Until recently cholera had never been reported in Papua New Guinea despite the close proximity of cholera-endemic countries and the presence of environmental and social characteristics that are considered risk factors for cholera outbreaks. The current outbreak began in July 2009 and rapidly spread throughout the coastal regions of the country. Initial characterization studies using variable-number tandem repeat analysis indicate that the outbreak was a recent clonal incursion from South-East Asia. By mid-2011 the outbreak had resulted in the reporting of more than 15 500 cases of cholera and over 500 deaths: a case fatality ratio (CFR) of approximately 3.2%. Following an outbreak of cholera, interventions such as the introduction of oral rehydration therapy aim to reduce the CFR to below 1%. This elevated CFR is likely a reflection of the inaccessibility of much of the country, the lack of health care services available in remote regions and the general unpreparedness for an outbreak of this kind. This premise is supported by the differences in CFRs between the relatively well-serviced National Capital District (0.1%) and more remote regions such as the Western Province (8.8%).

Cholera was first detected in Papua New Guinea in July 2009, caused by Vibrio cholerae O1 El Tor serotype Ogawa. By late 2011, 15 500 cases had been reported throughout lowland Papua New Guinea with a case fatality rate of 3.2%. The epidemic has since slowed, with only sporadic cases reported in Western Province and the Autonomous Region of Bougainville (ARB). Accurate and timely diagnosis is a critical element of the public health response to cholera, yet in low-income countries where the burden of cholera is the greatest, diagnostic services are often limited. Here we report on the diagnostic challenges and the logistical factors that impacted on diagnosis during the first reported outbreak of cholera in Papua New Guinea.

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.

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.

Diarrhoeal diseases still affect many people, especially children living in impoverished and under-developed settings. In Papua New Guinea (PNG) diarrhoea remains one of the leading causes of hospitalization and a major cause of death. Here, we focus on the role of Shigella in diarrhoeal illness in PNG, and provide an overview of the causative organism and the illness. A review of the available data on the aetiology of diarrhoea in PNG suggests that shigellosis is a major cause of diarrhoeal illness. Since shigellosis can cause protracted and life-threatening illness an appreciation of the burden of shigellosis is important to aid in the development of optimal prevention and control strategies. Treatment strategies for all cases of moderate-severe diarrhoeal illness should centre on rehydration, but where antimicrobial treatment is required consideration should be given to the increasing antimicrobial resistance observed in Shigella isolates in PNG.
Shigellosis ; Diseases ; Infection prevention

Abstract 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.