an existing field epidemiology training programme for Pacific health staff.
Action: The programme was delivered in country by epidemiologists working for Pacific Public Health Surveillance Network partners. The programme consisted of five courses: four one-week classroom-based courses and one field epidemiology project. Sessions were structured so that theoretical understanding was achieved through interaction and reinforced through practical hands-on group activities, case studies and other interactive practical learning methods.
Outcome: As of September 2016, 258 students had commenced the programme. Twenty-six course workshops were delivered and one cohort of students had completed the full five-course programme. The programme proved popular and gained a high level of student engagement.
Discussion: Face-to-face delivery, a low student-to-facilitator ratio, substantial group work and practical exercises were identified as key factors that contributed to the students developing skills and confidence. Close engagement of leaders and the need to quickly evaluate and adapt the curriculum were important lessons, and the collaboration between external partners was considered important for promoting a harmonized approach to health needs in the Pacific.